Hand Hygiene Lessons Learned

COVID-19 has increased the willingness of employees to practice hand hygiene in health institutions. Much remains to be done to ensure that this trend continues and also results in falling infection rates, even after we’ve moved past COVID-19.

The most important facts:

  • The increase in hand hygiene compliance at the start of the pandemic was a temporary phenomenon. The high compliance rates dropped again over time.
  • The highest rates are recorded AFTER contact with a patient and are mainly driven by the desire to protect oneself rather than to protect patients.
  • Gloves and long-sleeved clothing are important barriers to achieving good hand hygiene.
  • Intervention programs to intensify hand hygiene are more efficient and sustainable than the threat of COVID-19.

100% hand hygiene compliance. What experts around the world hardly think possible has become reality at the National University Hospital in Singapore: Influenced by COVID-19, the staff’s willingness to disinfect their hands, which was already very good at 85%, rose to 100%. The largest hospital in the country, with 1,800 beds, evaluated the data both by measuring how much disinfectant was used and also by directly observing all “5 Moments for Hand Hygiene.” Several studies report increased hand disinfection rates among hospital staff in the early stage of the pandemic.

From a standard procedure to a daily habit?

Could hand hygiene, a standard procedure, have become a daily habit that people do without thinking thanks to the COVID-19 pandemic? According to the studies, the picture is rather mixed. In some studies, hand hygiene increased significantly at the start of the pandemic, but then decreased again and often even settled at a rather low level. It’s also worth comparing the moments when hand disinfection is carried out. From September 2019 to November 2020, Huang et. al investigated hand hygiene compliance in an infectious disease ward with 25 single rooms using an electronic monitoring system with a sensor. Time points for observing compliance were when entering the room, when providing care at the patient’s bedside and when leaving the room.

Patient protection was not the main focus

The authors found that the rate of hand hygiene upon entering the room, interpreted as the “before patient contact” moment, decreased over time. Compliance when leaving the room, interpreted as the “after patient contact” moment, increased by 13.73% during the first wave of COVID-19, decreased by 9.87% during the post-lockdown period, and then increased again by 2.82% during the second wave of the pandemic. The authors believe that the most important factor in the increase in hand hygiene was the employees’ desire to protect themselves from infections. Marie Stangerup’s team found out that the compliance rate is falling again despite the fact that the pandemic has not been declared over: A research team from Denmark conducted an observational study on a surgical ward between January 2019 and December 2020. One phase of the study consisted of an intervention program with employee meetings and presentations and discussions of anonymous hand hygiene compliance data. The analyses showed that hand hygiene compliance was at 58% during the intervention program that was run prior to the pandemic but dropped to 34% during the pandemic.


Interventions and feedback remain indispensable tools to ensure that improvements in hand hygiene do not drop again. Employees quickly fall back into old routines as soon as intervention programs are stopped. On top of this, to ensure a high level of hand hygiene compliance, the management teams must remain committed to the issue of hand hygiene.

TIP: To achieve good hand hygiene, the basic conditions must also be right: Studies show that there is still room for improvement when it comes to placing dispensers at the point of care.

Checklists: Proper placement of dispensers at the point of care

1.) Dispenser placement in the OR

2.) Dispenser placement in the ER

3.) Dispenser placement in ICU

4.) Dispenser placement in General Wards

Huang F et al. (2021) Journal of Hospital Infection 111: 27.-34
Moore LD et al. (2021) American Journal of Infection Control 49: 30−33
Stangerup M et al. (2021American Journal of Infection Control 49: 1118-1122
Thomas BW et al. (2009). JAOA; 109 (5): 263-267
Azim S et al. (2016). American Journal of Infection Control; 44 (7):772-776

More articles:
„Hygiene in context with Corona“
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