VA National Center for Patient Safety

Hand Hygiene Information and Tools

One frequent and important question asked is this: What data can be acquired, studied and returned to providers and other health care workers to better understand hand hygiene practices? The answer is simple: Three different types.

1. Observed overall performance on hand hygiene practices
2. Quantity (mass in grams) of alcohol based hand rub used per 100 or 1000 patient days
3. Responses to questionnaires regarding attitudes and perceptions about hand hygiene practices

• Hand Hygiene/Glove Use Observation Tool for recording staff hand hygiene practices (Word)
  • Instructions for Using the Hand Hygiene/Glove Use Observation Tool (Word)
• Questionnaire for measuring local perceptions and attitudes regarding hand hygiene in healthcare settings (Word)
  Some points to consider when using the questionnaire:
  • If you are going to observe the quantity of alcohol-based hand rub used, it's best to do the observations before distributing the questionnaire.
  • The questionnaire has the potential to raise awareness; thus making your baseline observed level of hand hygiene compliance higher than it was prior to issuing the questionnaire.
  • Another interesting point is that in our work and in other published studies, a large disconnect between the self-reported compliance and the observed compliance was noted.
  • People don't seem to realize hand hygiene opportunities are being missed: For example, before and after patient contact or after removing gloves.
• Excel spreadsheet for computing grams of alcohol product used per 100 patient days 
• Excel spreadsheet for computing grams of alcohol product used per 1000 patient days
  Some points to consider regarding measuring product use:
  • Doing this for ICU and non-ICU inpatient areas is a challenging but not unrealistic goal. It requires cooperation from a number of areas, such as nursing, supply, logistics, and housekeeping -- everyone involved locally in replacing and tracking the replacement of alcohol hand-rubs.
  • It might be best to start in the ICU because the ICU is the most controlled environment in the hospital, patient care is easiest to observe there, and ICU patients are more likely to be seriously harmed by a hospital-acquired infection.
  • Though the "powers that be" seem to vary from place to place,
    what's really entailed is keeping an accurate record of how many full dispensers replace empty ones within a certain area of the hospital per month. This data needs to be cross-checked with the number of patient days experienced in that same area per the same unit of time.
  • This is also an opportunity for non-clinical staff to contribute to improving patient care and might be effectively described to them as such.
  • Measuring the quantity of alcohol-based hand rub product used per 100 or 1,000 patient days is surprisingly difficult and requires cooperation from different people and role-players in the hospital. (In our project we tried to do this with four ICUs and were successful with three. One ICU's data included the number of canisters used in a larger area than the ICU - this made the data unusable.)
• Checklist of Interventions developed in VA-3M Six Sigma Project to improve Hand Hygiene Practices (Word)
  An obvious question is this: What do we need to do to improve performance on hand hygiene practices, other than just reminding people to decontaminate their hands more often?
  • This document describes what we did in our project at four VAMC ICUs. Implementing these interventions in a setting with enthusiastic staff participation and input led to observed overall hand hygiene compliance increasing from 47% to 80% and nearly doubling the quantity of alcohol-based hand rub used.
• It's OK to Ask Buttons (Word)
• Sample Data from four VAMC Intensive Care Units
  Sample data collected using the above tools and sample charts of the data.
• CDC Educational Materials to Promote Hand Hygiene in your Healthcare Facility

Additional Resources

• "Infection: Don't Pass It On" web site (VHA Office of Public Health and Environmental Hazards)
• Guide to recommended use of I:DPIO Hand Hygiene Posters (Word) 
• CDC Hand Hygiene web site*
• United Kingdom's National Patient Safety Agency "Clean Your Hands" web site*†
• Safe Care Campaign*† (This is an excellent resource for patients and families interested in preventing healthcare-acquired infections.)

Reference Documents

• One page summary for caregivers of the key points of the VHA Directive on Hand Hygiene Practices (Word) 
• The VHA directive on Hand Hygiene Practices, #2011-007 
• One page summary of all the CDC Hand Hygiene Guideline recommendations required by Joint Commission and the VHA Directive (Word) 
• The CDC Guideline on Hand Hygiene in Health Care Settings (PDF)*
• Hand Hygiene Information from The Joint Commission*†
• Article on the joint project between VA and the 3M Company that used the Six Sigma process to implement the CDC Hand Hygiene Guideline: "Using the Six Sigma Process to Implement the Centers for Disease Control and Prevention Guideline for Hand Hygiene in 4 Intensive Care Units"*†

*By clicking on these links, you will leave the Department of Veterans Affairs Web site.

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