What causes hand hygiene noncompliance? 24 issues

Hand hygiene compliance rates remain generally low despite the well-documented connection between improper hand hygiene and healthcare-associated infections — but there are many varied reasons healthcare workers don't comply to hand hygiene protocol, a study published in The Joint Commission Journal on Quality and Patient Safety found.

In the study, teams in eight hospitals used secret observers, as well as "just-in-time coaches, who observed instances of noncompliance and intervene right after to ask the workers why he or she had not done hand hygiene, to identify the causes of hand hygiene noncompliance. Data from the eight hospitals revealed 41 different causes of noncompliance, which were then grouped into 24 causes.

Those 24 groups are listed below, in no particular order.

1. Healthcare worker forgot

2. Inconvenient placement of hand rub dispenser or sink

3. Broken dispenser or sink

4. No hand rub in the dispenser or missing soap at sink

5. Healthcare worker was distracted

6. Perception that wearing gloves negated need for hand hygiene

7. Proper use of gloves slows down work process

8. Ineffective education

9. Inadequate safety culture that doesn't stress the need for everyone to perform hand hygiene

10. Worker's hands were full with no convenient place to put supplies

11. Staff did not remind each other to clean hands

12. Isolation area: special circumstances related to gowning and gloving

13. Skin irritation from the cleaning product

14. Lotion dispenser used instead of soap

15. Following another person in or out of the patient room

16. Equipment sharing between rooms requiring frequent entry and exit

17. Bedside procedure requires frequent room entry and exit

18. Admitting or discharging patients requires frequent room entry and exit

19. Hand hygiene data are not collected or are inaccurate or infrequently reported

20. Perception that excessive hand cleaning is required

21. Hand cleaning product feels unpleasant

22. Healthcare worker was too bust

23. Emergency situation

24. Workflow was not conducive to proper hand hygiene

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