Hand Hygiene

Healthcare Human Factors

Hand Hygiene: Using human factors to create supportive environments and processes

It’s well known that hand hygiene is the best way to prevent hospital acquired infections, yet rates of compliance with best practices remain below 40%. This project sought to identify and address process and environmental barriers to performing hand hygiene through an iterative user centered approach.

A literature review was first conducted to understand initiatives that focused on hand hygiene environment and process design. Heuristic evaluations assessed hand hygiene products that were used in various clinical areas. The results identified violations such as inconsistent placement and poor visibility of hand sanitizers versus hand soap. Diverse healthcare workers were shadowed in a variety of environments to identify additional barriers, such as a sink hidden in the back of a patient room. Focus groups with healthcare workers were conducted to brainstorm and prioritize solutions to identified barriers. The existing clinical environments were modified with these solutions, and the impact was evaluated through surveys and observation for validation.


Findings from this work have been formulated into a toolkit for healthcare workers to optimize and customize their environments and processes to better support hand hygiene activities. Toolkits are available from the Canadian Patient Safety Institute.