Speaking Up: The Next Step to Improving Health Care Worker Hand Hygiene.

Since Ignaz Semmelweis recognized hand hygiene as a key behavior to prevent health care–associated infections, health care workers (HCWs) have struggled to listen to and act on this seemingly simple advice. Despite this knowledge, HCW hand hygiene remains poor, ∼40% nationally.1 The hand hygiene behavior of HCWs is significantly influenced by long-standing habits, which are often difficult to change. This difficulty contributes to the challenges hospitals have faced trying to sustainably improve HCW hand hygiene. Multiple studies reinforce the need for a multimodal approach to improve hand hygiene.1–3 The World Health Organization recommends a combination of interventions: an institutional focus on hand hygiene, education and training, supply availability, workplace reminders, and feedback of compliance data.1 Hospitals that have implemented a similar bundle of interventions have seen HCW hand hygiene improve, but compliance usually plateaus at 90%.4In the recent quality improvement (QI) initiative by McLean et al,5 the goal was to improve HCW hand hygiene to ≥95% by using high-reliability concepts. This was a time series QI study implemented on 2 pediatric medical surgical units within a large academic medical center. Hand hygiene compliance was defined as correct hand hygiene before and …