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Assess The Risk Of Underwashed Hands

The Healthcare Circles of Success Workshop

“Outbreaks cost us in credibility and cash. Let’s reset our handwashing.”

This executive call to action moved Handwashing For Life Healthcare to develop a cross-functional framework for the self-assessment of the risk ascribed to compromised hand hygiene in long-term and acute care facilities. The Circles of Success workshop is designed for executives, those with a depth of experience but in divergent disciplines, to collaboratively agree their current risk level and chart a course of continuous improvement.


Healthcare providers, particularly multi-facility operators, can reduce their corporate risk of an outbreak by increasing their ability to preemptively talk about the #1 unresolved risk, poor hand hygiene. These discussions and assessments must become a regular component of strategic planning as well as operational budgeting down to the unit level. Without measured standards, trends are difficult to identify. The words high, moderate and low are by themselves not actionable. There is simply a void in the lexicon of risk. The Circles of Success is a working tool to help establish numbers by identifying an operation’s Handwashing Risk Credit Score.

Poor hand hygiene continues leading the CDC's list of factors contributing to HAIs. The management of the #1 risk warrants specific assessment, agreed standards and a periodic reporting mechanism. Of particular interest is the monitoring of trends to catch the “near misses” rather than waiting for the "crash".

The target-looking cover graphic summarizes a scoring system modeled after the financial community’s way of assessing the risk in lending money. Neither our program nor the financial one represents true science. Both are interpretations and approximations based on history. But both yield actionable numbers. The overall circle graphic is comprised of five segments seen here as pie slices. Each “wedge” or slice represents a stage of the problem-solving process we call the HandsOn System. It is designed to help analyze and implement needed enhancements to the hand hygiene process once the risk is established.

Drilling down on each section, you now see six bands of risk levels from Very Safe at the core to an outer ring of OUTBREAK Waiting to Happen. An identifying trait accompanies each level along with something you might casually hear in unguarded informal situations - something a voice of experience might say when operating in this band. Adding sontaneous phrases from the participants can be helpful in the discussion phase.

A 3-7 member team of assessors is recommended. It should preferably start at headquarters for multi-location companies. For single-site hospitals, be sure to include the C-suite leaders of Operations, Infection Prevention, Patient Safety, Environmental Services, Culinary and Risk Management. They will be collaboratively rating their operation in each of the five slices, representing the five steps to gain process control of handwashing throughout the facility.

What level are we operating at for each of the 5 steps of the HandsOn process? Each participant will place a removable dot in the circle of choice, ready to defend his or her selection. Discussion commences in search of understanding, finding common ground and agreement to a single operational circle and the refinement by assigning a single number.

This is repeated for the five steps and the points added up and divided by 5 to yield your operation's Handwashing Risk Credit Score.

Until an operation measures and monitors handwashing beyond observation, the likelihood of consistently meeting the safe Circle of Success is low. Many good healthcare providers register a risk score of 580 - 679, a range indicating either “Dangerous” or that “Safety Is Threatened.” It is common for us to find handwashing rates at less than 50% of the desired standard. That is the principal driver of low scores and higher risk.

Successfully implemented handwash monitoring, splicing electronic technology with existing observation techniques, is the gateway to the core Circle of Success and the annual saving of thousands of lives.

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Good hand hygiene is critical to any and all healthcare operations. If you are satisfied with your hand hygiene standards and handwashing compliance, keep up the good work and please share with us your system.

Most facilities are less than happy with their hand hygiene compliance and concerned that staff hands, especially at busy times, are less than CareReady®, presenting an unnecessary level of risk for HAIs.