A Case Study

Digital Hand Hygiene Audit: Impact on Compliance and Quality Outcomes

Hand washing has been established as the single most effective way to significantly reduce the transmission of infections.


Rising higher complexity of patients, multi-drug resistant infections and increasing need for broad spectrum antimicrobial therapies have been well documented at post-acute and long-term care settings. Proper hand washing education and an organized hand hygiene audit tool could have a great impact on reducing the spread of infections, decreasing the utilization of antimicrobials and achieving overall good patient outcomes.


To leverage a digital hand hygiene tool for easier hand washing observation data capture and to establish an accurate compliance process. This organized digital process would empower the organizational teams to achieve measurable quality metrics for post-acute and long-term care facilities.

Quality Improvement Methods

Developing a digital tool included understanding the challenges to effective hand washing audit processes. The digital tool was designed as a simple interface for smartphones, moving away from traditional paper methods. The digital tool was primarily used by the facility Infection Preventionist, Director of Nursing and Assistant Director of Nursing to document hand washing observations in any part of the facility. Implementation of “secret shoppers” and leaders performing just-in-time coaching helped drive compliance. This tool also helped to easily log the hand washing compliance by all types of healthcare personnel involved in patient care. The data was saved in a spreadsheet, which allowed the user to generate a robust hand hygiene compliance report outlining different personnel in different areas of the facility.


The results of the observations are efficiently organized by the different areas of the facility, the type of healthcare staff as well as the opportunity for compliance. This ability of the digital audit tool to categorically capture and organize the data helped the facilities to identify the areas and personnel who needed more hand washing education. In one facility, the digital tool improved the hand washing observations rate to more than 90 percent over the first month of implementation. Also, the tool enabled targeted education for the staff who were less compliant with hand washing. The overall impact with improved hand washing compliance showed a 66% decrease in C. difficile cases, 64.7% decrease in MRSA cases and a 76% decrease in Urinary Tract Infections, with further reduction in complications like Sepsis.


Hand hygiene, to include hand washing with soap and water as well as alcohol based hand rub, is one of the simplest and cost-effective strategies for preventing infections in all kinds of settings.

C. difficile Infections (LTCF-O)

  • Infection Rate

MRSA Infections (LTCF-O)

  • Infection Rate

Urinary Tract Infection (LTCF-O)

  • Infection Rate