I’d like to direct your attention to a flurry of fairly recent correspondence in the Journal of Hospital Infection around whether the high levels of hand hygiene compliance commonly reported in England are realistic and useful.1-5
On the one hand, we know that actual hand hygiene compliance with the WHO 5 moments for hand hygiene is seldom more than 40%.6 In fact, if you count the number of typical opportunities and the time it takes to wash your hands (properly), then 100% compliance probably isn’t possible, even in theory.1, 2, 4, 5 Therefore, an expectation to report a high level of hand hygiene compliance (north of 95%) is neither realistic nor useful as a performance indicator.
On the other hand, how can we possibly justify not achieving a high level of hand hygiene compliance (in excess of 95%)? Semmelweis’ data should be enough to convince everybody of the importance of this simple, low-cost, high-impact intervention. So, if our hand hygiene compliance isn’t already >95% then it jolly-well should be!3
When I first joined the NHS, I spent some time on a ward doing some covert auditing. I dressed in my doctor’s uniform (light blue shirt rolled up to just below the elbow, sand coloured chinos, and shinyish shoes) and pretended to take notes. I can tell you that hand hygiene compliance was nowhere near 95%. In fact, it was nowhere near 50%. And I would say that this is fairly typical!
So, for me, we need a useful performance indicator of hand hygiene compliance. It doesn’t really matter to me whether the bar is set at 10% or 90%. But it needs to be a performance indicator that can identify areas of poor performance and drive focussed genuine improvement initiatives.
 Mahida N, Boswell T, Vaughan N. Re: In defence of high hand-hygiene compliance rates. J Hosp Infect 2017; 97: 32-3.
 Mahida N. Hand hygiene compliance: are we kidding ourselves? J Hosp Infect 2016; 92: 307-8.
 Oliver C, Thompson A, Cooke RPD. In defence of high hand-hygiene compliance rates. J Hosp Infect 2017; 97: 31-2.
 Bradley CW, Holden E, Garvey MI. Hand hygiene compliance targets: what are we actually targeting? J Hosp Infect 2017; 95: 359-60.
 Jones S, Reay S, Bull D, Gray J. Hand hygiene compliance monitoring: we need to stop kidding ourselves. J Hosp Infect 2017; 97: 33-4.