Increasing compliance with hand hygiene among healthcare workers is the most important strategy to reduce healthcare acquired infections and should be the core activity of any infection prevention program. In 2006, a hand hygiene program was launched at a medium-sized acute care hospital and six months later was extended to the whole health district. The main components of the program involved easy access to antimicrobial hand gel, establishment of a hand hygiene champion team, a ‘talking walls’ approach with posters and an ongoing direct observational audit and performance feedback on hand hygiene practice.

Over a three year period, hand hygiene practice has improved with fluctuations influenced by new staff, staff workloads and senior manager leadership qualities. Compliance has been excellent for all high risk activities. Most non-compliant activity has been in medium-low risk activities. In the first two years, the highest non-compliance was for after patient contact. Since then this has changed to after contact with the patient environment, a low risk activity which may take years to improve compliance. Doctors have continued to have the lowest compliance of all staff groups and have not visibly demonstrated any leadership as a staff group to improve although some medical teams have made a concerted effort. Easy access to the waterless hand cleaning product has been achieved. Hand hygiene champions count for ten per cent of employees and are a visible district team spanning all employee streams.

Improved hand hygiene compliance has reduced healthcare acquired infections and is visibly noticeable when compared to Methicillin Resistant Staphylococcus Aureus (MRSA) transmission. As hand hygiene compliance improves, MRSA transmission falls and the reverse is also true. The health district has a visible hand hygiene culture that is sustained on four simple components tied together with regular communication, education and executive support. Future strategies will need to focus on gaining recurrent funding and targeting doctors to improve their compliance.