Let's talk about compliance Let's talk about compliance
The hand disinfection challenge?

Let's talk about compliance

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Hygiene is two thirds of health. (Proverb)

Hand disinfection can save lives

Healthcare-associated infections (HAIs) are infections acquired by patients during their stay in medical facilities like hospitals or nursing homes. It is estimated that in Germany alone, over 600,000 people experience a healthcare-associated infection every year. Around 20,000 of these infections end fatally [1].

Not all healthcare-associated infections are preventable, but circa one third of them are considered avoidable [2]. One prevention method is simple: regular and thorough hand disinfection.

Studies have shown that some 90% of all healthcare-associated infections are transmitted via the hands. The importance of hand disinfection in fighting healthcare-associated infections is well known among medical and nursing staff. Nevertheless, studies show that required hand disinfection is only performed 50% of the time on average [3].

Hand disinfection at the point of care

What is compliance?

According to the Robert Koch Institute, "compliance" means the "extent to which a recommendation is followed" [4].

The health sector includes several such hygiene recommendations, such as regular and thorough hand disinfection. Compliance in this context means disinfecting the hands according to official recommendations.

Gaps and obstacles

Why is compliance with hand disinfection often insufficient – despite its high importance?

Various obstacles to compliance with hand hygiene indications have been identified [3]. These range from poor tolerability to product unavailability, or even missing awareness about when to disinfect the hands during complex care activities.

Recognising these problems is the first step to more compliance. The next step is discussing possible solutions. Here, we provide 6 suggestions that can lastingly improve compliance with hand disinfection.

Six tips to improve hand disinfection compliance

Good skin compatibility

1. Skin compatibility

It sounds trivial, but it is anything but: good skin compatibility of a hand disinfectant. A well-formulated, alcohol-based and skin-friendly hand disinfectant contributes significantly to good compliance. Such a product is better accepted by medical staff and thus more likely to be used.

2. Availability

Availability of a hand disinfectant is also an important factor. It should be available directly at the point of care, i.e. the point of treatment and close to the patients. Disinfection dispensers can be wall-mounted, ideally sensor-controlled, or manually operated by the elbow. Such dispensers should preferably be mounted directly at the hospital bedside. Pocket-sized bottles can be a useful complement to wall-mounted dispensers.
Availability of the hand disinfectant
Training and education

3. Training and education

Training and education that promotes hand hygiene has proven to be very effective. To protect patients, all staff members with patient contact must follow the same instructions for hand hygiene. This means that all staff must receive training, regardless of where they are in the hierarchy. Flexibility and practicality are also important. Training can take place in the respective work areas and with employee teams, eliminating the needs for journeys to training sites, for example.

4. Compare costs

According to calculations by the European Centre for Disease Prevention and Control (ECDC), healthcare-associated infections cost the European healthcare system around 7 billion euros every year [5].

Considering the costs for the healthcare system related to healthcare-associated infections, this clearly justifies the costs for disinfection products, infrastructure and staff training.

Costs of hand disinfection products
Role models

5. Role models

Pathogens do not care about hierarchies. Senior staff, chief medical officers or experienced nurses are role models. If personnel at these levels do not adhere to valid guidelines, this will reduce the respect others have for the guidelines. When leaders set a good example, however, this can motivate junior staff to practise good hand hygiene and positively influence other employees [4].

6. Adequate human resources

When individual staff members are overworked, hygiene can quickly fall by the wayside. Staff shortages demonstrably affect hand disinfection compliance, which makes a balanced ratio of professional staff to patients all the more important.
Human resources

Unite for safety

Singly, any of these tips would help improve compliance. An even better strategy, however, would be to address several problems simultaneously. This would allow tackling insufficient compliance from a number of angles at once and achieving lasting aims.

Together we can save lives. Let's work together at all levels toward a common goal: Better compliance and more safety in healthcare facilities!


[1]: Zacher et al. Application of a new methodology and R package reveals a high burden of healthcare-associated infections (HAI) in Germany compared to the average in the European Union/European Economic Area, 2011 to 2012. Euro Surveill. 2019; 24(46): pii=1900135.

[2]: BVMed / Press release
https://www.bvmed.de/de/bvmed/presse/pressemeldungen/bvmed-hygieneforum-2012-mit-konsequenten-hygienemassnahmen-sind-rund-30-prozent-aller-krankenhausinfektionen-vermeidbar (retrieved on: 04.03.2022)

[3]: Händehygiene in Einrichtungen des Gesundheitswesens. Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut (RKI). Bundesgesundheitsbl. 2016, 59:1189–1220.

[4]: RKI / Compliance in the implementation of hygiene guidelines
https://www.rki.de/DE/Content/Infekt/Krankenhaushygiene/Praevention_nosokomial/Compliance_pdf.pdf?__blob=publicationFile (retrieved on: 04.03.2022)

[5]: European Centre for Disease Prevention and Control (ECDC) (2008) Healthcare-associated infections. In: European Centre for Disease Prevention and Control (ECDC) (Hrsg) Annual epidemiological report on communicable diseases in Europe 2008. European Centre for Disease Prevention and Control (ECDC), Stockholm, S 16–38

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