Using Workflow Diagrams to Address Hand Hygiene in Pediatric Long-Term Care Facilities 1

• Pediatric long-term care facility staff developed workflow diagrams highlighting hand hygiene.
• Six workflow diagrams were developed, which underwent 22 validation exercises.
• Several overarching infection prevention themes emerged during validation observations.
• Workflow diagrams helped to identify the complexity of hand hygiene practices.
• The development of workflow diagrams helped to engage staff in hand hygiene practices.

Hand hygiene (HH) in pediatric long-term care settings has been found to be sub-optimal. Multidisciplinary teams at three pediatric long-term care facilities developed step-by-step workflow diagrams of commonly performed tasks highlighting HH opportunities. Diagrams were validated through observation of tasks and concurrent diagram assessment. Facility teams developed six workflow diagrams that underwent 22 validation observations. Four main themes emerged: 1) diagram specificity, 2) wording and layout, 3) timing of HH indications, and 4) environmental hygiene. The development of workflow diagrams is an opportunity to identify and address the complexity of HH in pediatric long-term care facilities.