Hand Hygiene Compliance Monitoring: the State of the Art

  • Claudia Jarrin TejadaEmail author
  • Gonzalo Bearman
Healthcare Associated Infections (G Bearman, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Healthcare Associated Infections


Hand hygiene is crucial to prevent transmission of hospital-acquired infections. The WHO recommends five moments for hand hygiene: (1) before patient contact, (2) before performing an aseptic task, (3) after exposure with body fluids, (4) after patient contact, and (5) after contact with patient’s surroundings. Nevertheless, hand hygiene compliance rates remain low among healthcare workers. Direct observation is the gold standard method for hand hygiene monitoring; however, it is time consuming and observer dependent. Technology has allowed the development of several other hand hygiene surveillance methods. In this article, we review the different modalities for hand hygiene compliance monitoring.


Hand hygiene Healthcare workers Methods Compliance monitoring 


Compliance with Ethics Guidelines

Conflict of Interest

Claudia Jarrin Tejada and Gonzalo Bearman have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by the author.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Pittet D, Allengranzi B, Boyce J. The World Health Organization Guidelines on hand hygiene in health care and their consensus recommendations. Infect Control Hosp Epidemiol. 2009;30:611–22.CrossRefPubMedGoogle Scholar
  2. 2.
    Swoboda SM, Earsing K, Strauss K, et al. Electronic monitoring and voice prompts improve hand hygiene and decrease nosocomial infections in an intermediate care unit. Crit Care Med. 2004;32:358–63.CrossRefPubMedGoogle Scholar
  3. 3.
    Kampf G, Löffler H, Gastmeier P. Hand hygiene for the prevention of nosocomial infections. Dtsch Arztebl Int. 2009;106:649–55.PubMedCentralPubMedGoogle Scholar
  4. 4.
    Jabbar U, Leischner J, Kasper D, et al. Effectiveness of alcohol-based hand rubs for removal of Clostridium difficile spores from hands. Infect Control Hosp Epidemiol. 2010;31:565–70.CrossRefPubMedGoogle Scholar
  5. 5.
    Boyce JM. Update on hand hygiene. Am J Infect Control. 2013;41(5 Suppl):S94–6.CrossRefPubMedGoogle Scholar
  6. 6.
    World Health Organization. WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety Challenge Clean Care Is Safer Care. Geneva: World Health Organization; 2009. 16, Hand hygiene practices among health-care workers and adherence to recommendations. Available from: Accessed March 16, 2014.
  7. 7.
    Boyce JM, Pittet D. Guideline for Hand Hygiene in Health-Care Settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Society for Healthcare Epidemiology of America/Association for Professionals in Infection Control/Infectious Diseases Society of America. MMWR Recomm Rep. 2002;51:1–45.PubMedGoogle Scholar
  8. 8.
    Haas JP, Larson EL. Measurement of compliance with hand hygiene. J Hosp Infect. 2007;66:6–14.CrossRefPubMedGoogle Scholar
  9. 9.
    Gilbert K, Stafford C, Crosby K. Does hand hygiene compliance among health care workers change when patients are in contact precaution rooms in ICUs? Am J Infect Control. 2010;38:515–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Biddle C, Shah J. Quantification of anesthesia providers’ hand hygiene in a busy metropolitan operating room: what would Semmelweis think? Am J Infect Control. 2012;40:756–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Scheithauer S, Oberröhrmann A, Haefner H. Compliance with hand hygiene in patients with methicillin-resistant Staphylococcus aureus and extended-spectrum β-lactamase-producing enterobacteria. J Hosp Infect. 2010;76:320–3.CrossRefPubMedGoogle Scholar
  12. 12.
    Graf K, Chanberny IF, Vonberg RP. Beliefs about hand hygiene: a survey in medical students in their first clinical year. Am J Infect Control. 2011;39:885–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Conrad A, Kaier K, Frank U, et al. Are short training sessions on hand hygiene effective in preventing hospital-acquired MRSA? A time-series analysis. Am J Infect Control. 2010;38:559–61.CrossRefPubMedGoogle Scholar
  14. 14.
    Armellino D, Hussain E, Schilling ME. Using high-technology to enforce low-technology safety measures: the use of third-party remote video auditing and real-time feedback in healthcare. Clin Infect Dis. 2012;54:1–7.CrossRefPubMedGoogle Scholar
  15. 15.•
    Fakhry M, Hanna GB, Anderson O, et al. Effectiveness of an audible reminder on hand hygiene adherence. Am J Infect Control. 2012;40:320–3. This is a pre and post-interventional study that describes the benefits of audible reminders in increasing HH compliance rates.CrossRefPubMedGoogle Scholar
  16. 16.
    Reid N, Moghaddas J, Loftus M, et al. Can we expect patients to question health care workers’ hand hygiene compliance? Infect Control Hosp Epidemiol. 2012;33:531–2.CrossRefPubMedGoogle Scholar
  17. 17.
    Schweizer ML, Reisinger HS, Ohl M, Formanek MB, et al. Searching for an optimal hand hygiene bundle: a meta-analysis. Clin Infect Dis. 2014;58:248–59.CrossRefPubMedGoogle Scholar
  18. 18.
    Marra AR, Edmond MB. Hand hygiene: state-of-the-art review with emphasis on new technologies and mechanisms of surveillance. Curr Infect Dis Rep. 2012;14:585–91.CrossRefPubMedGoogle Scholar
  19. 19.
    The Joint Commission. Measuring hand hygiene adherence: overcoming the challenges. In: Developing a strategy for measuring hand hygiene. The Joint Commission. 2009. Accessed Mar 16, 2014.
  20. 20.
    Boyce JM. Measuring healthcare worker hand hygiene activity: current practices and emerging technologies. Infect Control Hosp Epidemiol. 2011;32:1016–28.CrossRefPubMedGoogle Scholar
  21. 21.
    Pan SC, Tien KL, Hung IC, et al. Compliance of health care workers with hand hygiene practices: independent advantages of overt and covert observers. PLoS One. 2013;8:e53746. doi: 10.1371/journal.pone.0053746.CrossRefPubMedCentralPubMedGoogle Scholar
  22. 22.
    Edmond MD, Goodell A, Zuelzer W, et al. Successful use of alcohol sensor technology to monitor and report hand hygiene compliance. J Hosp Infect. 2010;76:364–5.CrossRefPubMedGoogle Scholar
  23. 23.•
    Polgreen PM, Hlady CS, Severson MA, et al. Method for automated monitoring of hand hygiene adherence with our radio-frequency identification. Infect Control Hosp Epidemiol. 2010;31:1294–7. This study describes a novel, less expensive method of electronic surveillance monitoring.CrossRefPubMedCentralPubMedGoogle Scholar
  24. 24.••
    Sahud AG, Bhanot N, Radhakrishnan A, et al. An electronic hand hygiene surveillance device: a pilot study exploring surrogate markers for hand hygiene compliance. Infect Control Hosp Epidemiol. 2010;31:634–9. This is a pilot study that compares the direct observation method versus electronic monitoring.CrossRefPubMedGoogle Scholar
  25. 25.
    Venkatesh AK, Lankford MG, Rooney DM, et al. Use of electronic alerts to enhance hand hygiene compliance and decrease transmission of vancomycin-resistant Enterococcus in a hematology unit. Am J Infect Control. 2008;36:199–205.CrossRefPubMedGoogle Scholar
  26. 26.••
    Pineles LL, Morgan DJ, Limper HM, et al. Accuracy of a radiofrequency identification (RFID) badge system to monitor hand hygiene behavior during routine clinical activities. Am J Infect Control. 2014;42:144–7. This (multisite) study assessed the accuracy of RFID badge system to monitor HH.CrossRefPubMedGoogle Scholar
  27. 27.
    Davis CR. Infection-free surgery: how to improve hand-hygiene compliance and eradicate methicillin-resistant Staphylococcus aureus from surgical wards. Ann R Coll Surg Engl. 2010;92:316–9.CrossRefPubMedCentralPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Virginia Commonwealth UniversityRichmondUSA

Personalised recommendations