Hand Hygiene

Better hand hygiene and fewer infections thanks to a holistic approach


Hand hygiene (HH) compliance is a key factor in preventing healthcare-associated infections. Data from Germany indicate a great potential for improvement, especially in the indication before aseptic tasks. A cluster-randomised, two-arm study [1] – conducted by the Charité Universitätsmedizin Berlin with active participation of the HARTMANN SCIENCE CENTER – therefore investigated the effects of a multimodal bundle of measures on HH compliance as well as on the rate of device-associated bloodstream infections (BSI). For this purpose, a total of 20 peripheral wards on three campuses were included from 2017 to 2018, 10 of which were randomly assigned to either the intervention group or the control group. In accordance with the recommendations of the World Health Organisation, five observation cycles took place: Four subsequent quarterly cycles with ≥150 observations (of which ≥30 were before aseptic tasks) were compared against the first (baseline).

Comprehensive intervention bundle with a focus on aseptic tasks

The comprehensive intervention bundle included a kick-off meeting, quarterly feedback on HH behaviour and training material (focus on HH before aseptic tasks: 10 step-by-step checklists for optimised workflows including hygiene-relevant steps and two training films). In addition, all infusion stands were equipped with easily accessible disinfectant dispensers (Eurospender 3 flex). During the observation cycles, trained student assistants documented HH compliance according to the Five Moments“ [2] using the Observe App. The rate of BSI (defined as one blood culture with pathogenic agent or two with common skin germs within 5 days; intravenous catheter on the day or the day before blood collection; present for at least 3 days, etc.) was recorded 11 months during and one month after the intervention.

Hand hygiene compliance before aseptic tasks increased significantly with the bundle of measures

Over the course of the entire study, a total of 21,424 HH opportunities and 12,920 HH actions were documented. While overall compliance did not change significantly, it increased significantly by 20% - from 44% to 53% - before aseptic tasks in the intervention group.

Positive influence also on rate of bloodstream infections

In addition to the improvement in HH compliance, another positive effect of the bundle of measures was observed. It was shown that the total BSI rate in the intervention wards decreased significantly. Per 1000 patient days, only 0.71 BSIs were recorded here, compared to 1.16 in control wards (p<0.01). The difference was particularly large for catheter-associated BSI, with 0.31 in intervention wards vs. 0.71 in control wards (p<0.01).

Thus, the study successfully demonstrated that a bundle of measures focusing on aseptic tasks has a demonstrably positive impact - on both HH compliance and BSI rates.

Figure based on data from [1]


  1. Aghdassi SJS et al. (2020) A multimodal intervention to improve hand hygiene compliance in peripheral wards of a tertiary care university centre: a cluster randomised controlled trial. Antimicrob Resist Infect Control 9: 113. https://doi.org/10.1186/s13756-020-00776-9

  2. Sax H et al. (2007) 'My five moments for hand hygiene': a user-centred design approach to understand, train, monitor and report hand hygiene. J Hosp Infect 67: 9–21. https://doi.org/10.1016/j.jhin.2007.06.004

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