Achieving and sustaining significant improvements in hand-hygiene compliance throughout a hospital unit, let alone across a facility or a large health system, remains an elusive goal for many organizations. So, why do many health care facilities fall short of their compliance goals when hand hygiene remains the cornerstone of infection prevention?

For one thing, the issue is far more complex and multifaceted than many might assume, says Klaus Nether, director of solutions development for the Joint Commission Center for Transforming Healthcare.

The Center has developed a wealth of data and insights after working with more than 600 different health care organizations that employed its web-based Targeted Solutions Tool (TST) on 4,500 hand-hygiene projects since 2010. And while Nether is careful not to make generalizations about why many health care organizations still struggle with hand-hygiene compliance, he says there are some key takeaways from the data.

“Some of the top contributing factors that we’ve seen include the improper use of gloves, the lack of accountability in just-in-time coaching, and frequent entry to and exit from the patient’s room,” Nether says.

Building a culture of safety including accountability and just-in-time coaching in which all staff members feel empowered to talk to a physician, nurse or others who come in contact with patients without having washed their hands is essential.

Appreciating the complexity of the challenge to achieving a hand-hygiene compliance rate of 90 percent or higher is another key issue for hospitals. The TST follows the concepts of Lean, Six Sigma and change management and what the Joint Commission calls Robust Process Improvement. Organizations that go through this analysis inevitably find that there are many distinct root causes within each unit of a facility that help to identify specific challenges to hand-hygiene compliance. Some other key contributing factors include:

  • Hands full: Health care workers carrying supplies, medication and other items into a patient room sometimes can’t wash their hands without having a convenient spot to place the items. This is an area in which facilities management personnel can work to place shelving near hand-hygiene stations, Nether says.
  • Sources of distraction: Nurses and other caregivers are frequently engaged in multitasking and conversations with patients and staff and can forget to wash their hands.
  • Ineffective placement of dispensers and sinks: “Look at the flow within the unit,” Nether suggests. “One pilot program hospital found they had all their hand hygiene dispensers on the left side of the door and the flow of the traffic came in from the right side. With everyone being very busy, sometimes ‘out of sight' is 'out of mind.’” Nether suggests that facilities managers work closely with the clinical teams and follow local and state ordinances to optimize the location of hand-hygiene dispensers. Also, do not assume that you can standardize the hand-hygiene dispenser location throughout the organization because the workflow direction can differ from one unit to the next. 

Access to the Center for Transforming Healthcare’s Targeted Solutions Tool is a complimentary benefit of Joint Commission accreditation. Use of the TST is confidential and separate from accreditation. Find our more information about the TST program.