What is a hand hygiene level?

In this article, you will learn how the hand hygiene level is defined and which level to expect.

The hand hygiene level is not just a number, but an important patient safety indicator. It tells how often you have been in a situation (hand hygiene opportunity) that required a hand hygiene action (alcohol-based hand rubbing or hand wash with soap) and whether that hand hygiene action was actually performed.

The hand hygiene level is often provided as a percentage, e.g. 30%. A hand hygiene level of 30% shows that you have remembered to sanitize hands in 30 out of 100 hand hygiene opportunities that were registered by the system.

It is a dynamic number that changes over time according to the change in behavior. It is therefore important to measure hand hygiene continuously in order to identify sudden changes or red flags.


 A guide for what the number means:

 0-25%: Focus on hand hygiene is needed in your organization. 

 25-50%: Your organization can benefit from prioritizing hand hygiene more.

 50-75%: Good job.

 75-100%: You are doing excellent!

Did you know that the risk of hospital-acquired infections decreases by 6% for every 10% improvement in hand hygiene levels? Every 1%-improvement in hand hygiene levels safe lives! 

Did you also know that the average hand hygiene levels for hospitals are 30-40%. Therefore, do expect unrealistically high hand hygiene levels in your organization. Especially, if you are used to inflated numbers with direct observations

A hand hygiene level of 100% is almost impossible to reach, which is also why anything above 70% is considered a good level. 


Patient rooms are the most difficult

Because many hand hygiene opportunities occur around the patient, it is difficult to achieve hand hygiene levels above 60% in patient rooms. Also, acute situations in patient rooms occur and self-protection by using gloves which are also factors decreasing the hand hygiene. 


Look beyond the average

In addition, the hand hygiene level is often presented as an averaged number of all healthcare workers in a ward, representing both the top-, middle-, and low-performers as shown in the figure below from Sani Analytics's Team Insights. As you can see by the horizontal line, the average compliance is 45% but what is also clear is that many healthcare workers are performing better than 45%. 

Instead of solely focusing on the general hand hygiene level remember to acknowledge that some healthcare workers are actually performing well and that some can improve even further.