Status of the implementation of the World Health Organization multimodal hand hygiene strategy in United States of America health care facilities

Am J Infect Control. 2014 Mar;42(3):224-30. doi: 10.1016/j.ajic.2013.11.015.


Background: The World Health Organization (WHO) launched a multimodal strategy and campaign in 2009 to improve hand hygiene practices worldwide. Our objective was to evaluate the implementation of the strategy in United States health care facilities.

Methods: From July through December 2011, US facilities participating in the WHO global campaign were invited to complete the Hand Hygiene Self-Assessment Framework online, a validated tool based on the WHO multimodal strategy.

Results: Of 2,238 invited facilities, 168 participated in the survey (7.5%). A detailed analysis of 129, mainly nonteaching public facilities (80.6%), showed that most had an advanced or intermediate level of hand hygiene implementation progress (48.9% and 45.0%, respectively). The total Hand Hygiene Self-Assessment Framework score was 36 points higher for facilities with staffing levels of infection preventionists > 0.75/100 beds than for those with lower ratios (P = .01) and 41 points higher for facilities participating in hand hygiene campaigns (P = .002).

Conclusion: Despite the low response rate, the survey results are unique and allow interesting reflections. Whereas the level of progress of most participating facilities was encouraging, this may reflect reporting bias, ie, better hospitals more likely to report. However, even in respondents, further improvement can be achieved, in particular by embedding hand hygiene in a stronger institutional safety climate and optimizing staffing levels dedicated to infection prevention. These results should encourage the launch of a coordinated national campaign and higher participation in the WHO global campaign.

Keywords: Health care-associated infection; Infection control; US hospitals; WHO Hand Hygiene Self-Assessment Framework; WHO multimodal strategy.

MeSH terms

  • Cross-Sectional Studies
  • Hand Hygiene / methods*
  • Health Facilities*
  • Health Services Research*
  • Humans
  • United States
  • World Health Organization