However various studies have shown that hygiene compliance rates in these critical industries are not what they should be. According to WHO, even in resource-rich hospital settings, hand hygiene compliance can be well below 40 per cent. Elsewhere, the Food Standards Agency found that a shocking 39 per cent of staff do not wash their hands after visiting the toilet, and a huge 53 per cent do not wash their hands before preparing food. Hand hygiene has a part to play in general washrooms too – less than six per cent of the population wash their hands adequately according to a study by Borchgrevink, C.P. et al.

So why is this the case, and how can better hand hygiene compliance be promoted and put into place?

Hygiene critical areas: healthcare

The first and most obvious area where hand hygiene is critical is healthcare. Healthcare Associated Infections (HCAIs) are a persistent and serious health threat to patients, and inadequate hand hygiene compliance has a significant part to play in this. In the UK alone, a study by the University of Nottingham found that HCAIs caused by hospital superbugs such as C.difficile and MRSA are responsible for at least 5,000 deaths a year; greater than the number associated with road traffic accidents.

There are several reasons for low hand hygiene compliance in healthcare. According to a report by the AHA Health Forum, the issue is twofold: the human factor, and the method of reporting. On an individual level, insufficient education can lead to common misconceptions; that glove use does not necessitate hand washing; demands being placed on medical staff can lead to fewer hand hygiene events than necessary, or simply forgetfulness. Furthermore, when it comes to reporting hand hygiene compliance, data can also be inaccurate. If measured incorrectly, the required actions are less likely to be implemented when it comes to a hand hygiene review.

Tackling hand hygiene compliance can come in many forms. Greater awareness and education is needed, for example, the teaching of the WHO’S 5-Moments for Hand Hygiene. Strategic placement of resources around healthcare facilities can aid this, encouraging and reminding healthcare professionals when to sanitise and clean.

Alcohol-based hand sanitisers have been cited by the WHO as an essential, complementary method to washing with soap to drive hand hygiene compliance within healthcare facilities, as they require less time and are highly effective at killing potentially harmful germs. Well-placed dispenser points, and smaller more portable pump packs can also be effective here.

Monitoring can also assist when evaluating hand hygiene rates. Existing observation methods can be unreliable, but technology-based electric monitoring systems can both remind professionals of hand hygiene events and record these. They have been proven to provide accurate and reliable data on true hand hygiene compliance levels to help identify areas for improvement.

Hygiene critical areas: the food industry

Another critical area for hand hygiene compliance is the food industry, where the cross contamination of food can cause serious illness outbreaks. Thirty per cent of foodborne illness outbreaks can be traced to poor personal hygiene according to a study by Epidemiol, but many of these diseases are preventable through proper hand washing.

A study by Oregon State University found that the top factors affecting hand hygiene compliance were time constraints, inadequate facilities, a lack of accountability and a lack of general support for hand washing practices in the workplace. With the fast pace and turnover of the food industry, factors such as language barriers and unfamiliarity with the working environment can also lead to misunderstandings and a low compliance rate.

Long-term behavioural change needs to be driven in order to improve hand hygiene compliance in the food industry. More awareness and education of the risks and procedures involved is recommended, ensuring that proper training is fulfilled so that employees are aware of how to avoid cross-contamination. However for high compliance, the right products need to be provided at the right times – an on-site assessment can help with this, by identifying critical hand hygiene control points.

As with the healthcare environment, if products are clearly signposted and labelled, this will assist in promoting thorough and compliant hand washing.  Hand washing should also be incorporated with the use of hand sanitisers, which can be used without water, at the point of need, to provide rapid and easily accessible hand hygiene.

Protecting the general population

When it comes to the general washroom, although less hygiene critical in relation to acute illnesses, hand washing is important when it comes to infection prevention across the general population in places such as offices, schools and public spaces. According to the Centre for Economic and Business Research, the UK economy lost €4.9 billion in 2013 due to poor hygiene related sick leave.

The WHO states that 80 per cent of germs are spread through personal contact or by touching contaminated surfaces, and in office environments, for example, if hand hygiene is not promoted it can quickly manifest in absenteeism and loss of productivity.

A recent survey by the Royal Society for Public Health also found that although the importance of hand hygiene is generally well understood by the public, there is some confusion over the relationship between germs and hygiene, and the times and situations where hand washing is most vital.

There are a wide range of factors that contribute to low hand hygiene compliance levels in general washrooms. An understanding of the difference between washroom types is vital, as is awareness amongst users. In offices, for example, it is critical to bring raised awareness of hand hygiene and the potential risks to truly drive compliance. Resources such as posters and signs can help encourage this, as can training and skin care plans.

One of the important factors is quality product provision and its presentation. Products which are easy and enjoyable to use, have a pleasant scent and care for the skin communicate freshness and cleanliness to the user, thus encouraging hand hygiene compliance.

Despite the above, hygiene compliance rates can swiftly become irrelevant if the washroom itself is unhygienic, or the products contaminated. Commonly seen in general washrooms, open soap systems that are bulk filled can actually present a serious hygiene problem. Airborne germs and bacteria can enter the soap reservoir, potentially contaminating the soap – these dispensers are also often inadequately cleaned or refilled.

Procedure states that they should be emptied and cleaned thoroughly on each refill, however this rarely happens, meaning that contaminated soap is simply topped up. According to a study by Chattman, Maxwell and Gerba, a huge 25 per cent of public refillable bulk soap dispensers are contaminated with unsafe levels of bacteria and can actually leave the hands with 25 times more bacteria after washing.

Maximum hygiene

Cartridge soap dispensers which are sealed will bring maximum hygiene, with a measured dose of fresh product dispensed each time. The maintenance of washrooms has a significant impact on hand hygiene, and with a more readily replaceable cartridge, this is made easier and simpler for cleaning professionals. With visibly cleaner and more pleasant soap dispensers, users are far more likely to wash hands thoroughly and carry out a full hand hygiene event.

Not only are soap cartridges more hygienic, when coupled with foam soaps, they are much more cost effective with savings on refill time and water use, as well as reducing product usage and packaging.

Although the risks of inadequate hand hygiene are clear to most users, a clean washroom and availability of product is often the primary concern. Whether in hygiene-critical environments or general washrooms, it is clear that more could be done to really raise awareness of the risk, and make hand hygiene matter to users.

Time constraints, lack of awareness and proper facilities are common factors across all sectors from hospitals to office washrooms. More education, raised awareness and the provision of quality, safe skin care products could have a huge impact on hand hygiene compliance rates, thus reducing the spread of infection and ultimately the risk to life across all industries.

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Recent studies indicate that electronic devices can play an important role in hand hygiene compliance. Venkatesh conducted a prospective, interventional study to evaluate the use of an electronic device to measure and impact hand hygiene practices and control transmission of VRE in a 30-bed academic medical center hematology unit. The researchers identified 8,235 measurable hand hygiene opportunities during the study, with compliance improvement from 36.3 percent at baseline to 70.1 percent during the second phase of the study. The use of audible alerts improved hand hygiene compliance for both the day shift and the night shift, as well as across rooms with higher HCW traffic and lower HCW traffic.

Swoboda  attempted to determine through a three-phase study whether electronic monitoring of hand hygiene and voice prompts could improve hand hygiene and decrease infection rates in a 14-bed, university hospital-based surgical intermediate care unit. Phase I was electronic monitoring and direct observation; phase II was electronic monitoring and computerized voice prompts for failure to perform hand hygiene on room exit; and phase III was electronic monitoring only. All patient rooms, utility room and staff lavatory were monitored electronically. Participants included all healthcare personnel including physicians, nurses, nursing support personnel, ancillary staff, all visitors and family members, and any other personnel interacting with patients on the unit. All patients with an intermediate care unit length of stay greater than 48 hours were followed for hospital-acquired infections (HAIs). Electronic monitoring was conducted during all phases, with computerized voice prompts during phase II only. The researchers evaluated a total of 283,488 electronically monitored entries into a patient room with 251,526 exits for 420 days (10,080 hours and 3,549 patient days). Compared with phase I, hand hygiene compliance in patient rooms improved 37 percent during phase II and 41 percent in phase III. When adjusting for patient admissions during each phase, point estimates of HAIs decreased by 22 percent during phase II and 48 percent during phase III; when adjusting for patient days, the number of infections decreased by 10 percent during phase II and 40 percent during phase III. Although the overall rate of HAIs significantly decreased when combining phases II and III, the association between HAIs and individual phase was not significant. The researchers concluded that electronic monitoring provided effective ongoing feedback about hand hygiene compliance.

Swoboda also hypothesized that both patient isolation and electronic hand hygiene prompts incrementally improve hand hygiene of HCWs compared with non-isolation rooms. They conducted a prospective, 14.5-month, three-phase electronic surveillance study of hand hygiene behavior on an intermediate care unit with nine patient rooms (three isolation rooms and six non-isolation rooms); phase I was electronic observation, phase II was electronic observation with automated voice messages urging hand hygiene, and phase III was electronic observation. Electronic sensors monitored room entries and exits and use of all sinks and all soap dispensers. Phase I (1,616 patient-days) HCWs were 49 percent more likely to wash their hands in isolation rooms versus non-isolation rooms; phase II (1,390 patient-days) and phase III (543 patient-days) healthcare workers were 59 percent more likely to wash their hands in isolation versus non-isolation rooms, P = .001. The researchers concluded that HCWs improve hand hygiene when constrained by isolation rooms, that electronic voice prompts further improve hand hygiene behavior, and that both physical and auditory reminders improve hand hygiene.

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