Rethinking Hand Hygiene in Healthcare: A Comprehensive Approach to Infection Control

By Robert P. Lee

This article appears in the Jan-Feb 2026 issue of Healthcare Hygiene magazine.

Infection prevention is one of the cornerstones of patient safety in healthcare settings. The importance of hand hygiene in preventing the spread of harmful pathogens cannot be overstated, particularly in environments where patients are vulnerable to hospital-acquired infections (HAIs). However, there exists a significant gap between the strict hand hygiene protocols followed in the operating room (OR) and those adhered to in general patient-care areas. This discrepancy raises the question: Why is hand hygiene so rigorously enforced in the OR, yet sometimes underemphasized in other parts of the hospital, despite similar infection risks? And, what can be done to address this imbalance?

Infection Risk Beyond the Operating Room: The Unsung Danger of Patient-Care Areas
At first glance, one might assume that the OR represents the highest infection risk due to the need for sterile conditions during surgery. While this is true, the infection risks outside the OR are just as serious—if not greater. Once a patient leaves the sterile environment of the OR and enters general care areas, they are exposed to a broader range of infection risks. The patient's immunocompromised state after surgery, coupled with high-contact surfaces in patient rooms and shared medical equipment, makes the hospital environment ripe for the transmission of pathogens like MRSA, C. difficile, and other multi-drug-resistant organisms (MDROs).

In fact, the environment outside the OR may even pose a greater risk due to a higher number of contamination points. Bed rails, IV poles, thermometers, blood pressure cuffs, and patient monitoring equipment are all potential sources of infection. The risk increases significantly when healthcare workers interact with these surfaces and then move between tasks without sanitizing their hands, introducing cross-contamination to the patient or the environment. Moreover, patient hands, which often carry pathogens from contact with bodily fluids or surfaces, can further contribute to the spread of infection.
Given that the pathogens in both the OR and the general patient care areas are the same, it becomes clear that infection control protocols should be just as stringent in patient rooms, intensive care units (ICUs), and other care areas as they are in the OR.

The Role of Gloves and Hand Hygiene: A Critical, Yet Overlooked, Link
One of the most important aspects of infection control in both the OR and patient-care areas is the proper use of gloves and hand hygiene. Healthcare workers often rely on gloves as a barrier against pathogens, but gloves are not a substitute for hand hygiene. Before donning gloves, it’s essential to perform hand hygiene to eliminate any microorganisms present on the hands. Likewise, after gloves are removed, hand hygiene must be performed again to ensure that no pathogens transferred to the gloves are spread to the healthcare worker’s hands or the environment.

Multiple Glove Changes and Hand Hygiene Events
In many situations, multiple glove changes are necessary during patient care. For example, after touching a patient, a healthcare worker might change gloves before interacting with equipment or the patient’s environment. This requires frequent hand hygiene events between glove changes. The process may seem cumbersome, but it is essential for reducing the risk of contamination. Each glove change represents a new opportunity to eliminate pathogens before they spread.

Remember, gloving only protects the wearer, not the patient, when proper hand hygiene and proper changing of gloves is ignored.
To facilitate this process, strategically placed hand hygiene stations are critical. Hand sanitizers should not just be available at doorways or sinks but at the point of care—at the bedside, near IV poles, at workstations, and on equipment. By having hand hygiene dispensers within arm’s reach of where healthcare workers are actively engaged in patient care, the likelihood of adherence to infection control protocols increases significantly. This approach would eliminate the need for healthcare workers to leave the point of care to access hand hygiene stations, making the process more efficient and seamless.

Optimizing Workflow: The Case for More Dispensers at the Point of Care
Workflow disruptions caused by poorly deployed or malfunctioning hand hygiene dispensers are a common frustration for healthcare workers. Empty dispensers, hard-to-reach locations, or dispensers placed too far away from where care is being delivered can lead to lapses in hand hygiene compliance. Traditionally, hand sanitizers have been placed at doorways and near sinks, based on the previous entry/exit workflow. However, this approach doesn’t consider the dynamic nature of patient care, where workers need to sanitize their hands multiple times during each interaction with the patient or their environment.
To streamline infection control and improve workflow efficiency, hand hygiene dispensers should be placed at the point of care. For instance, placing dispensers:
• At the bedside (on both sides and at the foot of the bed) allows workers to sanitize before and after patient interaction.
• Near IV poles, medication workstations, and patient equipment allows for hand hygiene after handling devices or medications.
• By work areas (such as patient charts, nurse stations, and diagnostic equipment) ensures hygiene between tasks.

This strategy ensures that healthcare workers can sanitize their hands at each critical moment, in alignment with the WHO’s 5 Moments of Hand Hygiene. The five key moments—before patient contact, before a clean/aseptic procedure, after bodily fluid exposure, after patient contact, and after touching the patient’s environment—are moments when hand hygiene can break the chain of infection. The more dispensers are available where care is taking place, the more likely it is that these moments will be acted on effectively.

Recommendation: Get a Lean 6 Sigma analysis completed for workflow by unit.

Vendor Collaboration: Meeting the Demands of Modern Healthcare
To implement this vision of more strategically placed dispensers, vendors must be engaged to provide more dispensers and develop innovative solutions that meet the needs of healthcare settings. It’s not enough to simply add more dispensers; they must be placed at critical touchpoints within the workflow. Hand sanitizers should be available in places where healthcare workers need to sanitize their hands most — near the patient, at workstations, and by medical equipment. This strategic placement will ensure that infection control is integrated seamlessly into the daily care process.

Also remember: Vendors need to evolve their technology to capture all hand hygiene opportunities particularly inside the patient room. What does measuring hand hygiene compliance at the doorway tell you? Really nothing with respect to patient and high touch interaction? Patient and patient environment touches are not a single event. So, you sanitized your hands at the door but touched so many contaminated surfaces while you are inside the patient room. Don’t be fooled by slick marketing, pretty dashboards and more data than you are used to. Understand the data as it relates to a safe workflow. Understand your patient and high touch workflow environment, as it is different for different units.

The Role of Visitors: A Key Element in Infection Control
One often overlooked aspect of infection control is the role of hospital visitors. While healthcare workers are educated and trained in proper hand hygiene, visitors are less likely to be aware of the critical role they play in preventing infection. Visitors who enter the hospital can unknowingly introduce pathogens to the patient environment by touching common surfaces like door handles, chairs, and the patient’s bed. Their actions, while well-intentioned, can expose patients to additional infection risks.

Hospitals must implement visitor safety protocols to limit the spread of infection. These protocols should include:
• Require hand sanitization upon entering your facility
• Require mandatory hand hygiene training and education for visitors at time of entry
• Encourage visitors to wash or sanitize their hands before and after interacting with the patient or touching surfaces.
• Post clear signage to remind visitors of the importance of hand hygiene.
• Provide hand sanitizers at the entrances to patient rooms, so visitors have easy access before entering.

Moreover, allowing patients to perform hand hygiene—with dispensers at the bedside—would enable healthcare workers to guide patients in maintaining hygiene, especially when they are most vulnerable. Teaching patients to clean their hands before meals, after using the restroom, or before interacting with medical devices can significantly reduce the transmission of pathogens.

High-Touch Surface Disinfection and the Role of EVS
So, the question is, if hand hygiene compliance is 90-plus percent based on an entry/exit metric, then why are we still seeing infections on the rise and antibiotic resistance increasing unchecked and predicted to be a major health issue in the near future? Could it mean that hand hygiene is not the No. 1 preventive that we thought it was? Or are there other factors that must be synchronized with hand hygiene to make it move the needle on infection? The Society for Healthcare Epidemiology of America (SHEA) promotes a “horizontal” versus “vertical” approach, which suggests multiple simultaneous interventions. The World Health Organization (WHO) promotes patients and high-touch surfaces (Moment 5). What we have learned from the OR is that both work together.

Unfortunately, the further you get away from the OR the less focus and resources are dedicated to hand hygiene compliance and high-touch disinfection. In fact, in many observed cases, environmental services (EVS) doesn’t even show up (we call this “proof of presence”). How do we know this? Sensor technology allows us to track, map and document human asset activity. Many hand hygiene technologies can provide this data when deployed on EVS personnel. Advanced technology can provide in-room activity data, such as cleaning of workstations, IV poles, bed rails, patient bathroom, etc.

So, do you know what your EVS team is doing, how they are spending their time?

Finally, to support EVS, some thought ought to be given for nursing to do a quick high-touch clean for each patient during turnover. This would ensure that a minimal level of disinfection was performed. If I was a nurse, I would want to ensure that the hand off of patient and patient environment was safe, both clinically and physically.

Moving Forward: Integrating Infection Control into the Healthcare Workflow
To truly minimize the risk of infection and improve patient safety, healthcare organizations must move beyond static infection control measures. The key to a more effective approach lies in integrating hand hygiene seamlessly into the healthcare workflow. This means deploying more hand hygiene stations at the point of care, ensuring that they are within arm’s reach whenever a healthcare worker needs to sanitize their hands. By working closely with vendors, hospitals can ensure that dispensers are strategically placed at critical points and that the system aligns with the WHO 5 Moments of Hand Hygiene.
In addition to healthcare workers, visitors and patients must be part of the infection control process, and their participation in hand hygiene should be actively encouraged. Together, we can create an environment where infection prevention becomes an inherent part of every interaction, ensuring that patients are protected and that healthcare workers can perform their tasks without unnecessary barriers.

By addressing these key areas — workflow optimization, strategic dispenser placement, glove use, patient hand hygiene, and visitor safety protocols — we can transform infection control from a task to a natural part of the patient care experience, ultimately reducing the burden of hospital-acquired infections and improving patient outcomes.

Robert Lee, BA, the CEO and founder of MD-Medical Data Quality & Safety Advisors, LLC, is the senior biologist and performance improvement consultant. MD-MDQSA is the home of The IPEX - The Infection Prevention Exchange, a digital collaboration between selected evidence-based solutions that use big data, technology, and AI to reduce risk of HAIs.