Design and implementation of a Successful patient hand hygiene strategy Using Quality Improvement Methodology

Mrs Claire Chadwick1

1Bradford Teaching Hospital Nhs Foundation Trust, Bradford , UK


This study investigated a patient hand hygiene strategy using quality improvement methodology. The aim was to determine whether quality improvement methodology could successfully be used to ensure a reliable and sustained improvement in patient hand hygiene compliance using a ‘5 Moments for Patient Hand Hygiene’ model.


A test of change was implemented  in 2 Acute Hospital Trusts in England.  A strategy was designed based on a prototype 5 moments for patient hand hygiene. The test of change included patient information , a pictograph card and posters, and  education  for nursing staff.  Hand hygiene observations were undertaken at meal times and at other times  by the Infection Prevention Team and also anonymous colleagues. Plan, Do, Study, Act (PDSA) cycle meetings aided modification and improvements with compliance. A review of hand cleaning products formed part of the PDSA cycles and their adaptability for patient ease of use.


Compared to a baseline of 0%,  patient hand hygiene improved to an average of 80.5 % . Hand wipes were preferred to alcohol gel and observations of patient hand hygiene noted use of hand wash basins is often impractical due to immobility or reliance on walking aids. Nursing feedback highlighted that offering the wipe improved compliance compared with verbal  or visual prompts.


Hand hygiene  for patients  can achieve high levels of compliance. Offering a wipe was more effective than verbal and visual prompts .


Claire’s career commenced in Infectious Diseases in Sheffield in 1987, followed by moves to North Wales and Manchester within the specialities of Cardiology, Coronary Care and Infectious Diseases/HIV.

She commenced her career in infection control in 1994 at the Christie Hospital in Manchester, a National cancer specialist centre. In 2006, she became Head Nurse Infection Control at a large district general hospital, covering 4 hospital sites 2,200 inpatient beds and community provider services. In 2018 she was appointed as Nurse Consultant/ Assistant Director Infection Prevention and Control at Bradford Teaching Hospital NHS Foundation Trust.

She is currently Honorary Treasurer of the UK Infection Prevention Society and was part of the England National working party to develop guidelines for the control of Glycopeptide Resistant Enterococci.

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