Improving Adherence to Hand Hygiene Practice: A Multidisciplinary Approach

Didier Pittet, University of Geneva Hospitals, Geneva, Switzerland.


Emerging Infectious Diseases. 2001;7(2) 

In This Article

Abstract and Introduction


Hand hygiene prevents cross-infection in hospitals, but health-care workers' adherence to guidelines is poor. Easy, timely access to both hand hygiene and skin protection is necessary for satisfactory hand hygiene behavior. Alcohol-based hand rubs may be better than traditional handwashing as they require less time, act faster, are less irritating, and contribute to sustained improvement in compliance associated with decreased infection rates. This article reviews barriers to appropriate hand hygiene and risk factors for noncompliance and proposes strategies for promoting hand hygiene.


Hand hygiene is the simplest, most effective measure for preventing nosocomial infections[1,2]. Despite advances in infection control and hospital epidemiology, Semmelweis' message is not consistently translated into clinical practice[3,4], and health-care workers' adherence to recommended hand hygiene practices is unacceptably low[3,5,6,7,8,9,10]. Average compliance with hand hygiene recommendations varies between hospital wards, among professional categories of health-care workers, and according to working conditions, as well as according to the definitions used in different studies. Compliance is usually estimated as <50% ( Table 1 ).

Promotion of hand hygiene is a major challenge for infection control experts[3,19,20,21]. In-service education, distribution of information leaflets, workshops and lectures, and performance feedback on compliance rates have been associated with transient improvement[3,6,13,22,23]. No single intervention has consistently improved compliance with hand hygiene practices[24]. This review summarizes factors influencing lack of adherence by health-care personnel to hand hygiene procedures and suggests strategies for improvement.


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