5 Common Mistakes That Will Impact Your Leapfrog Hand Hygiene Survey

By Clean Hands - Safe Hands

Want to earn a top Leapfrog Hospital Safety Grade

Pour some extra effort into avoiding these five common mistakes that can negatively affect your rating on the Leapfrog Hand Hygiene survey:

1. Failing to monitor all bedside areas

The Leapfrog Hand Hygiene survey asks whether hospitals collect hand hygiene compliance data on at least 200 hand hygiene opportunities, or 1.7% of all possible hand hygiene opportunities, each month in each patient care unit.

Many infection control practitioners and hospital leaders get bogged down in the numbers. They’re so focused on collecting an adequate amount of data that they neglect to notice the requirement to gather data from each patient care unit.

Leapfrog defines a “patient care unit” as any unit of the hospital “where patients are receiving direct bedside nursing care,” including post-anesthesia care units (PACUs), observation units, dialysis units, and emergency departments. 

Hospitals that have devoted their efforts to decreasing hospital-acquired infections (HAIs) often don’t track hand hygiene statistics in these units because most patients only spend a little bit of time in these locations – and infections aren’t counted as HAIs unless a patient tests positive for infection after being in a hospital for more than 48 hours. 

To achieve the highest possible Leapfrog score, make sure each of your patient care units has a system in place to collect hand hygiene data. If you don’t, your Leapfrog Hospital Safety Grade may be a letter grade lower than it otherwise might be. 

2. Not validating the accuracy of your hand hygiene data

Hospitals can (and, in fact, are encouraged) to use electronic hand hygiene monitoring systems. However, to earn a top Leapfrog score, individual hospitals must validate the accuracy of the electronic system. 

Leapfrog states that “validation should ideally be performed by hospital personnel or independent third-party personnel, in addition to any validation conducted by the manufacturer” and “should include both a ‘planned path’ phase where the researcher(s) make timed observations of room entries and exits and use of dispensers, and compare their results to data recorded by the electronic compliance monitoring system. Followed by a ‘behavioral path’ phase where observers record the same variables…” as individuals are performing their usual duties.

This validation process is necessary to detect (and correct) inaccuracies resulting from improper positioning of devices – and to ensure accurate, actionable data.

3. Not utilizing real-time feedback

To earn full marks on Leapfrog’s Hand Hygiene survey, patient care units that use an electronic monitoring compliance system must also use direct observation for “coaching and intervention purposes,” with observers intervening immediately prior to any harm occurring to provide “non-compliant individuals with immediate feedback.”

This requirement is grounded in good intent: No one wants individuals who haven’t adequately sanitized their hands to inadvertently harm a patient. But requiring occasional direct observation and intervention is unlikely to lead to lasting improvements in hand hygiene. Individuals almost always modify their behavior when someone is watching – that’s the Hawthorne effect, and that’s why hand hygiene rates go up during periods of direct observation (and decrease when observation ceases).

The SwipeSense electronic hand hygiene system is the only one with an automated Real-Time Voice Reminder. If a staff member fails to sanitize their hands, the system will verbally remind them to do so. Hospitals that use the SwipeSense system will still have to conduct periodic direct observation sessions for coaching purposes to satisfy the Leapfrog requirements, but their hand hygiene rates should remain consistently high, even after the direct observation period ends.

4. Skipping executive involvement

Evidence has shown a strong correlation between leaders’ and followers’ hand hygiene. And work by Elaine Larson, RN, PhD, a pioneer in promoting hand hygiene for infection control, has proven the necessity of executive support for system-wide hand hygiene initiatives. For these reasons, the Leapfrog Hand Hygiene survey asks hospitals if their Chief Executive Officer, Chief Medical Officer, and Chief Nursing Officer have all demonstrated a written or verbal commitment to support hand hygiene improvement in the last year. Importantly, Leapfrog states that this commitment must be delivered to “those individuals who touch patients or who touch items that will be used by patients.”

SwipeSense utilizes a six-step process to facilitate behavioral change in hospitals — and executive involvement is a big part of that process.

5. Ineffectively tying hand hygiene to performance reviews and compensation

The Leapfrog Hand Hygiene survey asks if “senior administrative leadership, physician leadership, and nursing leadership [are] held directly accountable for hand hygiene performance through performance reviews or compensation.”

Linking leaders’ performance reviews or compensation to “meeting targets for hand hygiene compliance rates,” as suggested by Leapfrog, can be tricky because hospital leaders cannot control the behavior of those who report to them. A better, likely more effective approach is to tie bonuses (or performance reviews) to “structural changes like the implementation of electronic compliance monitoring systems” or regular meetings to review units’ hand hygiene data and create plans to optimize workflow to improve hand hygiene.

Hospitals that avoid these five common mistakes are in a better position to earn top grades on the Leapfrog Hand Hygiene survey.


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