Patient and visitor engagement in improving health care personnel hand hygiene: A multihospital pilot program

Hand hygiene is the cornerstone of infection prevention; however, many health care institutions struggle to achieve consistently high health care personnel (HCP) compliance. Engaging patients/visitors in hand hygiene interventions is an important strategy to improve accountability and compliance.

We piloted a program enabling patients/visitors to audit HCP hand hygiene practices across 3 acute care hospitals and a pediatric/adolescent behavioral health hospital. An initial pilot ran from August 2024 to January 2025 in 1 outpatient clinic and 5 inpatient units across 4 hospitals before being expanded to all inpatient units and select on-site outpatient areas across these hospitals. Patient/visitor participants submitted anonymous audits via QR code or paper forms, documenting HCP hand hygiene and comfort prompting staff to perform hand hygiene.

Participants completed 360 hand hygiene audits, with observed HCP compliance of 86% (286/326), aligning with staff-reported compliance of 88% (126,653/144,214). HCP compliance observed by patients/visitors varied by hospital (77%-97%). 78% (254/324) of participants reported feeling comfortable prompting HCP to perform hand hygiene. Discomfort was associated with lower observed compliance across all sites.

Patient and visitor auditing of HCP hand hygiene is feasible, acceptable, and may enhance accountability, representing a scalable, patient-centered adjunct to traditional compliance programs.