Hand Hygiene Among Healthcare Workers


Most disease transmissions in healthcare facilities happen due to the negligence of hand hygiene guidelines among healthcare workers. Having clean hands provides great benefits in preventing transmitted infections, which are rampant in healthcare institutions. To ensure hygiene, medical professionals should wash their hands with soap and water or use antiseptics before and after contact with the patient. They are also recommended to clean their hands using alcohol-based sanitizers or water and soap when donning and doffing Personal Protective Equipment (PPE). A reward-punishment system that gives incentives to conforming healthcare workers and punishes those who do not obey is imperative. Data collected should also be measured, analyzed, and evaluated for decision-making in hand hygiene matters.


Addressing hand hygiene is interesting since infections that can be contracted during health care are a significant reason for morbidity and death among patients worldwide. It is essential to mention that the transmission of pathogens associated with health care usually occurs through the contaminated hands of medical staff (Caris et al., 2018). Hand hygiene of health care workers is one of the most crucial measures to prevent the spread of infections associated with providing medical treatment.

Hand hygiene is a reason for concern in nursing practice because one of the primary factors in transmitting pathogens from the hands could lead to a prolonged hospital stay due to infection. Hand contact can spread tens of millions of microorganisms, including pathogenic and opportunistic ones (Caris et al., 2018). Observance of basic rules of hand hygiene by healthcare professionals has a significant role in preserving patients’ lives and enhancing the infectious safety of medical staff. Even surgical gloves are not sufficiently effective if basic hand hygiene principles are neglected, as they have micropores through which microorganisms from contaminated hands penetrate the sterile surface.

Hand hygiene is the most fundamental component of preventing infectious diseases. To enhance hand hygiene, healthcare workers should wash their hands with soap and water or use antiseptics before and after contact with a patient and before working with invasive devices, body fluids, and when hands are visibly soiled. However, recommendations to cleanse hands with an alcohol-based hand rub are also recommended. It is also essential to perform hand hygiene when donning and doffing PPE. These guidelines are realistic to resolve the problem of spreading infections.

It is beneficial to study and monitor hand hygiene as it can help decide the incentives given to performing professionals and to determine the support necessary for those who do not comply. Moreover, studying this issue can help allocate resources to staff and assist in infrastructural planning. Studying the levels of compliance of healthcare workers to hand hygiene guidelines and regulations of a given institution at any particular time is hard. This is because easier methods like direct observations are subjected to personal bias, and the health workers may alter their normal behavior when they know that they are being observed (Cawthorne & Cooke, 2020). However, proper monitoring tools that do not interfere with the habits of the targeted participant would help access the level of adherence to the guidelines mentioned above. The more advanced methods, like the use of technology, are expensive and hard to install and prone to errors.

How to Study the Problem

Due to the complexity of studying hand hygiene, I would review it using the direct observation method because of its universal applicability. Despite the direct observation method being susceptible to personal bias, it beats other scientific methods because a skilled observer can notice the number of hand hygiene actions done. The trained observer can as well gauge the attention and focus of healthcare workers on ensuring hand hygiene. This observation method by trained auditors is considered the “gold standard” method for establishing hand hygiene compliance rates (Boyce, 2017). The compliance rates are calculated by dividing the number of observations that needed hand hygiene by the number of sightings where hand hygiene was done.

The World Health Organization (WHO) recommends the use of this method. The WHO prescribes hand hygiene to be performed before and after touching the patient to minimize the spread of transmittable infections. Additionally, the healthy body states hands should be cleaned after touching a patient’s surroundings, before performing any aseptic procedure, and after exposure to body fluids (Boyce, 2017). These methods are hard to measure indirectly and require a trained expert hence the recommendation of the direct observation method. Moreover, skilled observers can notice other situations that are harder to categorize and measure automatically.

The goal of hand hygiene improvement tools is to ensure that compliance with the set guidelines is done to a certain percentage. The task for those entrusted with ensuring the improvement is two-fold. First, to gauge if progress is being made, and, second and more importantly, to determine when the required degree of compliance is reached. Since healthcare facilities are spread across the country, and it is impossible to study all healthcare workers, sampling would have to be done. A simple random sample where workers are analyzed without any guiding tool, and the number of times, they observe guidelines are divided by the number of observations made. Convenience, cluster, and stratified sampling techniques could as well be used and the percentages calculated using the same format as random sampling.

Some of the methods classified as direct include direct observation, assessing patients, and filling compliance reports by health care workers. 58% of healthcare workers do not strongly endorse direct observation assessment as a method of hand hygiene compliance (Cawthorne & Cooke, 2020). Assessing patients is beneficial because it shows the actual rate of infections that are caused by the HCW. Filling compliance reports has been known to work because the practitioners’ level of compliance is measured and makes the HCW introspect themselves.

Direct data collection methods can be supplemented by indirect methods, such as monitoring the consumption of substances used to ensure hand hygiene. For instance, the completion time for soaps and hand sanitizers in hospitals could gauge whether healthcare workers are compliant, not compliant, or very compliant. A more effective indirect monitoring method is automated monitoring of sinks, towels, hand rubs, and water used to perform hand sanitization. However, indirect methods are expensive, not flexible, not universal and prone to errors.

The Rationale for using the Selected Tool

The direct observation method has many advantages but only a few disadvantages. One unique advantage of the direct observation method is its nearly universal applicability of the technique (Boyce, 2017). This method is immune to complex structures and composite healthcare systems. Moreover, the trained observers can act as real-time supervisors of the workers to ensure their safety. Additionally, the method is cheap and easy to set up, irrespective of the resources available to the observer. The quality of handwash done by healthcare workers can as well be directly observed and analyzed using this method. The WHO has prescribed this method, as the “My five moments for hand hygiene” can be followed by this tool. This would be ideal for anyone without resources, and even those with resources can hardly find a better method. For this applicability, the direct observation method has come to be considered the gold standard for gauging hand hygiene.

Recommendations for Improvement

The best way to improve hand hygiene is to make it a habit for healthcare professionals. It should be made easy for them to have access to sanitation equipment. Professionals identified as allergic to soaps and sanitizers should be given appropriate alternatives. Nudging, the friendly push to encourage obedience to hygiene protocols, can also improve the course significantly (Caris et al., 2018). To implement the improvement plan, I would first consider the recommendations provided by the WHO. Secondly, it is imperative to evaluate and identify the level of compliance required. Finally, I would devise a program that can easily make hand hygiene part of the daily habits of healthcare workers.

How to Measure the Improvements

Improvements can be evaluated by calculating the percentages of compliance of the collected sample. The compliance forms filled by the auditors show the number of observations made and the hygiene instances done during the monitoring process. The quantity of sightings is taken as the numerator, while the hand hygiene instances go to the denominator. The percentages between different institutions at varied times would then be analyzed. It is important to compare the average percentage of compliance to the benchmark required level.


Hand hygiene poses a significant threat of infection to patients receiving treatment in hospitals. It is important for proper methods to be formulated to solve this issue. One of the best approaches is direct observation since it is universal and cost-effective. In addition, it is paramount to develop solutions after the problem has been identified. Building habits that promote hand hygiene could bring a significant level of change. When the change occurs, proper tools for measuring the improvements are needed, a role which percentage serves best.


Boyce, J. M. (2017). Electronic monitoring, in combination with direct observation, is a means to significantly improve hand hygiene compliance. American Journal of Infection Control, 45(5), 528–535. Web.

Caris, M. G., Labuschagne, H. A., Dekker, M., Kramer, M. H., van Agtmael, M. A., & Vandenbroucke-Grauls, C. M. (2018). Nudging to improve hand hygiene. Journal of Hospital Infection, 98(4), 352-358. Web.

Cawthorne, K.-R.., & Cooke, R. P. D. (2020). Healthcare workers’ attitudes to how hand hygiene performance is currently monitored and assessed. Journal of Hospital Infection. Web.

Find out the price of your paper