• Annette Jeanes, Pietro G Coen, Nicolas S Drey, and Dinah J Gould.
• Infection Control Department, University College London Hospitals, London, UK. Electronic address: annette.jeanes5@gmail.com.
• Am J Infect Control. 2018 Apr 1; 46 (4): 441-447.

BackgroundMonitoring results showing poor hand hygiene compliance in a major, busy emergency department prompted a quality improvement initiative to improve hand hygiene compliance.PurposeTo identify, remove, and reduce barriers to hand hygiene compliance in an emergency department.MethodsA barrier identification tool was used to identify key barriers and opportunities associated with hand hygiene compliance. Hand hygiene imperatives were developed and agreed on with clinicians, and a framework for monitoring and improving hand hygiene compliance was developed.ResultsBarriers to compliance were ambiguity about when to clean hands, the pace and urgency of work in some areas of the department, which left little time for hand hygiene and environmental and operational issues. Sore hands were a problem for some staff. Expectations of compliance were agreed on with staff, and changes were made to remove barriers. A monitoring tool was designed to monitor progress. Gradual improvement occurred in all areas, except in emergency situations, which require further improvement work.ConclusionsThe context of care and barriers to compliance should be reflected in hand hygiene expectations and monitoring. In the emergency department, the requirement to deliver urgent live-saving care can supersede conventional hand hygiene expectations.Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. All rights reserved.

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