Type of Project


Document Type


Publication Date



Maine Medical Center, Pediatrics, Nursing

MeSH Headings

Child, Hand Hygiene, Ambulatory Care Facilities, Infections, Pediatrics, Infection Control


Did You Wash Your Hands?

Kelley Coyne, RN, OPD Maine Medical Center

Introduction: While there is great focus and education regarding the importance of hand hygiene among healthcare workers there appears to be less focus and education on the importance of patient’s hand hygiene. My observation, as a healthcare provider in pediatrics, is that patient’s compliance with hand hygiene is rare and it appears that there is a need to educate patients on the importance of hand hygiene. Hand Hygiene has the highest efficacy and is a cost effective measure for preventing infection. Researchers in London estimate that if everyone routinely washed their hands a million deaths per year could be prevented. Other studies have shown that handwashing can prevent one in three diarrhea related sicknesses and one in five respiratory infections, such as a cold or the flu. Handwashing can also help fight antibiotic resistance. With fewer illnesses there would be reduced use of antibiotics. Fewer illnesses would mean fewer missed days of school for children, as well as fewer days of missed work and lost wages for parents. Therefore, it is important that patients are educated about the importance of practicing hand hygiene and there is no better place to provide this education than their healthcare provider’s office. It is a fact that patients are a common source of their own infections.

Purpose/PICO question: In the Pediatric Clinic, does providing education on the importance of hand hygiene, vs providing no education, increase compliance of patients practicing hand hygiene?

Method: To achieve a baseline, over a two week period patients were periodically observed entering the clinic. A gel sanitizer dispenser was located at the clinic entry, slightly obscured with no signage. After two weeks signage on how to use gel was hung over the multiple gel dispensers in the clinic. Educational posters were hung in the waiting room, the hallways, exam rooms, and the bath room. A hand hygiene survey was conducted on thirty-nine patients between the ages of four and sixteen years old to test their knowledge and understanding. The survey had a total of eight questions. Simple verbal education was provided, and then a fun hands-on activity was done using glitter bug gel and a black light that showed how well hand hygiene was performed. The same hand hygiene survey was then retaken. Observation of hand hygiene upon patients leaving the clinic was done to see if patient’s compliance of hand hygiene improved.

Results: In the Pediatric Outpatient Clinic hand hygiene was poor at the baseline when patients were entering the clinic. Posters and signage may or may not have had an impact. The initial survey showed poor understanding of hand hygiene. Simple education appeared to engage the patients in a conversation around the importance of hand hygiene, and even some parents became engaged. The glitter gel with the black light appeared to have had the greatest impact on educating the patients regarding hand hygiene. The repeat survey showed significant improvement in the knowledge and understanding of hand hygiene. Increased patient compliance with hand hygiene by using the gel dispenser when exiting the clinic was observed.

Conclusion: Hand hygiene compliance, by patients, in the Pediatric Outpatient Clinic may be improved by providing education on the importance of hand hygiene through the use of posters, hands-on experiments, surveys, and general friendly reminders.

Key Words: Hand Hygiene; Infection Prevention; Pediatrics; Acute Care Clinic Setting