Challenges of Hand Hygiene in Healthcare: The Development of a Tool Kit to Create Supportive Processes and Environments

Hand hygiene compliance by healthcare providers has been difficult to achieve due to diverse environments, work culture, processes and task requirements.Because of this complexity, hand hygiene lends itself well to a human factors analysis in order to design a system that matches human cognitive and physical strengths and makes allowances for human limitations.A multi-phased user-centred approach was undertaken to explore barriers and enablers to hand hygiene in diverse environments (rehabilitation, family medicine, emergency and intensive care) for a number of healthcare workers (HCWs; physicians, nurses, allied health, housekeeping and patient support workers).Observational studies, interviews, focus groups and surveys were used to engage end users in solution development.Solutions were then validated through an environmental modification study, which sought to quantify the benefits of proposed solutions.This research highlighted the need to take into consideration the differences between HCWs, their environments and the tools with which they are provided when recommending solutions to mitigate barriers.Context-specific recommendations resulting from this work have been formulated into a tool kit for dissemination by the Canadian Patient Safety Institute (CPSI).