Table 4 Levels of Hand Hygiene Implementation Progress Defined by the WHO Hand Hygiene Self-Assessment Framework (HHSAF)

Inadequate

Hand hygiene practices and promotion are deficient. Significant improvement is required

Basic

Some measures are in place, but not at a satisfactory standard. Further improvement is required

Intermediate

An appropriate hand hygiene promotion strategy is in place, and hand hygiene practices have improved. It is now crucial to develop long-term plans to ensure that improvement is sustained and progresses

Advanced

Hand hygiene promotion and optimal hand hygiene practices have been sustained and/or improved, helping to embed a culture of safety in the healthcare setting

Leadership^a

The healthcare facility is considered as a reference center for and contributes to the promotion of hand hygiene through research, innovation and information sharing