Stephanie Hill

Publication Date



The purpose of this quality improvement (QI) project was to improve hand hygiene (HH) compliance rates among healthcare workers on a medical-surgical microsystem. Hand hygiene is globally recognized as the single best practice for reducing the spread of unwanted and harmful diseases. Despite its simplicity, literature indicates HH compliance as an endemic healthcare concern with observations that reflect insufficient or disregardable behavior. Understanding factors that contribute to poor compliance can inform education and training for healthcare workers. Hand hygiene practices are largely a behavioral practice, and recent literature supports ongoing training and education that facilitates behavior barrier identification and positive reinforcement. Standard practice HH observation tool reports for the facility reflect poor compliance rates specific to the microsystem. The CNL student conducted direct observation of healthcare workers’ HH behaviors using a HH observation application on a handheld electronic device. Pre- and post-surveys were created and adapted from the World Health Organization (WHO) and Institute for Healthcare Improvement (IHI) questionnaires. Results from the pre-survey and direct observation were used to inform microsystem-specific education targeting HH practice barriers. Barriers to HH compliance were identified from direct observation and the pre-survey. Hand hygiene education was conducted to promote facility standards and recognize microsystem specific barriers and any alterations that transpired as a result of uncovered barriers. A post-survey was used to reflect any knowledge changes within the microsystem population. Continued direct observation after staff education reflected healthcare workers’ improved HH behaviors and compliance.

Author Supplied Keywords

Disease transmission; Hands; Hygiene; Patient safety

Publication Information

NRS 596: Clinical Nurse Leader Residency, Scholarly Project.

Copyright for this work is retained by the author.



Document Type

Master's Project

Included in

Nursing Commons