Leapfrog Report Shows Improved Hand Hygiene in U.S. Hospitals

By Jay Kumar

U.S. hospitals have dramatically improved their hand hygiene practices over the last four years, according to a new report from The Leapfrog Group.

Leapfrog, a nonprofit organization dedicated to improving patient safety in hospitals and ambulatory surgery centers, last week released its 2024 Hand Hygiene Report.  Leapfrog found that hospitals have made significant progress in hand hygiene practices thanks to increased leadership involvement and adoption of electronic hand hygiene monitoring systems.

Since Leapfrog began public reporting on hand hygiene in 2020, the percentage of hospitals meeting its hand hygiene standard has improved from 11% to 74% by 2023. The report reveals a 78% rise in hospitals holding leadership directly accountable for hand hygiene through performance reviews or compensation adjustments, suggesting that hand hygiene—and the safety of patients—is increasingly a priority among hospitals.

Improved hand hygiene is a vital intervention for reducing healthcare-associated infections and enhancing patient safety in hospitals. The Leapfrog standard isn’t easy to meet, but the report’s results show hospitals are making the effort.

“Some people love it, some people hate it, but I think we all recognize that it has good things in it that are helping make hospitals safer. They’re just kind of hard to do,” says Dr. Emily Landon, Associate Professor of Medicine, University of Chicago and Leapfrog expert panelist.

Leapfrog’s Hand Hygiene Standard mandates that clinicians and staff adhere to hand hygiene best practices from a national Hand Hygiene Expert Panel and is adapted from the World Health Organization’s “Hand Hygiene Self-Assessment Framework.” To date, there is no standardized or feasible mechanism to measure actual compliance levels among staff within each individual hospital; Leapfrog verifies evidence-based best practices known to achieve high levels of compliance are in place.

Hospitals are evaluated across five key domains:

• Monitoring: Checking if hand washing is done correctly and often enough.
• Feedback: Using data to see how well hand hygiene practices are followed and drive improvements.
• Training and Education: Teaching the right way to wash hands through physical demonstration.
• Infrastructure: Making sure there are enough hand sanitizer dispensers and washing stations.
• Culture: Establishing a strong focus on hand hygiene at every organizational level.

Leapfrog’s standard was challenging to develop, Landon says. “It’s kind of difficult to come up with a standard that’s going to be practical and realistic for hospitals, but at the same time really push the envelope and expect people to do more. I think the standard really tries to do that and it’s had a lot of good achievement.”

The report also reveals a dramatic increase in the adoption of electronic hand hygiene monitoring systems. In 2020, only 4.7% of hospitals employed such technology; by 2023, this figure has more than doubled to 10%. This growth demonstrates a broader trend toward integrating advanced tools to address the limitations of human observers.

“A lot of hand hygiene monitoring happens because someone just shows up on the unit and secretly observes whether or not people are doing it, and that doesn’t give people that real-time feedback and reminding that they need in order to be successful at hand hygiene,” Landon notes. “I also think there’s some ethical issues with just watching people do something unsafe and then just marking it down.”

More hospitals are using compliance coaches, which is helpful, she says.

“Having people there to say, ‘Hey, I noticed you might have messed that up’ is probably far better for people to learn how they are maybe not hitting their own expectations for hand hygiene as a nurse or doctor or food service delivery worker,” says Landon. “Without that, it’s just some numbers that are on a graph that show up once a month to your unit manager or whatever. I think those compliance coaches are really important. They’re a big part of the standard and they are on the rise.”

Leadership accountability is also playing a significant role in hand hygiene improvement, she says.

“It’s really easy to sort of lose track of something like hand hygiene in the very metric-heavy situation in hospitals these days,” Landon says. “There’s just so many quality metrics that everyone has to follow and hand hygiene is just one little piece of that. It is fundamental to a lot of other standards and infection control—and the process of improving the behavior for hand hygiene can be pivotal for understanding how to change behavior and get success in other quality metrics.”

Read the full 2024 Hand Hygiene Report here.