In the home health and hospice world, you’re juggling endless big picture essentials: patient care, billing, and scheduling. But sometimes, it’s the seemingly “small things” that create the biggest risks. One of the most common? Hand hygiene.
It sounds simple: wash or sanitize your hands before and after certain touch points during patient care. But surveyors consistently cite agencies for hand hygiene failures. Why? Because without practice and documentation, you can’t prove your staff are consistently doing it. And that puts patient safety, compliance, and your agency’s reputation at risk.
*This article was written in consultation with Mariam Treystman.
At The Home Health Consultant, we’ve guided hundreds of agencies through surveys and compliance programs. We know exactly what surveyors look for when it comes to infection control, and how hand hygiene logs can help you avoid citations while protecting patients.
In this article you’ll learn:
- A quick history of hand hygiene
- Why keeping hand hygiene logs is important
- Best-practices for keeping (and maintaining!) hand hygiene logs
Why and When Did Handwashing Become a Pillar of Healthcare?
In the mid-1800s, Ignaz Semmelweis, a doctor in Vienna, noticed a dramatic difference between two maternity wards: one run by doctors and one by midwives. Women in the doctors’ ward, where physicians delivered babies after performing autopsies, were three times more likely to die of childbed fever. Dr. Semmelweis introduced handwashing with chlorinated lime, and maternal mortality dropped from 18% to under 2% within a year.
This discovery highlighted a foundational truth: proper hand hygiene is essential for preventing healthcare-associated infections. That same principle underlies the hand hygiene logs you keep, and saves lives daily.
What Are Hand Hygiene Logs and Why Do Agencies Need Them?
Hand hygiene logs are forms agencies use to evaluate and document whether staff follow correct hand hygiene practices. They prove your team is not only trained, but also observed and tested on infection control.
Accreditors like ACHC and The Joint Commission expect to see them. In fact, for TJC, hand hygiene is tied to a National Patient Safety Goal, which means surveyors are extra tough on it.
Importance Nuance: Hand hygiene isn’t just about washing your hands. It’s about when you wash, whether you use soap vs. sanitizer, how you glove, and how you avoid recontaminating yourself. Logs must reflect all of these elements, not just a yes/no checkbox.
How Often Should Agencies Perform Hand Hygiene Checks?
Every clinician must be evaluated at least once per year.
Agencies often choose between two approaches:
- Annual check month: Pick a month (like October) and evaluate every clinician during that time.
- Quarterly checks: Evaluate new hires right away and spread out checks for current staff across the year.
Smaller agencies can realistically evaluate all staff in one round, while larger agencies may find it more practical to stagger evaluations by quarter.
How Should Agencies Conduct Hand Hygiene Evaluations?
The most effective evaluations happen during real patient visits. That’s because home environments aren’t as controlled as hospitals or classrooms. So, watching staff wash up in a real kitchen or bathroom is the best way to assess compliance.
Other options, like simulations with fake patients, are acceptable but less ideal.
Best practices:
- Combine hand hygiene checks with other required visits (like annual competencies or supervisory visits) to save time.
- Let the clinician complete their hand hygiene process before offering feedback. Don’t interrupt mid-process.
What Should Be Documented in a Hand Hygiene Log?
An effective log goes beyond “did they wash?” and should include every step of proper technique:
- Timing: before and after patient contact, after touching surfaces, before glove use.
- Method: soap and water vs. sanitizer.
- Accuracy: no missed steps, no recontamination (like touching a dirty surface after washing).
- Result: 100% accuracy required.
If a clinician doesn’t pass, it’s not as simple as correcting their mistake and moving on. Surveyors want to see that agencies don’t just track failures, but also correct them.
What Happens If a Clinician Fails a Hand Hygiene Check?
Failing a hand hygiene evaluation isn’t uncommon. How your agency responds to the failure is what matters.
- Provide on-the-spot education.
- Require the clinician to redo the process until it’s correct.
- Schedule a surprise recheck within 1–4 weeks to confirm retention.
- Document the initial failure, re-education, and retest.
Surveyors may ask to see not only logs, but also how failures were handled. If you have a failure on record but no follow-up, it’s an easy deficiency.
Logs should also feed into your QAPI program. CMS and accreditors want to see that agencies review results during QAPI meetings and take action if patterns emerge.
Why Do Home Health and Hospice Agencies Need to Keep Hand Hygiene Logs?
Hand hygiene is simple, but failures are one of the most common survey deficiencies. Logs provide proof that your staff know the rules and follow them.
Hand hygiene logs don’t need to be complicated. A simple form combined with real-world observation is enough, as long as it’s used consistently.
To improve or start your hand hygiene logs off strong:
- Schedule annual hand hygiene evaluations into your calendar.
- Use real patient visits when possible.
- Don’t stop until you achieve 100% accuracy (with retesting for failures).
Hand hygiene logs are just one part of a bigger picture. To explore a more overarching picture of infection control compliance for home health & hospice, check out the article below.
*Disclaimer: The content provided in this article is not intended to be, nor should it be construed as, legal, financial, or professional advice. No consultant-client relationship is established by engaging with this content. You should seek the advice of a qualified attorney, financial advisor, or other professional regarding any legal or business matters. The consultant assumes no liability for any actions taken based on the information provided.
