Pediatric Annals

Editorial Free

Hand Hygiene Strategy, Masks, Social Distancing, and Modified Rounds During the COVID-19 Pandemic in the Medical Center

Joseph R. Hageman, MD

At Comer Children's Hospital, we have an electronic hand hygiene (HH) monitoring system that provides HH compliance rates. Clinicians have weekly calls with pediatric infectious disease and infection control colleagues to examine HH compliance all over the hospital, including the clinical transition care unit (CTCU) portion of the neonatal intensive care unit.

During the call, the infectious disease professionals ask our team of clinicians what interventions have been instituted to improve awareness of the importance of washing our hands with either soap and water or cleansing with hand sanitizer before and after we enter every patient room.1–5 Thanks to all of the clinicians including the nurses, nursing managers, neonatal nurse practitioners, residents, fellows, attending neonatologists, and patient care advocates, HH compliance at Comer Children's Hospital has not only significantly improved, but has been sustained over the last year in the CTCU (Figure 1).

Hand hygiene data at Comer Children's Hospital from 2018 to 2020.

Figure 1.

Hand hygiene data at Comer Children's Hospital from 2018 to 2020.

With the ongoing coronavirus 2019 (COVID-19) pandemic, HH, wearing masks, social distancing, and modified rounding on the units in the hospital, as was outlined in a previous editorial,6 are all important parts of keeping hospital-acquired COVID-19 infection rates low. Different strategies to encourage and reinforce the importance of HH have been used in hospitals on different units including reminder signs, text messages, HH champions (clinicians who observe HH on the unit and remind colleagues and caretakers to wash or sanitize their hands), staff incentives (rewards and prizes), verbal reminders from colleagues and patients, and electronic HH technology.1–8

A quality improvement initiative using multiple plan-do-study-act cycles with interventions including focused education, timely feedback, empowering patients and families to participate in mitigation, interdisciplinary HH champions, and audits demonstrated an increase in HH compliance rates from an average of 87% to more than 95% within a 9-month period, which was sustained for more than 2 years on both pediatric units.3

However, mixed results of other interventions2,7,8–11 in other hospital studies using variations from reminder signs to electronic technology demonstrate the challenge of sustaining HH. The World Health Organization (WHO) has a HH intervention that identifies five specific times for hand washing when caring for patients: (1) before touching the patients, (2) before antiseptic procedures, (3) after body fluid exposure or risk, (4) after touching the patient, and (5) after touching patient surroundings.11,12

In a recent cohort study of 9,149 patients who were admitted to a hospital, 697 of them were positive for COVID-19.13 Of the 697 patients with COVID-19, only two acquired the infection in the hospital: “1 patient was likely infected by a presymptomatic spouse before visitor restrictions were implemented, and 1 patient developed symptoms 4 days after a 16-day hospitalization but without known exposures in the hospital.”13

Let us continue to observe and follow these infection control strategies as we provide care for all of our patients and their families.


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  3. McLean HS, Carriker C, Bordley WC. Good to great: quality-improvement initiative increases and sustains pediatric health care worker hand hygiene compliance. Hosp Pediatr. 2017;7(4):189–196. doi:10.1542/hpeds.2016-0110 [CrossRef] PMID:28280120
  4. Linam WM. Linman WM Speaking up: the next step to improving health care worker hand hygiene. Hosp Pediatr. 2017;7(4):245–246. doi:10.1542/hpeds.2016-0212 [CrossRef] PMID:28280119
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  6. Hageman JR. What is the “new normal” for pediatric care?Pediatr Ann. 2020;49(8):e326–e327. doi:10.3928/19382359-20200722-01 [CrossRef] PMID:32785713
  7. Cawthorne KR, Cooke RPD. Innovative technologies for hand hygiene monitoring are urgently needed in the fight against COVID-19. J Hosp Infect. 2020;105(2):362–363. doi:10.1016/j.jhin.2020.04.005 [CrossRef] PMID:32304726
  8. Lotfinejad N, Peters A, Pittet D. Hand hygiene and the novel coronavirus pandemic: the role of healthcare workers. J Hosp Infect. 2020;105(4):776–777. doi:10.1016/j.jhin.2020.03.017 [CrossRef] PMID:32201339
  9. Centers for Disease Control and Prevention. Coronavirus disease 2019 (COVID-19). Accessed November 17, 2020.
  10. The Joint Commission. Preventing coronavirus transmission in the hospital setting. Accessed November 17, 2020.
  11. World Health Organization. Coronavirus disease (COVID-19): infection prevention and control for health care workers. Accessed November 17, 2020.
  12. World Health Organization. Save lives – clean your hands campaign. Accessed November 17, 2020.
  13. Rhee C, Baker M, Vaidya V, et al. CDC Prevention Epicenters Program. Incidence of nosocomial COVID-19 in patients hospitalized at a large US academic medical center. JAMA Netw Open. 2020;3(9):e2020498. doi:10.1001/jamanetworkopen.2020.20498 [CrossRef] PMID:32902653
Joseph R. Hageman, MD

Pediatric Annals Editor-in-Chief Joseph R. Hageman, MD, is the Director of Quality Improvement, Section of Neonatology, Comer Children's Hospital; a Senior Clinician Educator, The University of Chicago Pritzker School of Medicine; and an Emeritus Attending Pediatrician, NorthShore University HealthSystem.

Address correspondence to Joseph R. Hageman, MD, via email:

Disclosure: Joseph R. Hageman is a member of the Owlet, Inc advisory board.


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