More Than Skin Deep: Improving patient hand hygiene


9th July 2021


A study on improving patient hand hygiene in a District General Hospital in England showed a multimodal strategy, including the implementation of Clinell wipes, improved patient hand hygiene.

Following on from our “More Than Skin Deep” collaboration with British Skin Foundation and ITN Productions Industry News, which premiered at the British Association of Dermatologists’ Annual Conference, we want to focus on a recent study on patient hand hygiene.

The recently published study reports the impact of a bundle of measures to improve patient hand hygiene in a District General Hospital in England (Wilson et al, 2021).

Hand hygiene is recognised as one of the most effective methods to protect patients from healthcare associated infections, but while much attention has focused on the role of hand hygiene for healthcare workers; there is less emphasis on patient hand hygiene. Patients confined to beds are often unable to access hand washing facilities and rely on healthcare staff to support them to perform hand hygiene.

In a previous study, Wilkinson et al (2018) concluded that an antimicrobial patient hand wipe, when applied for 60 seconds, is at least as good as soap and water, at removing transient microorganisms from the hands, representing an acceptable alternative to handwashing.

Where did the study take place?

The new study took place in 6 implementation wards in the care of older people speciality at a large District General Hospital in England.

What did the intervention consist of?

The study introduced a patient hand hygiene bundle, comprising of:

  • Individual patient hand wipe packs
  • Patient hand hygiene protocol for staff
  • Information about patient hand hygiene for patients
  • Monitoring and feedback of rates of compliance

Who designed the bundle?

Healthcare staff from the wards in the hospital participated in focus groups to explore their opinions about the importance of and strategies to improve patient hand hygiene. Opinions on pack size, ease of removal of wipe from the packaging, etc, was combined with results from a public survey, resulting in a co-designed patient hand hygiene bundle.

How was the impact measured?

A baseline audit of patient hand hygiene opportunities was conducted over a 6-week period in 3-hour periods between 7am-7pm. Opportunities were defined as before meal, before touching and after touching an invasive device, after using the toilet, after sneezing/coughing, and after vomiting). The effect of thepatient hand hygiene bundle was monitored by structured observation of hand hygiene opportunities over a 12-week period.

What were the results?

The baseline audit of practice found that pre-intervention compliance with patient hand hygiene was 13.2% (40/303; 95% confidence interval 9.9-7.5). Following the implementation of the patient hand hygiene bundle there was a significant increase in compliance with patient hand hygiene. 526 patient hand hygiene opportunities were observed with hand hygiene occurring in 58.9% (310/526); an increase of 45.7% versus baseline (95% confidence interval 39.7%-51.0%; P < .001). A key finding was that access to a method of hand hygiene simply by placement of a pack of wipes correlated with an increase in hand hygiene compliance.

What were the findings?

The findings of this study suggest healthcare staff have an essential role in encouraging patients to perform timely and appropriate hand hygiene. Providing patients with packs of hand wipes was found to be a simple, cost-effective approach to increasing patient hand hygiene and reducing the risk of healthcare associated infections in hospital.

Find out more about Clinell’s Antimicrobial Hand Wipes here.



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