Improve your Leapfrog Hospital Safety Grade with Sani Nudge

The Leapfrog Group was established as a non-profit to provide people with important healthcare information. The organization is an advocate for transparency and open access to healthcare data across the United States to improve patient safety and quality of care.

You can access How Safe is Your Hospital on their website to see how a particular hospital ranks in different quality and safety metrics. These rankings are based on the annual Leapfrog Hospital Survey that includes information about patient safety practices, infection rates, medication safety, and much more. 

The requirements encourage hospitals to use a multimodal hand hygiene strategy. To meet the criteria for the Leapfrog hand hygiene standard, each hospital must satisfy all requirements for the Monitoring and Feedback domains and 2 of the 3 other domains (Training & Education, Infrastructure, and Culture).

Is it possible to meet the requirements with direct observation? 

Although direct observation in principle seems simple to implement, it is known to have some inherent disadvantages. Direct observation is a resource and labor-intensive method that can only capture a small fraction of all hand hygiene opportunities. Moreover, the data lack reliability due to the Hawthrone effect (1). 

All in all, meeting hand hygiene standards on the Leapfrog Survey using direct observation can be extremely resource-intensive, expensive, and challenging due to the specific requirements that a facility must meet:

  • Both hand hygiene opportunities and compliance rates need to be included in the observations, which can be very time-consuming when using manual processes and calculations.
  • 200 observations (1.7% of all potential hand hygiene opportunities) must be included in the reporting for each ward to live up to the requirements. That is almost impossible when using direct observation.
  • When people aren’t complying, observers need to step in immediately to prevent harm. The observers will instantly lose their “hidden” status. The reporting will be biased and the results unreliable (2).
  • The observation must be individual rather than collective. The reporting must reveal who practiced hand hygiene, when, and if the person used the correct method. This is difficult to fulfill when you do direct observation. 
  • The observations must include a range of professions (nurses, physicians, techs).
  • Observations must be made during all shifts and days of the week when interacting with patients.

Source: 2022 Leapfrog Hospital Survey 

Leapfrog’s hand hygiene standards can be met in an easier and cost-effective way

Adopting an electronic hand hygiene system like Sani Nudge makes it considerably easier and less expensive for a facility to fulfill Leapfrog’s requirements. 

For example, the Sani Nudge solution enables hospitals to monitor compliance for all shifts, including nights and weekends, capturing around 100 times more opportunities each month than direct observations.

Sani Nudge easily meets all of Leapfrog’s criteria – and much more!

In addition to giving a hospital the resources needed to perform exceptionally well on the Leapfrog hand hygiene survey, Sani Nudge also provides a platform for ongoing hand hygiene improvement and decreasing HAIs.

Contact us to learn more or book a live demo today!




  1. Jeanes A, Coen PG, Gould DJ, Drey NS. Validity of hand hygiene compliance measurement by observation: A systematic review. Am J Infect Control. 2019;47(3):313-322. doi:10.1016/j.ajic.2018.08.004
  2. Srigley JA, Furness CD, Baker GR, Gardam M. Quantification of the Hawthorne effect in hand hygiene compliance monitoring using an electronic monitoring system: a retrospective cohort study. BMJ Qual Saf. 2014;23(12):974-980. doi:10.1136/bmjqs-2014-003080

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A true hand hygiene horror story

At times when I talk with hospitals about the importance of healthcare workers performing hand hygiene I am asked:  “Yes, you can significantly improve hand

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