Skip to main content

Background and features of the WHO hand hygiene self-assessment framework

Introduction / objectives

To develop a tool for self-assessment of HH resources, practice and promotion in healthcare facilities (HCF), based on the key components of the WHO Multimodal Hand Hygiene (HH) Improvement Strategy (MHHIS).


A task force (TF) of HH experts developed the tool and identified the following desired features: 1) to reflect the 5 components of the WHO MHHIS; 2) to include measurable indicators based on scientific evidence and expert consensus; 3) to be in the format of a user-friendly questionnaire; 4) to be associated with a score; 5) to be usable repetitively over time. Tool development steps were: 1) identification of indicators, score and format; 2) usability and reliability pilot testing; 3) review and finalization.


The tool was named HH Self-Assessment Framework (HHSAF) and structured in 5 sections corresponding to the WHO MHHIS components (system change; training and education; evaluation and feedback; reminders in the workplace; institutional safety climate for HH). 27 indicators were included and points assigned according to available evidence and importance attributed by experts. WHO implementation tools suited to the improvement of each indicator were referred to within the HHSAF. A score of maximum 100 points was established per each HHSAF section. According to the overall score, 4 HH situation levels were identified: inadequate; basic; intermediate; advanced. Additional leadership criteria for HH reference centres were included. The draft was finalized according to results of usability and reliability tests.


Through a thorough development process, all desired features identified for an optimal HH self-assessment tool at HCF level were successfully fed into the HHSAF.

Disclosure of interest

None declared.

Author information

Authors and Affiliations


Rights and permissions

This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Reprints and Permissions

About this article

Cite this article

Allegranzi, B., Stewardson, A., Grayson, L. et al. Background and features of the WHO hand hygiene self-assessment framework. BMC Proc 5 (Suppl 6), O68 (2011).

Download citation

  • Published:

  • DOI:


  • Healthcare Facility
  • Hand Hygiene
  • Improvement Strategy
  • Tool Development
  • Expert Consensus