Hand hygiene is critical to patient care and yet observational studies show low compliance in hospitals with guidelines on when and how to perform effective hand hygiene. Previous authors have looked at issues of motivation, workplace design, and technology to support hand hygiene. We chose instead to examine the effectiveness of hand hygiene training.

Neuroscience tells us physical skills, like hand hygiene, are learned through repeated short practice sessions over an extended period of time. This approach to learning has been studied by US academic K. Anders Ericsson and described as the Deliberate Practice methodology. This approach was popularised by the author Malcom Gladwell as the “10,000 hour rule” in his book Outliers. We know that learning hand hygiene does not take 10,000 hours but the question of how much training it requires intrigued us.

To measure how much training is required to learn the WHO hand hygiene technique we designed a study to train students until they could demonstrate the technique from memory. Our student population was a group of 42 Physicians Assistant students who were attending their 5-day induction training course in YALE Medical School. A SureWash GO device was used to deliver identical short burst training with feedback to each student and to objectively evaluate their technique. The results of the study were that it took 32 hand hygiene practice sessions that took a total of 23-minutes over 5 days to achieve proficiency.

The key take-away message from this study is that the effectiveness of hand hygiene training is dependant on the number of times training is provided. If we want healthcare workers to retain the skill of hand hygiene, we can’t expect them to do so after a single class. They need to be provided with regular training over multiple days to achieve proficiency. They also need the ability to train within a deliberate practice framework where they receive feedback on their proficiency during each practice session.

Access to the full paper: https://journals.sagepub.com/doi/pdf/10.1177/2382120519867681