The Association for Professionals in Infection Control and Epidemiology (APIC) has issued a formal request to The Leapfrog Group urging a revision of its hand hygiene observation requirements, citing a critical misinterpretation of the World Health Organization (WHO)'s guidance.

In a letter sent to Leah Binder, president and CEO of Leapfrog, APIC CEO Devin Jopp highlighted that Leapfrog’s current standard of 100–200 observations per hospital unit per month is not supported by WHO’s 2009 guidelines. Contrary to Leapfrog’s interpretation, APIC says, WHO does not prescribe a fixed monthly minimum. Instead, it recommends a cumulative approach—12 to 15 observations per denominator, repeated over several weeks, totaling 150 to 200 observations over time to ensure statistical significance. This clarification was provided directly to APIC in response to a formal inquiry submitted to the WHO.

“Leapfrog’s requirement is based on a misinterpretation of WHO’s intent,” said Jopp. “This standard has led to excessive observation burdens that divert critical resources away from more impactful infection prevention efforts.”

In an analysis more than 800,000 ) hand hygiene observations, APIC’s Center for Research, Practice, and Innovation (CRPI found that 50 observations per unit per month are sufficient to maintain data quality and detect meaningful compliance trends. This evidence-based approach aligns with WHO’s clarified guidance and reflects the operational realities faced by infection prevention professionals nationwide.

APIC is calling on Leapfrog to revise its standard to reflect this more practical and scientifically sound baseline. Additionally, APIC recommends that Leapfrog recognize facilities that exceed the baseline through commendations, rather than tying core scoring or rankings to higher observation volumes.

“We welcome the opportunity to partner with Leapfrog on a solution that supports both rigorous quality measurement and practical implementation,” added Jopp.

Source: Association for Professionals in Infection Control and Epidemiology (APIC)