We all probably knew it: targeted measures and incentives can significantly improve hand hygiene compliance. However, things get really interesting when you look at the figures more closely.

In a systematic review^[1] Irish researchers shed light on clinical trials between 2014 and 2020, which deal with hand hygiene compliance among healthcare workers. 57 studies, primarily from Asia, Europe, and the USA, were analyzed. The aim was to identify effective strategies for reducing infections in healthcare settings.

The results are clear: Combined approaches show significant success.

Systematic review

Evaluation clinical trials

Just Ø 41 percent This is the average hand hygiene compliance WITHOUT targeted interventions, as the review by Conor Clancy and colleagues shows. This means that in more than half of the situations where hand hygiene was necessary, it was not performed correctly.

Through various interventions, compliance was reduced to approximately Ø 67 percent to increase. Measures used – individually or in combination – included training, improved infrastructure, reminders, performance feedback, and team and leadership measures.

Within these studies, one approach stands out in particular: The multimodal model of the International Nosocomial Infection Control Consortium (INICC) was able to increase compliance by a net average of 35 percentage points – that is, from the average baseline value to approximately Ø 76 percent.

Approach 1: The INICC Model

Measurement and feedback

One approach that has shown particularly high effects in several studies is the multidimensional model of International Nosocomial Infection Control Consortium (INICC)^[2]. Compliance here increased by an average of 35 percentage points. Based on the baseline, this equates to approximately 76 percent.

The approach combines six building blocks, which interlock simultaneously:

1. clearly defined packages of measures for typical infection risks
2. Training courses and practical workshops
3. systematic recording of infection numbers
4. Verification of compliance with hygiene measures
5. regular feedback on infection rates
6. regular feedback on the implementation of the measures

The focus is on transparency and continuous feedback. Behavior should not only change through appeals, but through measurable results and visible progress.

The underlying principle is clearly structured: We measure. We present the results. We make targeted improvements.

Approach 2: The WHO Model

Infrastructure and security culture

Another internationally widespread concept comes from the World Health Organization (WHO).^[3] Here too, a multimodal approach is pursued – but with a stronger focus on changing the framework conditions and the security culture.

The WHO model typically combines:

1. Secure and always available infrastructure
2. Regular training courses and practical workshops
3. Reminders in the work environment (e.g. posters or visual cues)
4. Regular review of implementation and framework conditions
5. Transparent feedback on results and performance

The central question is: Are the conditions designed in such a way that correct behavior is easily possible?

Summary

Hygiene requires a system

Both models demonstrate the same basic principle: Sustainable improvement arises from an interplay of structure, training, control, and feedback.

While the INICC model relies heavily on data collection and systematic feedback, the WHO model additionally emphasizes the importance of infrastructure and security culture.

The message is that anyone who wants to sustainably improve hand hygiene needs a combination of measures on several levels – and training that truly motivates.

Hygiene & Compliance

How can DesiCoach help?

Hand hygiene is not something that can be achieved simply by taking one or more hygiene measures and then running smoothly. It is an ongoing issue that we must constantly remind ourselves of.

Our brain needs repetition.
Our behavior needs stimuli.
And teams need motivation.

Training is a highly effective component in the package of measures:
They shape routine actions, create "aha" moments, and establish fresh anchors in memory. Especially when phrases like these are used in the team: „"We already know that."“ Perhaps that's even true – but knowledge alone doesn't change behavior.

This is exactly where DesiCoach® comes in:
The training makes hand disinfection directly visible and tangible. Movement sequences can be immediately checked and improved. DesiCoach® can be easily integrated into regular hygiene training or is ideal for short training sessions in between other activities.

Do you want to integrate practical training into your hygiene strategy?
Then check out DesiCoach® in our Shop Join in and plan your next hand hygiene training.

Sources:

[1] Clancy, C., et al. “Hand Hygiene-Related Clinical Trials Reported between 2014 and 2020: A Comprehensive Systematic Review.” Journal of Hospital Infection, Volume 111, 6 - 26, May 2021.

[2] Victor Daniel Rosenthal, International Nosocomial Infection Control Consortium (INICC) resources: INICC multidimensional approach and INICC surveillance online system, American Journal of Infection Control, Volume 44, Issue 6, 2016, Pages e81-e90, ISSN 0196-6553, https://doi.org/10.1016/j.ajic.2016.01.005.

[3] World Health Organization, A guide to the implementation of the WHO multimodal hand hygiene improvement strategy, February 2009.