Beyond the Unit: Engaging Off-Unit and Across-Unit Staff in Hand Hygiene and Infection Prevention

Hand hygiene improvement efforts often focus on unit-based clinical teams. Nurses, patient care assistants, and unit leaders receive regular compliance updates, participate in audits, and hear frequent reminders from local leadership. As a result, hand hygiene becomes embedded into the daily rhythm of the unit.

However, many healthcare workers move across multiple units or spend limited time on any single unit. Physicians, respiratory therapists, physical therapists, transporters, environmental services staff, imaging personnel, laboratory staff, dietary staff, pharmacists, security personnel, and administrative leaders may interact with numerous patient care areas throughout a shift. These staff members often receive fewer unit-specific reminders, may not see local compliance data, and are less likely to be directly observed by unit leaders.

Yet from an infection prevention perspective, pathogens do not recognize organizational boundaries. Individuals who move between units can inadvertently contribute to the spread of organisms across patient care areas if hand hygiene opportunities are missed. The challenge for healthcare organizations is therefore not simply improving hand hygiene within units, but creating a culture in which infection prevention is viewed as everyone’s responsibility.

Hospitals around the world have increasingly adopted system-wide approaches to hand hygiene improvement. The World Health Organization (WHO) emphasizes multimodal strategies that combine leadership support, education, reminders, feedback, and safety culture rather than relying solely on audits or disciplinary approaches. Studies and international guidance consistently demonstrate that sustainable improvement occurs when hand hygiene becomes an organizational expectation for all healthcare workers, regardless of role or department. (WHO, 2009)

Why Off-Unit Staff Are Often Missed

Several factors contribute to lower engagement among staff who work across multiple units:

• They may not identify strongly with any one unit’s performance metrics.
• They often miss unit huddles, staff meetings, and local education sessions.
• Their leaders may not routinely observe their patient interactions.
• Unit-specific compliance data may not feel relevant to them.
• Their workflow often involves frequent movement between patient care environments, increasing the number of hand hygiene opportunities.

These challenges do not reflect a lack of commitment to patient safety. Rather, they highlight the need for organizations to deliberately include mobile and non-unit-based staff in infection prevention efforts.

1. Shift Hand Hygiene Messaging from Unit Ownership to Organizational Ownership

Many hospitals unintentionally frame hand hygiene as a nursing initiative or unit-based quality metric. A more effective approach is to communicate that hand hygiene is a core organizational safety expectation that applies equally to every individual entering a patient care environment.

The CDC identifies hand hygiene as a fundamental infection prevention practice that applies to all healthcare personnel and all care settings. Similarly, WHO guidance emphasizes safety culture and institutional commitment as essential elements of successful hand hygiene programs. (CDC, 2024b) When staff hear consistent messaging that infection prevention belongs to everyone, engagement becomes less dependent on unit affiliation.

Organizations can reinforce this principle by:

• Including hand hygiene expectations in orientation for all staff groups.
• Reporting department compliance performance along side unit-specific performance based on staff roles
• Reporting organization-wide compliance performance rather than only unit-specific results.
• Including non-nursing departments in infection prevention campaigns.
• Incorporating hand hygiene into annual competency reviews across disciplines.

2. Use Department-Specific Feedback Rather Than Unit-Specific Feedback

One reason off-unit staff disengage from hand hygiene initiatives is that they rarely see data connected to their own work. Hospitals that successfully engage mobile staff frequently provide feedback through professional departments rather than through patient care units alone. For example:

• Respiratory therapy receives respiratory therapy compliance data.
• Transport services receive transporter observations.
• Environmental services receive EVS-specific observations.
• Medical staff receive physician-specific compliance reports.

This approach creates accountability within professional groups while avoiding the perception that hand hygiene is solely a nursing responsibility.

Feedback remains one of the core components of the WHO Multimodal Hand Hygiene Improvement Strategy because it helps individuals understand their performance and identify opportunities for improvement. (WHO, 2024)

3. Expand Peer-to-Peer Reminders Across Disciplines

Research and international guidance consistently recognize safety culture as a key driver of infection prevention success. One hallmark of a strong safety culture is that any staff member feels empowered to respectfully remind another person about hand hygiene. (WHO, 2026)

Hospitals can strengthen this practice by:

• Establishing a “remind and thank” culture.
• Training staff on respectful reminder language.
• Encouraging leaders to model receiving reminders positively.
• Recognizing staff who intervene to protect patients.

Simple phrases such as, “Can I get you some sanitizer?” or “Let’s gel in before we enter.” can normalize peer accountability without creating conflict. Importantly, peer reminders work best when they are viewed as patient safety interventions rather than personal criticism.

4. Engage Non-Clinical Staff as Infection Prevention Partners

Many healthcare facilities focus hand hygiene education primarily on clinical staff. Yet environmental services, transport personnel, dietary staff, volunteers, and administrative leaders frequently enter patient care environments and influence infection prevention culture.

The CDC emphasizes that preventing transmission of pathogens requires coordinated efforts across healthcare personnel and environmental systems. Environmental contamination is often transferred through hand contact, highlighting the importance of engaging all staff groups in infection prevention activities. (CDC, 2024c)

Practical approaches include:

• Including non-clinical departments in hand hygiene campaigns.
• Recognizing non-clinical staff for infection prevention contributions.
• Inviting non-clinical staff to participate in infection prevention committees.
• Sharing infection prevention successes organization-wide rather than limiting recognition to clinical units.

When all staff understand how their actions affect patient safety, hand hygiene becomes a shared responsibility rather than a departmental requirement.

5. Increase Leadership Visibility Across Departments

Unit leaders often provide frequent reinforcement to their own teams. Mobile staff may receive significantly less direct engagement from leaders regarding hand hygiene expectations.

WHO guidance identifies institutional safety climate and leadership support as critical elements of successful hand hygiene programs. (WHO, 2025)

Hospitals can strengthen engagement by:

• Including infection prevention discussions during interdisciplinary rounds.
• Conducting leadership rounds that include ancillary departments.
• Recognizing positive hand hygiene behaviors in all staff groups.
• Discussing hand hygiene performance during physician, therapy, and ancillary department meetings.

Visible leadership involvement communicates that hand hygiene remains an organizational priority regardless of role or location.

Moving from Unit Compliance to Organizational Culture

The highest-performing organizations recognize that infection prevention does not belong to a single department, profession, or unit. Every individual who enters a patient care environment contributes either to reducing risk or increasing it.

While unit-based initiatives remain important, hospitals that achieve sustained improvement often broaden their focus to include staff who move between units and departments. By establishing organizational ownership, providing department-specific feedback, encouraging peer accountability, engaging non-clinical staff, and increasing leadership visibility, healthcare organizations can create a culture in which hand hygiene is not simply a unit metric but a shared commitment to patient safety.

Infection prevention succeeds when every staff member, regardless of title or location, understands that clean hands protect patients.

References

Centers for Disease Control and Prevention. (2024a). Clinical Safety: Hand Hygiene for Healthcare Workers. Retrieved from https://www.cdc.gov/clean-hands/hcp/clinical-safety/index.html

Centers for Disease Control and Prevention. (2024b). Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings. Retrieved from https://www.cdc.gov/infection-control/hcp/core-practices/index.html

Centers for Disease Control and Prevention. (2024c). Environmental Services: Guidelines for Environmental Infection Control in Health-Care Facilities. Retrieved from https://www.cdc.gov/infection-control/hcp/environmental-control/environmental-services.html

Centers for Disease Control and Prevention. (2024d). Isolation Precautions: Fundamental Elements Needed to Prevent Transmission of Infectious Agents in Healthcare Settings. Retrieved from https://www.cdc.gov/infection-control/hcp/isolation-precautions/prevention.html

World Health Organization. (2009). A Guide to the Implementation of the WHO Multimodal Hand Hygiene Improvement Strategy. Geneva: WHO. Retrieved from https://www.who.int/publications/i/item/a-guide-to-the-implementation-of-the-who-multimodal-hand-hygiene-improvement-strategy

World Health Organization. (2025). Infection Prevention and Control: Hand Hygiene. Retrieved from https://www.who.int/teams/integrated-health-services/infection-prevention-control/hand-hygiene

World Health Organization. (2009). WHO Guidelines on Hand Hygiene in Health Care. Geneva: WHO. Available through the National Center for Biotechnology Information. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK144013/