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Improving hand hygiene compliance in Singapore via innovation

Introduction / objectives

The National University Hospital (NUH) is a 997 bed acute tertiary hospital. In 2006, we embarked on a MRSA prevention bundle, the cornerstone of which was a hand hygiene (HH) compliance programme.


HH is a standard for NUH hospital accreditation. In 2007 it became an internal key performance area with alcohol hand rub fitted to the foot of all beds. HH audits, using the WHO toolkit were conducted by Infection Control Liaison Nurses across hospitals, medical students and staff from our partner health cluster. Ward-specific audit results were displayed publicly in wards. Poor results were reported to nominated senior clinical ’HH Champions‘. Good compliance results were recognised by the senior leadership. In 2009, a one week training programme demonstrated the WHO 5 moments for HH and the 6 steps to 4000 staff. HH competence was determined with UV lights and “glogerm”. Staff signed a contract and pledged to compliance. Movement activated audio reminders were placed on 3 wards along with posters, hospital wide. On May 5, 2010, a media campaign was launched with a 13 metre high sign posted at the NUH’s façade and internal events including awards and a roaming hand mascot.

Medical and nursing students undertake compulsory HH audits. Candidates in the final medical student (MBBS) clinical examination lose marks for failed compliance.


We published HH compliance rates of 16% in 2006. Through 2010, our rate was 64% with about 1000 observed opportunities/month. Our hand rub purchases increased significantly from 391 units (sd 87) in 2006 to 1760 (sd 308) in 2010.


HH compliance requires active commitment from all, particularly top management. Formal and informal education, stringent audits, public displays and senior management support has significantly raised the HH compliance in NUH.

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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.

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Ang, L., Ooi, K., Lim, A. et al. Improving hand hygiene compliance in Singapore via innovation. BMC Proc 5 (Suppl 6), P124 (2011).

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