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Updated: May 22, 2026
A Method to Test the Efficacy of Handwashing for the Removal of Emerging Infectious Pathogens
Published on: June 7, 2017
Republished: Improving hand hygiene in a paediatric hospital: a multimodal quality improvement approach
Ahmed Jamal1, G O'Grady, E Harnett
1Service Improvement Unit, The Children's Hospital at Westmead, Locked bag 4001, Westmead, NSW 2145, Australia. ahmedj@chw.edu.au
Insights
Implementing a multimodal strategy significantly improved hand hygiene compliance in a pediatric hospital. This led to sustained adherence and a reduction in hospital-acquired infections.
Area of Science:
- Healthcare epidemiology
- Infection prevention and control
- Public health
Background:
- Healthcare-associated infections (HAIs) pose a significant threat in clinical settings.
- Low adherence to hand hygiene practices is a persistent challenge in hospitals.
- The Children's Hospital at Westmead initiated a campaign to improve hand hygiene in 2006.
Purpose of the Study:
- To assess the impact of a multimodal strategy on hand hygiene compliance.
- To evaluate the sustainability of improved hand hygiene practices.
- To determine the effect of enhanced hand hygiene on HAI rates.
Main Methods:
- A comprehensive program involving strong leadership and stakeholder engagement was implemented.
- Alcohol-based hand rub was made readily available at the point of care.
- Multifaceted education, staff monitoring, and performance feedback were utilized.
Main Results:
- Hand hygiene compliance increased from 23% in 2006 to 87% in 2011.
- Sustained compliance was observed over a 4-year period.
- A decrease in hospital-acquired infections and increased alcohol-based hand rub usage were noted.
Conclusions:
- A multimodal, evidence-based approach effectively improves and sustains hand hygiene compliance.
- This strategy provides a framework for infection control in healthcare settings.
- Improved hand hygiene is linked to reduced rates of hospital-acquired infections.
Background:
Effective hand hygiene has long been recognised as an important way to reduce the transmission of bacterial and viral pathogens in healthcare settings. However, many studies have shown that adherence to hand hygiene remains low, and improvement efforts have often not delivered sustainable results. The Children's Hospital at Westmead is the largest tertiary paediatric hospital in Sydney, Australia. The hospital participated in a state-wide 'Clean hands save lives' campaign which was initiated in 2006.
Intervention:
Strong leadership, good stakeholder engagement, readily accessible alcohol-based hand rub at the point of patient care, a multifaceted education programme, monitoring of staff, adherence to recommended hand hygiene practices and contemporaneous feedback of performance data have significantly improved and maintained compliance with hand hygiene.
Results:
Hand hygiene compliance has increased from 23% in 2006 to 87% in 2011 (p<0.001). Sustained improvement in compliance with hand hygiene has been evident in the last 4 years. A decline in a set of hospital-acquired infections (including rotavirus, multiresistant organism transmission, and nosocomial bacteraemia) has also been noted as hand hygiene rates have improved. Monthly usage of alcohol-based hand rub has increased from 16 litres/1000 bed days to 51 litres/1000 bed days during this same period.
Conclusion:
This project has delivered sustained improvement in hand hygiene compliance by establishing a framework of multimodal evidence-based strategies.
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