• Article
  • April 25, 2016

Help Family Members Improve Hand Hygiene Compliance

An educational initiative can help improve parent hand hygiene compliance.

By Celeste Chandonnet, R.N., B.S.N., CCRN, CIC

According to the World Health Organization, hand hygiene practices among health care workers have historically been low, averaging about 39 percent. While this suggests room for improvement, hospitals are increasing their efforts to achieve a high rate of hand hygiene compliance and seeing positive results.

Proper hand hygiene is an integral component to preventing harmful, and even fatal health care-associated infections in hospitalized patients. Addressing the problem of non-compliance with hand hygiene is essential to reducing the risk of spreading infectious germs. This is especially important in the neonatal intensive care unit (NICU), where illness can complicate patients' sensitive immune systems. Traditional infection prevention strategies involve the education of health care providers, particularly bedside staff members. But to protect its most vulnerable patients, Boston Children's Hospital realized it needed to take another approach.

Through its participation in the Children's Hospital Neonatal Consortium (CHNC), a multi-center quality improvement collaborative, along with outcomes from CHA's Standardizing Line Care Under Guidelines (SLUG Bug) collaborative, Boston Children's identified an opportunity to improve NICU patient care through standardized hand hygiene education for parents and families.

The hospital realized that despite frequent reminders and signage asking families to wash their hands, a knowledge deficit about the importance of proper hand hygiene remained. At the time, the NICU did not have a formal process to monitor compliance of family hand hygiene practices or a consistently established process for staff members to provide real-time feedback to family members when hand hygiene was inadequate or not performed.

The NICU team at Boston's Children's took action by forming the "It's in Your Hands" campaign to educate patient families about the importance of hand hygiene. Following the lead of other successful national campaigns including the SLUG Bug, the Centers for Disease Control, The World Health Organization and The Joint Commission, Boston Children's broadened the primary focus from staff members' hand hygiene to include family hand hygiene with an emphasis on improving compliance during NICU visits.


The hospital conducted mandatory staff member education, introducing them to the campaign and the role they serve to achieve the goal of educating families about proper hand hygiene within 48 hours of admission. Staff members were educated on parental education tools and the auditing process that would continue as the hospital rolled out the campaign.

The campaign included handwritten materials about proper hand hygiene timing and techniques, and nurses include these education materials in admission packets. A checklist serves as a trigger for bedside nurses to complete parent hand hygiene education. Families receive special stickers upon completion of the initial hand hygiene education.

To improve visibility and convenience, hand sanitizer dispensers were added to exit points, in addition to those already at entry points. To engage not only the parents but also siblings, a display board was constructed and placed at the unit's entrance. A colorful hand-shaped cutout is given to siblings and then attached to the board to recognize those who successfully complete the hand hygiene education. Siblings are encouraged to draw or write on the cutout, or the parent can put the child's name on it before it is placed on the board for all to see.

Empowering families

Team members empower parents to hold them accountable. Families are encouraged to speak up and ask health care providers to perform hand hygiene prior to contact with their infant. Though many parents express ambivalence with making this request, the organization encourages them to do so despite any uneasiness they might feel.

Staff members are also prepared to speak with other health care providers and family members after receiving a parent's request to perform hand hygiene. Scripted phrases staff members use include simple ways to thank the parent or family member for the reminder or to confirm that they had performed hand hygiene before reaching the bedside. These requests are followed by responses like: "I just did it, but I would be happy to do it again," and, "Thank you for reminding me."

Seeing results

Through participation in the collaboratives and the subsequent rollout of the "It's in Your Hands" hand hygiene campaign, nurses leading this initiative noted a sustained increase in parent and family hand hygiene compliance.

While initial audits obtained during the collaborative demonstrated a lack of compliance—as low as 70 percent by parents and family members—audits of family members' hand hygiene following the rollout have remained above 90 percent. In addition, there has been a significant culture shift within the NICU. Parents and families who were once reluctant to speak up or advocate for hand hygiene now routinely ask staff members to wash their hands if they haven't witnessed it or have concerns.

Because of the successful outcomes of this campaign in the NICU, Boston Children's has rolled it out to inpatient units throughout the hospital. This has led to empowered parents, family members and staff members who have the education and necessary tools and support to carry out their individual roles and responsibilities in infection prevention throughout the hospital.

Celeste Chandonnet, R.N., B.S.N., CCRN, CIC, is an infection prevention coordinator in the NICU at Boston Children's Hospital. Send questions or comments to magazine@childrenshospitals.org.