The Challenges of Innovation in Improving Hand Hygiene Performance

By Clean Hands - Safe Hands

Dr. Ignaz Semmelweis is frequently referenced as the “Father of Hand Hygiene.” In 1846, he was faced with a clinic that had maternal mortality rates 250% higher than a similar clinic. Patients resisted being admitted to the clinic with higher mortality rates, in some cases preferring to give birth in the streets. In 1847, Dr. Semmelweis discovered the cause – hand hygiene. In the poorly performing clinic, medical students failed to wash their hands and often transitioned directly from performing autopsies to assisting in delivering babies. Surprisingly, Semmelweis’ discovery was met with resistance. Today, hand hygiene performance is still a primary contributor to hospital-acquired infections. And, like Semmelweis, today we wrestle with the same areas of resistance from conventional wisdom, science independent of behavioral attributions, social hierarchies and prioritization.

Departure from Conventional Wisdom

Conventional wisdom in hand hygiene has largely been reliant on direct observation. Despite the best of intentions, this methodology is largely inadequate. There was a time that direct observation could keep pace with clinical care. Most clinical care settings struggle to conduct 1500 observations a year. Some have dedicated full-time employees in order to collect as many as 20,000 hand hygiene opportunities. On average, a 300 bed hospital experiences about 4.3 million hand hygiene opportunities annually. The minute sample offered by direct observation is often tainted by the Hawthorn Effect, confirmation bias, observer drift, recording errors, performance bias, observer demographics, social hierarchies, complexity of observation, predictability of observer response, sample size, uniform application errors, etc.

Science Independent of Behavioral Attributions

Dr. Semmelweis’ peers characterized his findings as lacking scientific validity, so they were largely dismissed until after his death. But at the core, Semmelweis discovered that behaviors of a specific group, in a specific location, was having an effect on specific patients. His approach measured individual behavior and incorporated specific feedback in a timely manner.

Social Hierarchies

 Many of Dr. Semmelweis’ peers resisted his findings because of the implications upon their own behavior, despite the proposed benefits to their patients. Social hierarchies’ influence in infection control is well documented, from Dr. Semmelweis to Dr. Pronovost and Dr. Saint. Patients and nurses demonstrate hesitancy in correcting physicians due to concerns of vulnerability, legitimacy and/or concerns about retribution.   


The variation in mortality rates was not new. The disparity was recorded for at least six years prior to Dr. Semmelweis’ intervention. The importance of hand hygiene is well recorded. The World Health Organization, Centers for Disease Control and Prevention and The Joint Commission have all communicated the importance of hand hygiene in improving patient safety and the patient experience. Despite independent validation, hand hygiene innovation is often a topic that is explored and critiqued, but rarely executed upon.

Innovation in Hand Hygiene Performance Today

Presently, our technology and approach allow us to improve hand hygiene by counting each one and making each one count. Unlike direct observation, our technology captures opportunities without the limitations of bias. Our program overcomes behavioral attributions with a unique implementation approach that engages clinicians as opposed to embarrassing them. We do this through real-time, specific information that adapts to patient protocol. Our differentiated technology overcomes social hierarchy by uniquely offering voice reminders for physicians, nurses and other clinicians.

Overall, our company is dedicated to delivering value to clinical organizations and patients by affordably improving hand hygiene performance, reducing HAIs and helping to build a better patient experience.

Presently, hospital-acquired infections, The Joint Commission’s new hand hygiene standards and our current influenza challenges are not new or novel. But they’re all influenced by improved hand hygiene performance. Innovation in hand hygiene has never been without resistance and has rarely been a priority, but it has always been worthwhile.

Here’s a brief video about how our system works: A Unique Approach to Hand Hygiene Automation – Video. You can also contact us to partner with you in your improvement efforts:


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