Gregory B. Seymann, MD*;Anthony Biondo, MBA;Reid A Sasaki, MD;Angela Scioscia, MD and Ian Jenkins, MD, SFHM, University of California San Diego Health System, San Diego, CA

Meeting: Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev.

Abstract number: 124

Categories: Innovations Abstracts, Patient Safety

Background: Hospital-associated infections are a significant cause of morbidity and mortality, and are frequently preventable with careful attention to appropriate hand hygiene (HH).  Unfortunately, HH rates among healthcare providers are often unacceptably low. Driving complex behavior change requires influencing attitudes and culture, which can be challenging.

Purpose: To improve safety culture by encouraging all staff who interact with patients to commit to a HH pledge.


We adopted an approach referred to as the “300% HH Pledge,” which consisted of the following elements:


  1. I will wash my hands when entering and exiting a patient room, 100% of the time
  2. I will ask colleagues and visitors to wash if I’m not sure they have, 100% of the time
  3. I will say “thank you” if I am reminded to wash, even if I already have, 100% of the time.

We piloted the pledge on the Hospital Medicine service. We posted a colorful poster with brief background information, the 300% pledge, and a list of physician names in the hospital medicine office. We educated hospitalists about the initiative at faculty meetings and by email, and encouraged them to sign and commit to the pledge behaviors. Within 2 months, 100% of hospitalists signed.

After approval by UCSD’s multidisciplinary Patient Safety Committee, the 300% Pledge initiative was spread throughout the institution. The entire hospital executive leadership team signed the pledge, confirming the institutional commitment and setting a standard for a culture of commitment to HH. We presented the pledge to new resident physicians and fellows during their orientation in June, and recruited local champions across all areas of patient care. Marketing materials, including pledge posters, badge stickers for providers who signed, and educational posters for staff were provided. Individual nursing units identified HH champions to lead unique campaigns best suited to their own culture. For example, the SICU created a bulletin board with photographs of unit staff performing HH; photographs had to be rotated due to high staff engagement. Ancillary services eagerly participated, including rehab services, food services, and housekeeping. Signature rates were reported by unit to a HH Task Force and progress was updated monthly. Results are reported in Figures 1 and 2.


A centrally supported, locally implemented HH pledge campaign effectively impacted safety culture, as measured by the rapidity of provider commitment to signing. More important outcomes, such as HH compliance and infection rates, will be important to track.

To cite this abstract:

Seymann, GB; Biondo, A; Sasaki, RA; Scioscia, A; Jenkins, I . “RAISE YOUR RIGHT HAND:” IMPLEMENTING A HAND HYGIENE PLEDGE TO IMPACT SAFETY CULTURE. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 124. Journal of Hospital Medicine. 2017; 12 (suppl 2). https://www.shmabstracts.com/abstract/raise-your-right-hand-implementing-a-hand-hygiene-pledge-to-impact-safety-culture/. Accessed February 24, 2020.

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