Measuring Hand Hygiene Standards

There are currently a variety of ways to measure hand hygiene in healthcare organisations. Some of these metrics have a sound scientific basis, while other metrics have intuitive appeal but are methodologically flawed. As a result, there’s quite a lot of confusion and it is difficult for hospitals to compare performance. There are private organisations and public organisations that assess hand hygiene as part of an overall quality score. The World Health Organization (WHO) does provide a Hand Hygiene self-assessment framework; however, while this framework is useful for organisations to improve, it is not independently audited.


Aiming to Achieve a Global Standard for Hand Hygiene

A group of experts from around the world worked with the ISO to develop an international standard for hand hygiene in healthcare. Fundamentally, the aim was to get a consensus of what is defined globally as good quality relating to hand hygiene in healthcare facilities and allow these processes to be independently audited to a global standard.

The recently published ISO: 23447 hand hygiene standard provides scientific knowledge and evidence-based implementation guidance to achieve hand hygiene outcomes that can enhance patient safety. It builds on the top of existing national and international laws, regulations and recommendations supporting patient safety. It covers facility readiness, hand hygiene education and training, monitoring, performance, promotion and identifying key issues that support hand hygiene improvement.


Who was involved

There were 26 participating member countries and 22 observing member countries. SureWash founder Professor Gerry Lacey represented Ireland on the committee and provides expertise on hand hygiene skills development and measurement. The aim was to develop a hand hygiene standard that is independent, precise and delivers an improvement in patient safety by reducing hospital-acquired infections.


ISO Training & Education Requirements

A critical component of the new ISO standard for hand hygiene is the requirement around training and education for all staff, patients and visitors. The training should be a combination of both theoretical learning and practical sessions.

According to ISO: 23447, a successful training program shall include essential elements such as:

  • Information supported by evidence from the scientific literature, including a regular update of the content and quality of the course
  • Initial training of newly appointed staff
  • Regular training (at least annually) for retraining of previously trained staff to update their knowledge
  • A facility-wide system for monitoring the competence of all healthcare professionals on hand hygiene
  • A strong and positive leadership and support
  • Assessment of all learning outcomes meaning quizzes to test theoretical knowledge and measuring competence in hand hygiene demonstrations

At a minimum, all staff should be educated on how to perform hand hygiene correctly with hand wash and hand rub techniques following the WHO protocol. Training should also include indications for hand hygiene and the proper form of hand hygiene and the context of potential microorganisms present.

For more information regarding the recommended training requirements, access the complete ISO document here: 


How SureWash aligns with the new ISO for Hand Hygiene

SureWash combines practical hand hygiene technique training with theoretical education to provide a complete hand hygiene training and assessment solution to all staff, patients and visitors. All training data is accessible on SureWash.Net, an online reporting suite.

  • SureWash’s assessment-based training identifies gaps in users’ current practice.
  • A live video image guides them through the WHO hand hygiene technique process.
  • A user’s hand motions are measured, and real-time feedback is provided within a “deliberate practice” learning theory framework.
  • SureWash helps to build muscle memory by breaking learning into 5 different skill levels, each with a challenge
  • In line with the latest science on how we learn physical skills, SureWash encourages short, repeated training sessions to facilitate retention.
  • SureWash provide the training records to certify that staff have completed their training and assessment.


Contact SureWash: