Hand Hygiene
Overview
Updated on December 21, 2015
Issue
Health care associated infections kill between 8,000 and 12,000 Canadians every year, of which 40% occur in Ontario.1 Patients seeking help for other health issues may inadvertently get an infection at the health care facility, leading to more serious illness, prolonged hospital stays, and possibly induce long-term disability or death. These preventable infections inflict an unexpected complication on the patients and their families, as well as a substantial financial burden on the health care system.2 Proper hand hygiene is a key part of an effective infection control and prevention program, and can help prevent unnecessary cost, illness and death.
It has been estimated that 220,000 health care associated infections occur in Canada each year, meaning that one in nine patients admitted to Canadian hospitals will acquire an infection as a consequence of their stay.2 About twenty years ago, hospital-acquired infection was the 11th leading cause of death in Canada. Today, it is the fourth leading cause of death in the country.2
Call to Action
It is recommended that there are four important moments of hand hygiene compliance: before initial patient/patient environment contact, before aseptic procedures, after body fluid exposure risk, and after patient/patient environment contact.2,3 The overall rate of hand hygiene compliance before patient contact in Ontario 
hospitals in 2012 was 72% (all hospitals, a slight improvement since 2011 where it was about 66%) and the rate of hand hygiene compliance after patient contact was 83%.4 In 2011, acute teaching hospitals had a lower rate of hand hygiene compliance before patient contact (57%) compared to other hospitals (small community, 51%; large community, 70%; mental health, 63%; chronic/rehabilitation 69%).6 In Ontario, eighty-five hospitals chose hand hygiene as their number one priority in 2012.5 There has been some improvement in this rate of compliance but compliance is too low, leaving room for improvement in Ontario hospitals.6
Best Practices
Updated on December 21, 2015
“Not all changes lead to improvement, but all improvement requires change”
W. Edwards Deming
Evidence-informed best practices are based on quality evidence and should be implemented into practice to optimize outcomes.9 Listed below you will find best practices graded according to the type of evidence. To view a description of the types of evidence, click here.
To help you move from best evidence to best practice, click on the + button next to each best practice to find details on how to implement, as well as change ideas to test using a PDSA approach.
Change ideas are specific and practical changes informed by experience and research that focus on improving specific aspects of a system, process or behaviour. To learn more about change ideas see the QI: Getting Started tab.
Measurement
Updated on December 21, 2015
“Some is not a number, soon is not a time.”
Don Berwick, former President and CEO, IHI, December 2004, at launch of the 100,000 Lives Campaign
How will we know if a change is an improvement? Measurement is one of the critical steps in a quality improvement (QI) initiative that assesses the impact of your tests of change. Quality indicators are used to measure how well something is performing. There are three types of quality indicators used to measure your QI efforts: outcome (indicators that capture clinical outcomes and or system performance), process (indicators that track the processes that measure whether the system is working as planned), and balancing indicators (indicators that ensure that changing one part of the system does not cause new problems in other parts of the system).
| Key Measurement Guidelines |
|---|
|
Suggested measures for QI initiatives in hand hygiene are listed in the table below:
| Type of Measure | Measure |
|---|---|
| Process Measure | Hand hygiene compliance before initial patient/patient environment contact |
| Process Measure | Hand hygiene compliance before aseptic procedure |
| Process Measure | Hand hygiene compliance after body fluid exposure risk |
| Process Measure | Hand hygiene compliance after patient/patient environment contact |
| Process Measure | Hand hygiene compliance across all four moments - previously mentioned see above |
| Outcome Measure | Hospital-acquired infection rates |
Tools & Resources
Updated on December 21, 2015
Tools
Hand Hygiene Tools
-
2012/13 Quality Improvement Plans: An Analysis for Improvement
Health Quality Ontario -
Canada’s Hand Hygiene Challenge
Canadian Patient Safety Institute. Hand hygiene toolkits, fact sheets and training resources. -
Canada’s Hand Hygiene e-learning module
Canadian Patient Safety Institute. A web-based, multimedia learning module. -
Clean Care is Safer Care
World Health Organization (WHO). A range of WHO tools developed to complement the Five Moments for Hand Hygiene initiative, a user-centred approach to hand hygiene. -
How to help prevent healthcare-associated infections: Patient & Family Hand Hygiene Guide
Canadian Patient Safety Institute. This booklet helps patients and families learn how they can help stop the spread of infections by practicing good hand hygiene. -
IHI Improvement Map: Hand Hygiene
Institute for Healthcare Improvement (IHI). The IHI Improvement Map is an interactive tool that helps hospital leaders in the United States improve quality outcomes by guiding their improvement efforts.
QI Tools
- Communications Plan: Instructions , Tool
- Fishbone Template: Instructions , Tool
- Five Whys: Instructions , Tool
- Measurement Plan Template: Instructions , Tool
- Pareto Chart: Instructions , Tool
- PDSA Template
- Project Charter
- Tree Diagram Worksheet
Resources
Hand Hygiene Resources
-
Best Practices for Hand Hygiene in All Health Care Settings
Provincial Infectious Diseases Advisory Committee, December 2010. This manual provides infection prevention and control practices for hand hygiene in all healthcare settings in Ontario. Reproduced with permission from Public Health Ontario. - Community and Hospital Infection Control Association — Canada
- Provincial Infectious Diseases Advisory Committee Public Health Ontario.
- Public Health Ontario: Infectious Disease Prevention and Control
- Public Health Ontario: Just Clean Your Hands Public Health Ontario.
- Regional Infection Control Networks
-
Speak Up: Prevent the Spread of Infection
The Joint Commission, 2011. Speak Up is the Joint Commission’s award-winning patient safety program, designed to encourage patients to “speak up” about their healthcare. This short, animated video shows how washing hands and getting vaccinated can prevent the spread of infection.
QI Resources
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Interpreting Run Charts
Health Quality Ontario -
Model for Improvement (Clip 1)
Institute for Healthcare Improvement -
Model for Improvement (Clip 2)
Institute for Healthcare Improvement -
PDSA Cycle Video (Part 1)
Institute for Healthcare Improvement -
PDSA Cycle Video (Part 2)
Institute for Healthcare Improvement -
The run chart: a simple analytical tool for learning from variation in healthcare processes
Perla RJ, Provost LP, Murray SK. BMJ Qual Saf. 2011 Jan;20(1):46-51.