Hand Hygiene

October 30, 2020 | Health System Risk Management


The idea that physicians should wash their hands before and after patient contact dates at least as far back as the 12th century when Maimonides wrote, "I dismount my animal, wash my hands, go forth to my patients," and "Never forget to wash your hands after having touched a sick person." In the late 1840s, Semmelweis demonstrated that hand hygiene dramatically reduced maternal deaths in hospitals from puerperal fever. (Savio and Ramoska) But less than 40 years later, President James Garfield died of a lingering infection brought on by over a dozen physicians' dirty hands and unsterilized instruments probing the small wound in their attempts to remove an assassin's bullet ("Death of President Garfield").

It is not surprising, then, that in the 21st century, proper hand hygiene by healthcare workers is still considered to be one of the most important practices for preventing healthcare-associated infections (HAIs) (CDC "Guideline for Hand Hygiene"). HAIs can happen anywhere healthcare is delivered including hospitals; outpatient settings such as doctor's offices, ambulatory surgical centers, and dialysis facilities; and long-term care facilities such as nursing homes and rehabilitation centers. They may be caused by any infectious agent, although most are caused by bacteria, viruses, or fungi (ODPHP).

A variety of national and international organizations, such as the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO), have issued recommendations on how and when to perform hand hygiene. A compendium of strategies to prevent HAIs (a collaborative effort by virtually all organizations and societies with expertise on this topic, including the Society for Healthcare Epidemiology of America SHEA, the Infectious Diseases Society of America, the American Hospital Association, the Association for Professionals in Infection Control and Epidemiology APIC, the Joint Commission, CDC, the Institute for Healthcare Improvement, the Pediatric Infectious Diseases Society, and the Surgical Infection Society) summarizes practices based on the quality of the supporting evidence. This compendium lists hand hygiene as one of the "basic practices" for preventing all of the infections identified in the National HAI Action Plan (Yokoe et al.). Despite the focus on hand hygiene as an important safety practice, compliance is often low. On average, healthcare providers clean their hands less than half the times they should (CDC "Clean Hands Count").

This guidance article briefly outlines standards and guidelines related to hand hygiene, such as those from CDC and WHO, and provides recommendations on how to monitor and improve hand hygiene compliance.

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