Improving hand hygiene in general practice

Darshana Jeyaruban is a final year medical student at the University of Birmingham who has intercalated in psychological medicine, with a strong interest in General Practice.

Hand hygiene has become increasingly critical since the COVID-19 pandemic, as hands play a significant role in the spread of infection.1 The most important and effective technique to minimise the spread of infectious diseases is hand hygiene.2

Hand hygiene measures, such as hand washing as well as the use of alcohol-based hand sanitisers, were implemented following the initial outbreak, and they are playing a critical role in infection control.

Hand hygiene has certainly improved since the international recognition of the World Health Organisation’s (WHO) policies in 2009.3 Within the healthcare setting, despite regular training being provided, non-compliance is a major problem faced by many organisations. The reported level of compliance amongst healthcare workers is approximately 40% (ranging between 5-81%).

The most … effective technique to minimise the spread of infectious diseases is hand hygiene.

The standard of hand hygiene is unacceptable, given that it serves a dual purpose in preventing the spread of infections to both healthcare workers and patients. One approach to improve this has been via the introduction of alcohol-based hand hygiene products which can be more accessible than hand washing in some clinical scenarios.4

There is guidance provided for General Practices about infection prevention and control by the NHS. Within the recommendations for good practice is the suggestion for an annual audit to ensure a good standard of hand hygiene amongst staff.5

I conducted a hand hygiene audit on behalf of the GP surgery while on placement at the Kingsbury Road Medical Centre in Birmingham. During this audit it was found the overall hand hygiene of the practice was 87.5% (ranging from 44%-100%). Dr. Jha, the GP partner, ensured that all staff members completed annual hand washing training and that the NHS 8 steps to hand washing poster was available at each sink. Despite this, hand hygiene compliance did not meet the practice’s expectations.

It was surprising to see despite alcohol-based hand hygiene products being incorporated within clinical practice to increase accessibility, staff did not know how to use the products effectively. Members of staff were given immediate feedback on their hand hygiene technique, and many were reminded to use the same steps they used for hand washing while using alcohol-based hand hygiene products. During the re-audit the practice’s overall hand hygiene improved to 99.21% (ranging from 89% – 100%).

Although the necessity of hand hygiene is well known, regular monitoring of technique compliance is required.

Because alcohol-based hand treatments are frequently used as an alternative for hand washing, it is critical that the mandated training provided by General Practices to their employees include instruction on how to use alcohol gel correctly. Furthermore, the hand hygiene audit tool provided by infection prevention and control does not include a section to assess alcohol-based hand hygiene products.5 Therefore, GPs should consider using an audit tool which incorporates this in their assessment.

Although the necessity of hand hygiene is well known, regular monitoring of technique compliance is required. Participating in audits, as evidenced by this audit, can help general practices improve their hand hygiene standards. As a result, rather than being a suggestion, hand hygiene audits should become a mandatory annual requirement to improve hand hygiene standards throughout all General Practices.


1. Curtis V, Cairncross S. Effect of washing hands with soap on diarrhoea risk in the community: a systematic review. The Lancet infectious diseases. 2003 May 1;3(5):275-81.

2. Luangasanatip N, Hongsuwan M, Limmathurotsakul D, Lubell Y, Lee AS, Harbarth S, Day NP, Graves N, Cooper BS. Comparative efficacy of interventions to promote hand hygiene in hospital: systematic review and network meta-analysis. Bmj. 2015 Jul 28;351.

3. World Health Organization. WHO guidelines on hand hygiene in health care. InWHO guidelines on hand hygiene in health care 2009 (pp. 270-270).

4. Ritchie K, Iqbal K, Macpherson K, Riches E, Stout A. The provision of alcohol based products to improve compliance with hand hygiene. Health technology assessment-report. Edinburgh, NHS Quality Improvement Scotland. 2005.

5. Nunkoo B, Pickles H. Infection prevention and control in general practice. Nursing Standard. 2008 Dec 3;23(13):44-9.


Kingsbury Road Medical Centre and Dr Jha are identified with their consent.

Featured photo by Visual Stories II Micheile on Unsplash

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