Give a hand: Hospitals are making progress in hand hygiene

In looking at ways to improve patient safety, sometimes the most basic steps make all the difference.

More hospitals are meeting higher standards in hand washing, a key measure in preventing infections, according to the Leapfrog Group.

Leah Binder, president and CEO of The Leapfrog Group, has pointed to one seemingly obvious step as a persistent problem in protecting patients. She has preached the importance of ensuring caregivers are thoroughly washing hands.

In a 2022 interview with Chief Healthcare Executive®, Binder implored hospital and health system leaders to pay more attention to proper hand hygiene. And she acknowledged that may not be as compelling to healthcare leaders as a breakthrough in genomics.

“Washing your hands every time you touch a patient is not quite as interesting,” Binder said. “It may not be interesting to them. But it is catastrophic to the patient if it’s not done right, each and every time, every minute of the day.”

It appears that hospitals and health systems have been paying attention to hand hygiene. The Leapfrog Group, an advocacy group focused on patient safety, says more hospitals are meeting higher standards in hand washing.

Nearly three out of four hospitals (74%) reached the Leapfrog Group’s standards for hand hygiene in 2023, up from 11% in 2020, the organization said in a report released this week.

Binder gave hospitals a big hand for making gains.

“I congratulate hospitals on achieving this dramatic improvement in hand hygiene,” Binder said in a statement. “Leapfrog will continue to publicly report each hospital’s performance and uphold the highest possible standards for excellence. We believe transparency and high standards truly galvanize change, and we are proud to recognize the hospital leaders, clinicians, and teams that so successfully make that change.”

The Leapfrog Group says its standards are adapted from the World Health Organization’s “Hand Hygiene Self-Assessment Framework.”

More hospitals are starting to use electronic compliance monitoring systems to evaluate the hand hygiene of caregivers, the group said. While it’s still a fairly small number, the percentage of hospitals using electronic compliance has more than doubled between 2020 and 2023, rising from 4.7% to 10%.

However, the vast majority of hospitals are utilizing hand hygiene coaches or compliance observers, and that also represents a shift over the past few years. In 2023, 92.4% of hospitals reported the use of hand hygiene coaches or compliance monitors, up from 58.7% in 2020.

Hospital executives are also being held more accountable for hand hygiene, the Leapfrog Group says. In 2023, 86.3% of hospital executives had their compensation tied in part to hand hygiene measures, up from 48.6% in 2020.

Emily Landon, MD, an associate professor of medicine at the University of Chicago, is an expert panelist for Leapfrog. She said in a statement that the progress is encouraging, but there’s still room to improve.

"Hand hygiene is fundamental to preventing infections in all health care settings, as pathogens on unclean hands can easily spread between patients or contaminate clean surfaces," Landon said in a statement. "While the report highlights a dramatic improvement in hand hygiene practices, continued vigilance is essential to sustaining progress and closing gaps in compliance to protect more patients.”

Healthcare researchers point to hand hygiene as a critical factor in keeping patients safe. A 2020 article in Risk Management and Healthcare Policy finds that proper hand washing remains one of the key measures in preventing hospital-acquired infections.

Hospitals have been making noteworthy gains in patient safety since the pandemic. The Leapfrog Group, which releases two hospital safety report cards each year, found a significant drop in infections in its spring 2024 report.

The American Hospital Association released a report last week which concluded that hospitals are faring better in patient safety, even when compared to pre-pandemic measures.

Patients treated in hospitals were generally suffering more acute and complex illnesses in the first three months of 2024 than those examined in 2019, yet outcomes still improved, according to the AHA study.