SCP: Multimodal intervention to increase hand hygiene compliance Short description of the SCP and information on implementation


Hand hygiene is a general term for removing microorganisms using a disinfecting agent such as alcohol or soap and water (AHRQ 2013).

Health care organisations (HCOs) which will implement this SCP within Work Package 5 of the PaSQ Project are expected to introduce the WHO multimodal hand hygiene improvement strategy as outlined below (WHO 2009a, WHO 2009b):

·         Based on WHO Consensus Recommendations, hands should be washed with soap and water when visibly dirty or visibly soiled with blood or other body fluids or after using the toilet. Also if exposure to potential spore-forming pathogens is strongly suspected or proven, including outbreaks of Clostridium difficile, hand washing with soap and water is the preferred means. In all other clinical situations an alcohol-based hand rub should be used as the preferred means for routine hand antisepsis.

·         WHO has identified five crucial moments for hand hygiene in health care:

1.       Before touching a patient

2.       Before a clean/aseptic procedure
3.       After body fluid exposure risk
4.       After touching a patient
5.       After touching patient surroundings

·         WHO recommends that a multimodal strategy is necessary to induce sustained hand hygiene practice improvements; therefore recommendations for proper hand hygiene address different levels. Multimodal interventions to increase hand hygiene compliance are applicable to any health care setting or health care institution 1. Based on the WHO Guidelines on Hand Hygiene in Health Care a number of components make up an effective multimodal strategy for hand hygiene; HCOs are expected to implement features of each of the below components:

  • System Change: ensuring that the necessary infrastructure is in place to allow health care workers to practice hand hygiene. This includes two essential elements: access to a safe, continuous water supply as well as to soap and towels; readily-accessible alcohol-based hand rub at the point of care. Availability of alcohol-based hand rub at the point of care is usually achieved through staff-carried hand rubs (pocket bottles), wall-mounted dispensers, containers affixed to the patient’s bed or bedside table or to dressing or medicine trolleys that are taken to the point of care.
  • Training/Education: providing regular training on the importance of hand hygiene, based on the “My five moments for hand hygiene” approach and on the correct procedures for handrubbing and handwashing to all health care workers. HCOs should also provide information to health care workers regarding hand hygiene practices that reduce skin irritation and provide lotions or creams to minimize the occurrence of skin irritation.
  • Evaluation and feedback: monitoring hand hygiene practices and infrastructure, along with related perceptions and knowledge among health care workers, while providing performance and results feedback to the staff. WHO recommends using a validated methodology for training observers to directly monitor hand hygiene compliance using “My five moments for hand hygiene”.
  • Reminders in the workplace: prompting and reminding health care workers about the importance of hand hygiene and about the appropriate indications and procedures for performing it (for example “How to” and “5 Moments” posters from the WHO toolkit are displayed in all test wards, including patients’ rooms, staff areas and out-patient/ambulatory departments).
  • Institutional safety climate: creating an environment and the perceptions that facilitate awareness-raising about patient safety issues while guaranteeing consideration of hand hygiene improvement as a high priority at all levels, including: active participation at both the institutional and individual levels; awareness of individual and institutional capacity to change and improve (self-efficacy); and partnership with patients and patient organizations depending on cultural issues and the resources available.

·         Detailed information on each of the above components and tools developed specifically for these components can be found in the WHO Guide to Implementation (WHO 2009b) and online on the corresponding WHO site [  and (April 2nd 2013)].

All of the tools are available in French and a number of them also in Spanish and Russian [, and (April 2nd 2013)].

·         Patient awareness and understanding of hand hygiene are important aspects to be considered in the action plans of a multimodal hand hygiene improvement programme. Positive encouragement by patients of health care workers to motivate them to implement good hand hygiene could improve compliance with the “My 5 Moments for Hand Hygiene” approach. Performing correct hand hygiene in view of the patient can promote patient confidence and partnership between patients and health care workers to make care safer. More information on engaging patients in the hand hygiene programme can be found in the WHO tool “Guidance on Engaging Patients and Patient Organizations in Hand Hygiene Initiatives”, as part of the component “Institutional safety climate” [ (April 12th2013)].