Hand-Hygiene Adherence Varies at Critical Points of Care

person washing their hands
Healthcare workers were more likely to partake in hand-hygiene protocols after contaminating tasks vs critical tasks and before such tasks.

Healthcare workers were more likely to perform hand-hygiene protocols after contaminating tasks than critical tasks, compared with before such tasks, according to data published in Clinical Infectious Diseases. Results of the study suggested that habits and emotional responses may influence hand-hygiene adherence.

Hand hygiene is one of the most effective ways to decrease healthcare-associated infections, which occur in 4% to 10% of hospitalized patients globally. Despite recommendations in the World Health Organization’s My 5 Moments for Hand Hygiene, adherence ranges from 15% to 80% at many healthcare facilities. Previous studies were not designed to identify critical hand-hygiene moments from among the My 5 Moments for Hand Hygiene, and few have assessed whether healthcare workers’ hand hygiene compliance was affected by the tasks they performed immediately before or after individual hand hygiene.

To assess how task type influenced healthcare workers hand-hygiene adherence, investigators linked consecutive tasks they performed during the STAR*ICU study into care sequences and identified task pairs: 2 consecutive tasks and the intervening hand-hygiene opportunity. Tasks were defined as critical or contaminating and researchers calculated the odds of critical and contaminating tasks occurring, as well as the odds of hand-hygiene adherence.

The results of data from 42,349 task pairs showed that overall adherence was 39%. Healthcare workers were less likely to perform hand-hygiene protocols before critical tasks than before other tasks (adjusted odds ratio [aOR] 0.97; 95% CI 0.95-0.98) and more likely to do so after contaminating tasks than after other tasks (aOR 1.12; 95% CI, 1.10-1.13). Nurses were more likely to perform critical and contaminating tasks but their hand-hygiene adherence was better than physicians (aOR 0.94; 95% CI, 0.91-0.97) and other healthcare workers (aOR 0.87; 95% CI, 0.87-0.94).

The nature of the dataset used in the study posed several limitations including that the data was collected between 2005 and 2006, which may not represent the state of hand-hygiene today. Information on hand-hygiene before and after every contact was not available and workers could not be followed across multiple patient episodes, so adjustments to the analyses for individual workers’ behavior was not possible. Furthermore, patient characteristics were not accounted for and workers’ hygiene habits between caring for different patients was not analyzed. Also, the data was collected from intensive care units already participating in an intervention to improve hand-hygiene and may not represent typical ICUs. Finally, the data was collected solely from intensive care units and the results may not apply to general wards.

According to investigators, these results suggested hand-hygiene practices are often habitual and likely formed during childhood, when such practices involved removing dirt and contamination from one’s hands. Therefore, tasks associated with a high risk for contamination may trigger emotional responses in healthcare workers that prompt them to perform hand hygiene.

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The researchers highlighted that interventions designed to break ingrained habits and form new ones and provide triggers reminding workers to perform hand-hygiene before critical tasks may be more successful. They also suggested that future work is needed to evaluate healthcare workers’ motivations for performing hand-hygiene at specific points in patient care sequences and assess the efficacy of action planning.


Chang NN, Reisinger HS, Schweizer ML et al. Hand hygiene compliance at critical points of care [published online February 8, 2020]. Clin Infect Dis. doi:10.1093/cid/ciaa130

This article originally appeared on Infectious Disease Advisor