Achieve near-100% hand hygiene compliance

Demonstrate how easily germs are spread

At Baltimore-based Harbor Hospital, quality professionals were challenged to get staff to wash their hands 100% of the time. "Hand hygiene is the one action that protects everyone we provide care to, and also protects our own safety," says Patricia Moorhouse-Getz, RN, MSN, the organization's clinical analyst.

The organization used the Institute for Healthcare Improvement (IHI)'sHow-to Guide: Improving Hand Hygiene to identify strategies to improve compliance. "IHI encourages facilities to establish a target, measure, communicate, and expect compliance from all levels," says Moorhouse-Getz. (To obtain the IHI guide, go to Click on "Topics," "Critical Care," "Intensive care," Tools," "How-To Guide: Improving Hand Hygiene.")

Frequent and thorough hand hygiene allows nurses and other health care workers to reduce the transmission of invasive candida infections to patients who are susceptible to hospital-acquired diseases while being treated for other conditions.1

Despite a growing body of evidence showing the benefits of hand hygiene, compliance remains poor at many organizations. One study showed that even with hospitalwide programs in place, compliance only improved from 48% to 66% at one organization.2

"Our statistics are in the 80% compliance," says Moorhouse-Getz. "It is hard to move toward 100% compliance." In 2005, several initiatives were implemented to improve compliance.

Signs in patient rooms stating, "It's OK to Ask," encourage patients to ask everyone to foam their hands using dispensers mounted inside and outside of every patient room. "Gels on the counters and regular washing stations complete our offerings to staff and visitors," says Mary Biggs, RN, infection control coordinator.

These interventions track compliance with hand hygiene:

  • A spot monitoring is done on units, with three to five observations a day to check that staff wash their hands before and after caring for a patient. "The staff participates, with one member of each unit being a 'secret shopper' and monitoring for compliance," says Biggs.
  • The amount of soap used is monitored and reported quarterly. "We have had a significant jump in our foam usage," reports Biggs. Foam usage from September 2004 through August 2005 was 115 cases, and from September 2005 through February 2006 this increased to 171 cases.

During the organization's recent Joint Commission survey, hand hygiene compliance was a key area of focus.

One surveyor recommended that the "It's OK to Ask" signs also be posted near the alcohol gel offered to visitors at the entrance and also suggested that a quarterly report be done for each unit to give managers a better idea of compliance.

As a result, Biggs now distributes graphs to each unit on hand hygiene compliance on a quarterly basis.

Surveyors were impressed with the monitoring of soap usage. "The surveyor shared that one hospital she surveyed even monitored paper towel usage," says Biggs. "She commented that it was great to see the staff using the foam so consistently and the signage in every patient's room."


  1. Chettle CC. Life-threatening fungal infections on the rise.Nursing Spectrum, April 10, 2006.
  2. Pittet D, Hugonnet S, Harbarth S, et al. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene.Lancet 2000; 356(9238):1307-12.

[For more information, contact:

Mary Biggs, RN, Infection Control Department, Harbor Hospital, 3001 S. Hanover Street, Baltimore, MD 21225. Telephone: (410) 350-3591. E-mail:

Patricia Moorhouse-Getz, RN, MSN, Clinical Analyst, Harbor Hospital, 3001 S. Hanover Street, Baltimore, MD 21225. Telephone: (410) 350-2264. E-mail:]