Hand Hygiene Day 2022: What lessons remain in practice

On May 5, 2022, International Hand Hygiene Day took place for the 14th time under the WHO motto Unite for safety. The day of action refers to the WHO guidelines on hand hygiene in medical care and the recommendation of the Commission for Hospital Hygiene and Infection Prevention (KRINKO) at the Robert Koch Institute. For hospitals, care facilities and doctors' practices, hand hygiene is not a campaign, but a verifiable obligation according to Section 23 Paragraph 3 IfSG.

Three years after the 2022 Day of Action, it is worth looking back: Which measures from that campaign have remained in the hygiene plans? Where does CIVAC's compliance platform and officer-as-a-service close the gap between poster and audit evidence? This article summarizes the technical basics, the operational requirements for a hygiene officer and today's audit priorities.

The World Health Organisation (WHO) has been calling for World Hand Hygiene Day on May 5th every year since 2009. The date refers to the 5 fingers and the 5 moments of hand hygiene. In 2022, the motto of the day was Unite for safety: clean your hands, with a focus on the interaction between clinic management, hygiene specialists and treating staff. The message followed the experiences from the COVID-19 pandemic, in which hand hygiene became increasingly important as a standard measure.

In Germany, the Clean Hands Campaign flanked WHO Day with audits, training and a publicly accessible quota of participating hospitals. The campaign is a national campaign under the patronage of the Federal Ministry of Health and with the technical support of the National Reference Centre for the Surveillance of Nosocomial Infections (NRZ). Participating facilities can be certified at three levels: Bronze, Silver, Gold.

From today's perspective, Hand Hygiene Day 2022 is primarily characterized by the continuation of compliance monitoring in hospital routines, rather than individual innovations. The technical responsibility lies with the hygiene officer of the facility, who maintains the hygiene plan according to KRINKO recommendations.

The technical framework of the action days are the 5 moments of hand hygiene, described in the WHO guidelines on hand hygiene in medical care from 2009. The five moments are: before patient contact, before aseptic work, after contact with potentially infectious material, after patient contact, after contact with the patient environment. Every moment is backed up with specific indications that can be verified in observational studies.

In the KRINKO recommendation for hand hygiene in healthcare facilities, updated in 2016 and continued in subsequent publications, the requirements for the amount of rub, exposure time and selection of hand disinfectants are described. A rubbing time of at least 30 seconds is considered the standard for hygienic hand disinfection. For surgical hand disinfection, longer exposure times apply in accordance with the manufacturer's instructions and the EN standard.

The compliance rate, i.e. the proportion of correctly carried out indications out of all observed indications, is the central parameter. Values ​​below 50 percent are considered in need of improvement, values ​​above 80 percent are considered good. Observational studies should be carried out at least twice a year for each department and evaluated on a ward-specific basis.

The legal bracket is provided by Section 23 of the Infection Protection Act (IfSG). Paragraph 3 obliges heads of hospitals, outpatient surgery facilities, prevention and rehabilitation facilities and dialysis facilities to draw up and update a hygiene plan. Paragraph 4 requires the recording of nosocomial infections and pathogens with special resistance. Paragraph 8 authorizes the states to issue legal regulations that specify the personnel requirements.

At the state level, the medical hygiene regulations regulate the requirements for hygiene specialists, hospital hygienists and doctors responsible for hygiene. The regulations differentiate according to the number of beds, focus of care and risk profile. In Bavaria, Baden-Württemberg and North Rhine-Westphalia, the personnel requirements are particularly detailed. The appointment of a hygiene officer is mandatory in all regulations.

Violations can be punished with fines of up to 25,000 euros according to Section 73 IfSG. There are also liability consequences if nosocomial infections can be traced back to demonstrable failures of the hygiene organisation. In assessments by the medical service, hygiene documentation and compliance quotas are among the points regularly checked.

The hygiene officer is the operational interface between facility management, hygiene specialists and employees. His core tasks include participation in the hygiene plan, advice on procurement and construction planning, carrying out internal inspections, training employees and participating in outbreak investigations. In smaller facilities, he also takes over the maintenance of surveillance data.

The qualification depends on the function: Doctors responsible for hygiene complete a 40-hour curricular training course from the German Medical Association. Hygiene officers in nursing undergo a 24-hour basic qualification with an annual refresher. In medical practices and nursing facilities, the hygiene officer can also be used in conjunction with other officer roles, such as the Quality Management Officer.

The order is made in writing by the facility management. The appointment certificate is stored in version form in the CIVAC workspace, supplemented by certificates of further training, task description and reporting line to the management. The appointment certificate, signed, filed, verifiable. The auditor calls, the evidence is ready.

The compliance rate is only reliable if the observation methodology is standardised. The WHO method involves direct, covert observation by trained observers. 20 to 30 indications are recorded per observation session and are evaluated according to professional group, time of day and type of indication. Indirect methods such as the consumption of hand disinfectant provide trends, but do not replace observation.

Common errors in practice: observation only before the day of hand hygiene (Hawthorne effect distorts the result), evaluation only as an overall rate without ward details, lack of feedback to the observed teams, no repeat measurement after 6 months. A reliable quota is created from at least two measurement cycles per year, with feedback to station management and documented improvement measures.

Electronic recording via mobile devices speeds up the evaluation significantly. In the CIVAC workspace, observation forms can be stored centrally, quotas can be evaluated for each station and reported to management. Licence the workspace for your internal representatives or have our representatives appointed if the hygiene officer position cannot be filled internally.

Three developments from the context of Hand Hygiene Day 2022 have permanently become part of everyday hygiene. First: the significant increase in the consumption of alcohol-based hand disinfectant on wards. Surveillance data shows that the level in many houses is stable at 15 to 25 percent higher than in 2019. Second: the integration of hand hygiene into the annual mandatory training according to § 23 IfSG, no longer as an optional module.

Third: the stronger integration with antibiotic stewardship programs, because hand hygiene and the rational use of antibiotics both have an effect on nosocomial infections. The annual reports of the Clean Hands Campaign document this shift. The compliance rates in many houses remain below the target values ​​of the campaign, especially on weekends and during night shifts. The need for improvement remains structural in nature.

What hasn't remained: one-off poster campaigns without structural support. Hand Hygiene Day only works if a documented process exists for the remaining 364 days of the year. Others run compliance like a filing cabinet. We run it like software.

Hand hygiene should not be viewed in isolation. It interferes with occupational safety in accordance with the Work Substances Ordinance and TRBA 250 because hand disinfectants are hazardous substances and skin protection must be documented. The interface to the occupational safety specialist is regulated via the risk assessment in accordance with Section 5 ArbSchG.

For medical devices, the Medical Device Operator Ordinance (MPBetreibV) applies with requirements for reprocessing. Here, hand hygiene is combined with surface disinfection, instrument reprocessing and the validation of reprocessing processes. Responsibility is distributed between hygiene officers, medical device officers and sterile supplies.

The WTPG supplements the requirements in nursing facilities and the Federal Medical Association recommendations in medical practices. CIVAC maps these interfaces in the same workspace, with documented reporting lines between the representatives and an overarching hygiene organisation. In this way, audit preparation becomes a pulling movement instead of a collective action.

During a regular inspection by the health department in accordance with Section 23 Paragraph 6 IfSG, supervisors typically check six areas. First, the written hygiene plan, dated and approved. Secondly, the appointment documents of the hygiene officers and their representatives. Thirdly, the training certificates from the last 24 months. Fourth, the surveillance data on nosocomial infections and multi-resistant pathogens.

Fifth, the hand hygiene compliance rates with observation protocols and action plans. Sixth, the hygiene inspection protocols, including list of defects and resubmission. The typical references are: hygiene plan older than two years, appointment certificate from the hygiene officer without representation regulations, training certificates not named, compliance quotas without ward details.

CIVAC provides 490 ready-to-use audit templates, several of which are designed for hospital hygiene and Section 23 IfSG. You shorten the preparation time from typically 2 to 6 weeks to 2 working days in which the workspace is filled with the existing data. Audit-proof, documented, § 23-IfSG-proof.

The 2022 Day of Action is history, the operational duty remains. Anyone who expects a regular inspection by the health department in 2026 or is facing recertification of the Clean Hands Campaign has to decide between two paths. Path one: You have a trained hygiene officer and need structure, templates and an audit-proof observation system. Lizenzieren Sie den CIVAC-Workspace für Ihre internen Beauftragten und nutzen Sie die vorgefertigten Audit-Vorlagen.

Pfad zwei: Die Stelle ist unbesetzt oder die Stunden reichen nicht. Have a hygiene officer ordered via the officer-as-a-service option, with appointment certificate and task description within 2 working days. In both paths, the compliance platform and officer-as-a-service remain the common storage and reporting line.

If you would like to be specific, write to info@civac.de or use the contact form. You will receive an initial assessment of the personnel situation and the next step within one working day. Turn reading into an assignment.