Leapfrog Not Backing Down on Hand Hygiene Requirements

By Clean Hands - Safe Hands

Some hospitals have asked The Leapfrog Group to relax its hand hygiene standards, says Leah Binder, Leapfrog’s president and CEO, according to a January 28, 2022 Becker’s Hospital Review article. 

That’s not going to happen.

Becker’s Hospital Review reports that “A diverse expert panel has revisited the standards … and came to the conclusion that it is the absolute standard.” Hospitals that hope to earn a top Leapfrog Hospital Safety Grade in 2022 will have to demonstrate adherence to the stringent hand hygiene standards. 

The Leapfrog Hand Hygiene Standard

The Leapfrog Hand Hygiene Standard requires hospitals to:

  • Provide hand hygiene training to all individuals who touch patients or items that will touch patients
  • Assess individuals’ hand hygiene technique
  • Provide easily accessible alcohol-based hand sanitizer within 5 steps of patient beds
  • 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
  • Analyze and share hand hygiene compliance data with staff and leadership
  • Invite patients and visitors to remind staff to perform hand hygiene

The requirement to collect hand hygiene data on at least 200 hand hygiene opportunities (or 1.7% of all possible) each month, on every patient care unit – including short-stay units such as the post-anesthesia care unit (PACU) and emergency department (ED) – is the standard that’s creating the most stress for hospitals, which have frequently been overburdened.

Leapfrog CEO Binder is empathetic to the challenges hospitals and healthcare workers have faced over the past two-and-a-half years. But relaxing standards set to protect patient safety is not the path forward, she told Becker’s Hospital Review

[H]and hygiene still has to happen. Otherwise, we’re putting lives at risk,” Binder said. “Things are bad enough – let’s not make it worse with bad practices.” 

Increased HAI Rates Indicate Need to Strengthen Hand Hygiene

During the COVID-19 pandemic, rates of hospital-acquired infections climbed. According to the U.S. Centers for Disease Control & Prevention (CDC), in Q4 2020 (the most recent period of which data is available):

  • Central line-associated bloodstream infections (CLABSI) increased 47% over 2019 data
  • Catheter-associated urinary tract infections (CAUTI) increased 19%
  • Ventilator-associated events (VAE) increased 45%

Certainly, the pandemic strained healthcare providers’ capacity. The increase in HAIs isn’t due to intentional neglect or disregard for patient safety; it’s symptomatic of systemic problems. As noted by the authors of a recent New England Journal of Medicine article, “The fact that the pandemic degraded patient safety so quickly and severely suggests that our health care system lacks a sufficiently resilient safety culture and infrastructure.”

Relaxing hand hygiene standards may temporarily ease hospitals’ and healthcare workers’ sense of overwhelm, but may further erode efforts to improve patient and staff safety. That’s why the Association for Professionals in Infection Control (APIC) stated, “It is … time for investment in the infection prevention and control infrastructure in our nation’s healthcare facilities so that basic infection control practices can be hardwired into processes or care.” 

Preparing for the Leapfrog Hand Hygiene Survey

If collecting 200 hand hygiene observations from each patient care area monthly seems impossible with your hospital’s current systems, it may be time to invest in new infrastructure. 

Although Leapfrog has specifically stated that “hospitals can achieve the Leapfrog standard with direct observation alone,” the organization has said that “Leapfrog is communicating a strong preference for use of electronic monitoring … In addition to literature suggesting electronic monitoring works better to pinpoint compliance issues, sheer numbers of hand hygiene opportunities covered by the two monitoring strategies represent powerful evidence in favor of electronic monitoring.”The right electronic hand hygiene system may save your hospital money in the long run, as your HAI rates decrease and patients seeking safe care choose your facility over competitors with lower Leapfrog Hospital Safety Grades. As Becker noted in her Becker’s Hospital Review interview, “When hospitals demonstrate their commitment to hand hygiene, even when it’s frustrating, it’s also deeply reassuring to everyone … The focus sends the right message – we are going to value your life, your life matters.”


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