Quality Compass - Hand Hygiene

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.

EVIDENCE-INFORMED BEST PRACTICESType of Evidence

Hand hygieneIV (Expert Opinion)

Make Change

Evidence-Informed
Best Practice

How To Implement

Toolbox

Hand hygiene

Effective hand hygiene kills or removes transient bacteria on the skin and minimizes risk of infection. (Provincial Infectious Diseases Advisory Committee (PIDAC), December 2010.)

There are two methods of killing/removing microorganisms on hands:

Hand sanitizing with a 70 to 90% alcohol-based hand rub (ABHR) is the preferred method for cleaning hands (when hands are not visibly soiled). Using easily-accessible ABHR in health care settings takes less time than traditional hand washing and has been shown to be more effective in removing bacteria (when hands are not visibly soiled) than washing with soap and water.
Hand washing with soap and running water when hands are visibly soiled. The effectiveness of alcohol is inhibited by the presence of organic material.

The mechanical action of washing, rinsing and drying is the most important contributor to the removal of bacteria that might be present.

Best Practices for Hand Hygiene in All Health Care Settings, Provincial Infectious Diseases Advisory Committee (PIDAC), December 2010. Ontario Ministry of Health and Long-Term Care/Public Health Division. This manual provides infection and control practices for hand hygiene in all healthcare settings in Ontario.
Hand Hygiene Self-Assessment Framework, SaferHealthcare Now! (adapted from WHO Hand Hygiene Self-Assessment Framework 2010).

References

Hand Hygiene

Type of Evidence: IV (Expert Opinion)*

REFERENCES:

Guidelines

Canadian Patient Safety Institute. Your 4 Moments for Hand Hygiene. Government of Ontario; [cited 2012 Nov 19]. Available from: http://www.handhygiene.ca/English/Documents/Tools and Templates/Your 4 Moments for Hand Hygiene (Poster).pdf

Hand Hygiene Self-Assessment Framework (adapted from WHO Hand Hygiene Self-Assessment Framework 2010). Safer Healthcare Now!; [cited 2012 Nov 19]. Available from: https://shn.med.utoronto.ca/hh/

Health Quality Ontario. 2012/13 Quality Improvement Plans: An Analysis for Improvement. Toronto: Health Quality Ontario; 2012 Nov [cited 2012 Nov 19]. Available from: http://www.hqontario.ca/Portals/0/Documents/qi/qip-analysis-for-improvement-2012-en.pdf

How to Help Prevent Healthcare-Associated Infections: A Patient and Family Guide. Canadian Patient Safety Institute; 2012 Apr [cited 2012 Nov 19]. Available from: http://www.handhygiene.ca/English/Documents/Patients and Families/Patient Family Guide.pdf

Institute for Healthcare Improvement (IHI). Hand Hygiene [Internet]. Institute for Healthcare Improvement; [cited: 2012 Nov 19]. Available from: http://app.ihi.org/imap/tool/#Process=f0e22d9b-e08d-4d96-9f5b-181fe63743d8

Provincial Infectious Diseases Advisory Committee (PIDAC). Best Practices for Hand Hygiene in All Health Care Settings. Toronto: Ontario Ministry of Health and Long-Term Care/Public Health Division; 2010 Dec [cited: 2012 Nov 19]. Available from: http://www.publichealthontario.ca/en/eRepository/2010-12 BP Hand Hygiene.pdf

World Health Organization. Prevention of hospital-acquired infections: A Practical Guide. 2nd ed. World Health Organization; 2002 [cited 2012 Nov 19]. Available from: http://www.who.int/csr/resources/publications/whocdscsreph200212.pdf

TYPES OF EVIDENCE
A literature review of relevant studies was conducted to present the state of evidence that currently exists in support of each best practice presented in this resource. Where available, studies that are characterized by good methodological quality and rigorous scientific design, such as systematic reviews (e.g., Cochrane reviews) and meta-analyses, were included. Additional types of evidence were considered and presented, including primary research studies such as randomized control trials, correlation and case-controlled studies, and observational research. Where studies were not found, other evidence that supported the change idea were presented, including expert guidelines, clinical experience of respected authorities, or other reports. Each best practice included in this resource was then assigned a type of evidence in accordance with the classification outlined below in Table 1:

*Table 1: Description of Types of Evidence

Type of Evidence	Grade	Description
High	I	High quality evidence including systematic reviews/Cochrane systematic reviews or meta-analyses
Medium	II	Medium quality evidence including primary research studies such as randomized control trials, case control studies
Low	III	Low quality evidence including descriptive studies, controlled study without randomization, correlation, case studies, grey literature
Expert Opinion	IV	Guidelines, Expert committee reports, clinical experience of respected experts in the field
Experience	V	Locally driven ideas that have shown promise and emerging innovations

TOP OF TAB

4 Moments of Hand HygieneIV (Expert Opinion)

Make Change

Evidence-Informed
Best Practice

How To Implement

Toolbox

4 Moments of Hand Hygiene

A hand hygiene indication points to the reason hand hygiene is necessary at a given moment.

The 4 Moments for Hand Hygiene for Health Care Professionals include:³

BEFORE initial patient/patient environment contact
BEFORE aseptic procedure
AFTER body fluid exposure risk
AFTER patient/patient environment contact

Just Clean Your Hands, Public Health Ontario
Your 4 Moments for Hand Hygiene, Canadian Patient Safety Institute / Government of Ontario

References

Four Moments of Hand Hygiene

Type of Evidence: IV (Expert Opinion)*

REFERENCES:

Guidelines

Canadian Patient Safety Institute. Your 4 Moments for Hand Hygiene. Government of Ontario; [cited 2012 Nov 19]. Available from: http://www.handhygiene.ca/English/Documents/Tools and Templates/Your 4 Moments for Hand Hygiene (Poster).pdf

Hand Hygiene Self-Assessment Framework (adapted from WHO Hand Hygiene Self-Assessment Framework 2010). Safer Healthcare Now!; [cited 2012 Nov 19]. Available from: https://shn.med.utoronto.ca/hh/

Health Quality Ontario. 2012/13 Quality Improvement Plans: An Analysis for Improvement. Toronto: Health Quality Ontario; 2012 Nov [cited 2012 Nov 19]. Available from: http://www.hqontario.ca/Portals/0/Documents/qi/qip-analysis-for-improvement-2012-en.pdf

How to Help Prevent Healthcare-Associated Infections: A Patient and Family Guide. Canadian Patient Safety Institute; 2012 Apr [cited 2012 Nov 19]. Available from: http://www.handhygiene.ca/English/Documents/Patients and Families/Patient Family Guide.pdf

Institute for Healthcare Improvement (IHI). Hand Hygiene [Internet]. Institute for Healthcare Improvement; [cited: 2012 Nov 19]. Available from: http://app.ihi.org/imap/tool/#Process=f0e22d9b-e08d-4d96-9f5b-181fe63743d8

Provincial Infectious Diseases Advisory Committee (PIDAC). Best Practices for Hand Hygiene in All Health Care Settings. Toronto: Ontario Ministry of Health and Long-Term Care/Public Health Division; 2010 Dec [cited: 2012 Nov 19]. Available from: http://www.publichealthontario.ca/en/eRepository/2010-12 BP Hand Hygiene.pdf

World Health Organization. Prevention of hospital-acquired infections: A Practical Guide. 2nd ed. World Health Organization; 2002 [cited 2012 Nov 19]. Available from: http://www.who.int/csr/resources/publications/whocdscsreph200212.pdf

TYPES OF EVIDENCE
A literature review of relevant studies was conducted to present the state of evidence that currently exists in support of each best practice presented in this resource. Where available, studies that are characterized by good methodological quality and rigorous scientific design, such as systematic reviews (e.g., Cochrane reviews) and meta-analyses, were included. Additional types of evidence were considered and presented, including primary research studies such as randomized control trials, correlation and case-controlled studies, and observational research. Where studies were not found, other evidence that supported the change idea were presented, including expert guidelines, clinical experience of respected authorities, or other reports. Each best practice included in this resource was then assigned a type of evidence in accordance with the classification outlined below in Table 1:

*Table 1: Description of Types of Evidence

Type of Evidence	Grade	Description
High	I	High quality evidence including systematic reviews/Cochrane systematic reviews or meta-analyses
Medium	II	Medium quality evidence including primary research studies such as randomized control trials, case control studies
Low	III	Low quality evidence including descriptive studies, controlled study without randomization, correlation, case studies, grey literature
Expert Opinion	IV	Guidelines, Expert committee reports, clinical experience of respected experts in the field
Experience	V	Locally driven ideas that have shown promise and emerging innovations

TOP OF TAB

Remove impediments to hand hygieneIV (Expert Opinion)

Make Change

Evidence-Informed Best Practice	How To Implement	Toolbox
Remove impediments to hand hygiene	Maintain skin integrity Long sleeves or jewellery should not interfere with, or become wet, when performing hand hygiene If watches and other wrist jewellery are present, remove or push up above the wrist before performing hand hygiene Fingernail polish, if worn, must be fresh (<4 days) and in good condition Acrylic and artificial nails harbor microorganisms and are not to be worn Ensure hand sanitizer dispensers are always full and ensure quick identification of empty dispensers Optimize location of hand hygiene stations by completing an assessment of sanitizer availability/placement areas	2012/13 Quality Improvement Plans: An Analysis for Improvement. Table 16: Change Ideas to Improve Hand Hygiene (pp 34-38), Health Quality Ontario Read about Impediments to Hand Hygiene at Best Practices for Hand Hygiene (pp 24-26), Provincial Infectious Diseases Advisory Committee (PIDAC), December 2010. Ontario Ministry of Health and Long-Term Care/Public Health Division.

References

Remove Impediments to Hand Hygiene

Type of Evidence: IV (Expert Opinion)*

REFERENCES:

Guidelines

Canadian Patient Safety Institute. Your 4 Moments for Hand Hygiene. Government of Ontario; [cited 2012 Nov 19]. Available from: http://www.handhygiene.ca/English/Documents/Tools and Templates/Your 4 Moments for Hand Hygiene (Poster).pdf

Hand Hygiene Self-Assessment Framework (adapted from WHO Hand Hygiene Self-Assessment Framework 2010). Safer Healthcare Now!; [cited 2012 Nov 19]. Available from: https://shn.med.utoronto.ca/hh/

Health Quality Ontario. 2012/13 Quality Improvement Plans: An Analysis for Improvement. Toronto: Health Quality Ontario; 2012 Nov [cited 2012 Nov 19]. Available from: http://www.hqontario.ca/Portals/0/Documents/qi/qip-analysis-for-improvement-2012-en.pdf

How to Help Prevent Healthcare-Associated Infections: A Patient and Family Guide. Canadian Patient Safety Institute; 2012 Apr [cited 2012 Nov 19]. Available from: http://www.handhygiene.ca/English/Documents/Patients and Families/Patient Family Guide.pdf

Institute for Healthcare Improvement (IHI). Hand Hygiene [Internet]. Institute for Healthcare Improvement; [cited: 2012 Nov 19]. Available from: http://app.ihi.org/imap/tool/#Process=f0e22d9b-e08d-4d96-9f5b-181fe63743d8

Provincial Infectious Diseases Advisory Committee (PIDAC). Best Practices for Hand Hygiene in All Health Care Settings. Toronto: Ontario Ministry of Health and Long-Term Care/Public Health Division; 2010 Dec [cited: 2012 Nov 19]. Available from: http://www.publichealthontario.ca/en/eRepository/2010-12 BP Hand Hygiene.pdf

World Health Organization. Prevention of hospital-acquired infections: A Practical Guide. 2nd ed. World Health Organization; 2002 [cited 2012 Nov 19]. Available from: http://www.who.int/csr/resources/publications/whocdscsreph200212.pdf

TYPES OF EVIDENCE
A literature review of relevant studies was conducted to present the state of evidence that currently exists in support of each best practice presented in this resource. Where available, studies that are characterized by good methodological quality and rigorous scientific design, such as systematic reviews (e.g., Cochrane reviews) and meta-analyses, were included. Additional types of evidence were considered and presented, including primary research studies such as randomized control trials, correlation and case-controlled studies, and observational research. Where studies were not found, other evidence that supported the change idea were presented, including expert guidelines, clinical experience of respected authorities, or other reports. Each best practice included in this resource was then assigned a type of evidence in accordance with the classification outlined below in Table 1:

*Table 1: Description of Types of Evidence

Type of Evidence	Grade	Description
High	I	High quality evidence including systematic reviews/Cochrane systematic reviews or meta-analyses
Medium	II	Medium quality evidence including primary research studies such as randomized control trials, case control studies
Low	III	Low quality evidence including descriptive studies, controlled study without randomization, correlation, case studies, grey literature
Expert Opinion	IV	Guidelines, Expert committee reports, clinical experience of respected experts in the field
Experience	V	Locally driven ideas that have shown promise and emerging innovations

TOP OF TAB

IncentivesIV (Expert Opinion)

Make Change

Evidence-Informed Best Practice	How To Implement	Toolbox
Incentives	Recognize staff who show high compliance with hand hygiene practices prior to patient contact and the four moments of hand hygiene (e.g., letters of appreciation, vouchers, recognizing units that met or surpassed goals). Use champions Identify and publicly post hand hygiene champion posters in public spaces. Recognize top performers and identify and engage unit and staff champions to model excellent hand hygiene behaviors.	2012/13 Quality Improvement Plans: An Analysis for Improvement, Table 16: Change Ideas to Improve Hand Hygiene (pp 34-38), Health Quality Ontario

References

Incentives

Type of Evidence: IV (Expert Opinion)*

REFERENCES:

Guidelines

Canadian Patient Safety Institute. Your 4 Moments for Hand Hygiene. Government of Ontario; [cited 2012 Nov 19]. Available from: http://www.handhygiene.ca/English/Documents/Tools and Templates/Your 4 Moments for Hand Hygiene (Poster).pdf

Hand Hygiene Self-Assessment Framework (adapted from WHO Hand Hygiene Self-Assessment Framework 2010). Safer Healthcare Now!; [cited 2012 Nov 19]. Available from: https://shn.med.utoronto.ca/hh/

Health Quality Ontario. 2012/13 Quality Improvement Plans: An Analysis for Improvement. Toronto: Health Quality Ontario; 2012 Nov [cited 2012 Nov 19]. Available from: http://www.hqontario.ca/Portals/0/Documents/qi/qip-analysis-for-improvement-2012-en.pdf

How to Help Prevent Healthcare-Associated Infections: A Patient and Family Guide. Canadian Patient Safety Institute; 2012 Apr [cited 2012 Nov 19]. Available from: http://www.handhygiene.ca/English/Documents/Patients and Families/Patient Family Guide.pdf

Institute for Healthcare Improvement (IHI). Hand Hygiene [Internet]. Institute for Healthcare Improvement; [cited: 2012 Nov 19]. Available from: http://app.ihi.org/imap/tool/#Process=f0e22d9b-e08d-4d96-9f5b-181fe63743d8

Provincial Infectious Diseases Advisory Committee (PIDAC). Best Practices for Hand Hygiene in All Health Care Settings. Toronto: Ontario Ministry of Health and Long-Term Care/Public Health Division; 2010 Dec [cited: 2012 Nov 19]. Available from: http://www.publichealthontario.ca/en/eRepository/2010-12 BP Hand Hygiene.pdf

World Health Organization. Prevention of hospital-acquired infections: A Practical Guide. 2nd ed. World Health Organization; 2002 [cited 2012 Nov 19]. Available from: http://www.who.int/csr/resources/publications/whocdscsreph200212.pdf

TYPES OF EVIDENCE
A literature review of relevant studies was conducted to present the state of evidence that currently exists in support of each best practice presented in this resource. Where available, studies that are characterized by good methodological quality and rigorous scientific design, such as systematic reviews (e.g., Cochrane reviews) and meta-analyses, were included. Additional types of evidence were considered and presented, including primary research studies such as randomized control trials, correlation and case-controlled studies, and observational research. Where studies were not found, other evidence that supported the change idea were presented, including expert guidelines, clinical experience of respected authorities, or other reports. Each best practice included in this resource was then assigned a type of evidence in accordance with the classification outlined below in Table 1:

*Table 1: Description of Types of Evidence

Type of Evidence	Grade	Description
High	I	High quality evidence including systematic reviews/Cochrane systematic reviews or meta-analyses
Medium	II	Medium quality evidence including primary research studies such as randomized control trials, case control studies
Low	III	Low quality evidence including descriptive studies, controlled study without randomization, correlation, case studies, grey literature
Expert Opinion	IV	Guidelines, Expert committee reports, clinical experience of respected experts in the field
Experience	V	Locally driven ideas that have shown promise and emerging innovations

TOP OF TAB

Grol R, Grimshaw J. From best evidence to best practice: effective implementation of change in patients' care.

Lancet. 2003 Oct 11;362(9391):1225-30.
Available from: http://www.ncbi.nlm.nih.gov/pubmed/14568747
Canadian Patient Safety Institute. Your 4 Moments for Hand Hygiene.

Government of Ontario; [cited 2012 Nov 19].
Available from: http://www.handhygiene.ca/English/Documents/Tools and Templates/Your 4 Moments for Hand Hygiene (Poster).pdf

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
Choose measures that support the team’s aim statement Consider qualitative and quantitative measures Use existing data collection systems, whenever possible Integrate measurement into the daily routine Use a set of five to seven measures to track progress throughout your QI project

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

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.

Background

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

What is the hand hygiene rate in your hospital?

Click here to review your hospital performance on the public reporting site.

Overcrowded hospitals, cutbacks to cleaning linked to infection outbreaks [Internet].

Ontario Council of Hospital Unions; 2011 Oct 11 [cited 2012 Nov 19].
Available from: http://www.ochu.on.ca/hai_tour.html
Improving Hand Hygiene Among Health-Care Professionals [Internet].

The College of Physicians and Surgeons of Ontario; 2009 July [cited 2012 Nov 19].
Available from: http://www.cpso.on.ca
Canadian Patient Safety Institute. Your 4 Moments for Hand Hygiene.

Government of Ontario; [cited 2012 Nov 19].
Available from: http://www.handhygiene.ca/English/Documents/Tools and Templates/Your 4 Moments for Hand Hygiene (Poster).pdf
Health Quality Ontario. Quality Monitor 2012.

Toronto: Health Quality Ontario; 2012 Sept [cited 2012 Nov 19]
Available from: http://www.hqontario.ca/portals/0/Documents/pr/qmonitor-full-report-2012-en.pdf
Health Quality Ontario. 2012/13 Quality Improvement Plans: An Analysis for Improvement.

Toronto: Health Quality Ontario; 2012 Nov [cited 2012 Nov 19].
Available from: http://www.hqontario.ca/Portals/0/Documents/qi/qip-analysis-for-improvement-2012-en.pdf
Health Quality Ontario. Quality Monitor 2011.

Toronto: Health Quality Ontario; 2011 Sept [cited 2012 Nov 19]
Available from: http://www.hqontario.ca/portals/0/Documents/pr/qmonitor-full-report-2011-en.pdf

Hand Hygiene

Best Practices

Grol R, Grimshaw J. From best evidence to best practice: effective implementation of change in patients' care.

Canadian Patient Safety Institute. Your 4 Moments for Hand Hygiene.

Measurement

Tools & Resources

Tools

Hand Hygiene Tools

QI Tools

Resources

Hand Hygiene Resources

QI Resources

Background

Issue

Call to Action

What is the hand hygiene rate in your hospital?

Overcrowded hospitals, cutbacks to cleaning linked to infection outbreaks [Internet].

Improving Hand Hygiene Among Health-Care Professionals [Internet].

Canadian Patient Safety Institute. Your 4 Moments for Hand Hygiene.

Health Quality Ontario. Quality Monitor 2012.

Health Quality Ontario. 2012/13 Quality Improvement Plans: An Analysis for Improvement.

Health Quality Ontario. Quality Monitor 2011.