Improving visitors’ hand hygiene compliance in a pediatric oncology unit

Published:November 27, 2021DOI:


      • We aim to improve hand hygiene (HH) compliance by pediatric oncology unit visitors.
      • Cycles were 1) visual cue, 2) symptom screen added, 3) verbal HH instructions added
      • Visitors were significantly more likely to perform HH when directly instructed.
      • An anonymous staff survey confirmed the feasibility of the process.



      Hand hygiene (HH) is the single most important method to prevent infections. We aim at improving HH compliance by visitors to a pediatric oncology unit.


      A performance improvement project implemented several Plan-Do-Study-Act cycles in July-November 2018. At baseline, a wall-mounted alcohol-based hand sanitizer dispenser was available at the unit entrance. Cycle 1 (visual cue), cycle 2 (visual cue plus verbal symptom screen), and cycle 3 (visual cue, symptom screen, plus HH verbal instructions) were tested. Patient care associates (PCA) positioned at the entrance implemented the cycles and recorded data about visitor's estimated age, day and time of observations, and covert HH compliance monitoring. Participating PCAs were surveyed regarding process feasibility.


      Of 1230 (97%) analyzed observations; 204 (17%) were baseline, 293 (24%) in cycle 1, 374 (30%) in cycle 2, and 359 (29%) in cycle 3. The visitors’ HH compliance significantly increased to 16.0%, 22.5%, and 48.5% in cycles 1, 2, and 3, respectively, from a baseline of 4.9% (P < .001). Visitors were more likely to perform HH when directly instructed (cycle 3) compared to baseline (adjusted OR = 19.77, 95% CI, 10.30-42.09, P < .001). Although the surveyed PCAs agreed the process is easy and fast, they reported few barriers.


      Direct verbal instructions for HH were the most effective in improving visitors’ HH compliance.

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