SOAP UP: Simple Ways to Improve Hand Hygiene Compliance at Your Hospital

Sidney & Lois Eskenazi Hospital opened in 2013. The facility was designed to encourage hand washing and make compliance simple.

Sometimes the simplest idea can make the biggest impact.

In 1847, a young physician named Ignaz Semmelweis sought to discover why maternity patients at his hospital in Vienna were dying of puerperal fever at an alarming rate. Noting that many of these patients had been treated by students who worked on cadavers during an anatomy class before starting their rounds in the maternity ward, Semmelweis began insisting his students wash their hands after class.

The death rate on the maternity ward plummeted.

Almost 200 years later, hand hygiene is still the single most effective way to reduce the transmission of health care-associated infections (HAIs). Nonetheless, compliance is an issue. According to the Centers for Disease Control and Prevention (CDC), health care providers clean their hands less than half as often as they should. Caregivers might need to clean their hands as many as 100 times per 12-hour shift, depending on the number of patients and intensity of care.

The American Hospital Association’s Health Research and Educational Trust (AHA/HRET) recently launched the UP Campaign to simplify safe care and streamline interventions. A key component of the campaign is SOAP UP, which encourages hand hygiene compliance. The Indiana Hospital Association (IHA) is partnering with AHA/HRET on the UP Campaign to help educate Indiana hospitals on ways to improve hand hygiene compliance and ultimately reduce the spread of infection.


Imitation may be the sincerest form of flattery, but it is also an effective way to encourage hand hygiene compliance.

Lee Ann Blue, CNO/executive vice president of patient care services at Eskenazi Health, learned this after the Indianapolis-based system launched a campaign to encourage hand hygiene compliance in 2015. She observed that the simple act of a physician washing his or her hands before entering a patient’s room during rounds can improve compliance rates significantly.

“If a physician is on rounds and he foams his hands first, everyone is going to follow suit and do the same,” said Blue.

This was just one part of the hand hygiene campaign Blue and her team developed with guidance from Malaz Boustani, M.D., professor at the Indiana University School of Medicine and founding director/chief innovation and implementation officer of the IU Center for Health Innovation and Implementation Science. Boustani, who also is the founding director of the Sandra Eskenazi Center for Brain Care Innovation, is a leading expert on the rapid translation and implementation of research discoveries into clinical practice.

“Dr. Boustani taught us how to use the tools of implementation science to speed up the process of implementing best practices in hand hygiene,” said Blue. “He emphasized the need to focus on the positive and why you’re doing what you’re doing.”

The first step was to form a focus group made up of staff and providers to discuss barriers to appropriate hand hygiene and ways to recognize and encourage compliance. Blue and her team used feedback from the focus group and a staff survey to develop their plan. One key finding was the need to develop a strategy that started from the top.

“Leadership had to become part of the team and demonstrate the practices,” she said. “Involving leadership from the beginning helped demonstrate the value of what we were doing.”

This included encouraging physician leaders to make a point of washing their hands before entering patient rooms while on rounds.

“This was very effective very quickly,” said Blue. “It was just amazing.”

The executive team also was involved and supportive from the beginning. CEO Lisa Harris, M.D., helped kick off the campaign by speaking at a leadership forum about the importance of hand hygiene. She emphasized that this was not a problem at Sidney and Lois Eskenazi Hospital alone, but rather a problem at hospitals across the country.

“We had, and continue to have, strong support from Dr. Harris. Her support, and the support of our physician leaders and nursing leaders, led to quick engagement from the frontline staff,” said Blue.

The hospital also identified ways to recognize staff and to make compliance fun. One of the most effective methods of improving compliance, however, was simply sharing the data.

“We shared data by each unit. You didn’t want your unit to be the one with the lowest rate,” said Blue. “We held a campaign in 2015 to determine which unit would come out on top.”

Today, the hospital no longer needs campaigns or contests.

“It’s baked into our culture. It fits with every single thing that we do,” said Blue. “People wash their hands all the time. Before, our hand hygiene audits determined a compliance rate of 40-50 percent. Now we’re up to 80-90 percent.”


Like Eskenazi Health, many hospitals in Indiana are seeking to improve hand hygiene. In early 2017, IHA conducted a member survey to identify compliance rates, barriers and other insights related to hand hygiene. Sixty-six hospitals completed the survey.

Survey respondents reported compliance rates for the fourth quarter of 2016 ranging from less than 45 percent to more than 95 percent; the majority of respondents reported at least an 85 percent compliance rate. The most commonly reported methods to audit compliance were a customized in-house tool (31 percent) and the World Health Organization’s 5 Moments for Hand Hygiene process (28 percent).

Respondents use a variety of methods to promote hand hygiene among caregivers. Thirty of 66 hospital respondents use training, 22 share compliance rates with other units, 22 use signage, 15 promote hand hygiene campaigns and 12 use incentives/rewards.

The top barriers to adequate hand hygiene fell in seven categories: compliance (25 percent), education (19 percent), time (16 percent), data accuracy/reliability (13 percent), speaking up (11 percent), audit difficulties (8 percent) and resources (8 percent).

IHA has used the results of the survey to help launch SOAP UP initiatives throughout the third quarter of 2017. A hand hygiene/SOAP UP resource sheet and pre-written social media posts for hospitals are available on the website under Patient Safety Initiatives. A four-part webinar series highlighting case studies and best practices is taking place throughout the third quarter. The series began on July 18 with upcoming webinars on Aug. 8, Sept. 5 and Sept. 19. SOAP UP webinar information and recordings can be found on the Patient Safety section of as well.