September 01

6 key elements to better hand hygiene compliance

Explore a comprehensive strategy that helps make hand hygiene second nature.

The 6 essential elements of hand hygiene

Everyone who enters a healthcare facility has the right to expect the highest standards for patient safety and quality. And one of the most fundamental ways to achieve high levels of both is to create and value a culture in which hand hygiene is second nature for every staff member and volunteer.

Because compliance rates typically fall below 50% when measured accurately and reliably, an evidence-based strategic framework is essential to getting results.1 The “6 essential elements of hand hygiene” is a system we created to help organizations achieve highly reliable staff performance and sustained compliance increases. It approaches hand hygiene comprehensively and systematically.

6 essential elements of hand hygiene

Hand Hygiene Advanced Products

1 | Advanced products

Select a standardized product formulary that is supported by sound science and developed for high frequency hand hygiene including:

  • Alcohol-based hand sanitizers
  • Soaps – plain and/or antibacterial
  • Sanitizing wipes
Hand Hygiene Reliable Delivery Systems

2 | Reliable delivery systems

Align placement of product dispensers with CMS, CDC, Joint Commission and WHO guidelines such as:

  • Wall-mounted sanitizer dispensers (manual and/or touch-free) inside and outside of patient rooms
  • Soap dispensers at all sinks
  • Lotion dispensers adjacent to sinks
  • Touch-free hand sanitizer dispensers on stands at entrances, in lobbies and in other open areas
  • Personal carry size hand sanitizer bottles
  • Tabletop pump bottles with soap and/or sanitizer
  • Sanitizing wipes in packets and canisters
Hand Hygiene Point-of-care Access

3 | Point-of-care access

Position products where hand hygiene moments occur such as:

  • Inside and outside patient rooms
  • Bedside
  • OR (acute care or ASCs)
  • Nursing stations
  • Treatment rooms
  • Food service and prep areas
  • Information and reception desks
  • Entry ways and lobbies

Provide personal carry size bottles when access to other dispensers is limited.

Hand Hygiene Effective Learning Systems

4 | Effective learning systems

Provide targeted education and training tools based on behavioral science, human factors and high reliability organizational design for the following:

  • Organization leaders
  • Staff and volunteers
  • Patients, families and visitors

Emphasize proper technique at every hand hygiene moment, including:

  • Before/after touching patients or their surroundings
  • Before/after patient care tasks
  • Before/after personal activities such as eating, using a cell phone or device, using the restroom

Use facility wide reminders like posters, tent cards, brochures and videos to boost compliance.

Hand Hygiene Safety Culture

5 | Safety culture

Foster a safety culture that embraces the following:

  • Leadership engagement—leaders model desired hand hygiene behavior
  • Psychological safety—everyone feels safe to speak up when a hand hygiene opportunity is missed
  • A top-down accountability framework with a unit-based approach for barrier removal, action planning and goal setting
Hand Hygiene Actionable Feedback

6 | Actionable feedback

Implement best practices for collecting and analyzing data and understand how to pinpoint where improvement is needed.

  • Use reliable performance measurement methods such as electronic hand hygiene compliance monitoring and timely, actionable feedback tools
  • Issue individual hand hygiene report cards for frontline staff
  • Employ an easy-to-implement checklist approach
Paul Alper

Paul Alper, BA, VP, Patient Safety Innovation for Medline Industries, LP

Paul founded the Electronic Hand Hygiene Compliance Organization, Inc. (EHCO), a not-for-profit group to create data-driven hand hygiene standards for the Joint Commission, the CDC and CMS. He also shares hand hygiene insights as a monthly contributor to Healthcare Hygiene Magazine.

Want to explore more insights and strategies for better hand hygiene compliance?

Learn how you can create a stronger culture of safety supported by hand hygiene best practices, education and training and a system of products.

Learn more about an innovative new electronic monitoring technology that helps target staff training and drive sustained hand hygiene compliance.

Watch this video featuring thought leader Elaine Larson discussing lessons from COVID, Leapfrog standards and more.


  1. Hand hygiene in healthcare settings – core slides. Centers for Disease Control and Prevention website. Available at: Accessed January 19, 2021.