Why hand hygiene is not sufficient: modeling hygiene competence of clinical staff as a basis for its development and assessment

Adhering to hygiene standards in daily clinical work is an important characteristic of qualitatively high-value medical care. In this regards, hand hygiene is often focused on in the literature. From the viewpoint of medical education research, we argue that this focus is too narrow to explain how staff who are working clinically with patients implement and adhere to standards of hygiene across a wide variety of tasks of their daily clinical routine. We present basic features of a differentiated concept of hygiene competence, which includes specialized knowledge, corresponding inner attitudes, and action routines that are customized to the needs of specific situations. Building on that, we present a current simulation-based course concept aimed at developing hygiene competence in medical education. Furthermore, we describe a test instrument that is designed according to the principle of a situational judgment test and that appears promising for the assessment of hygiene competence. The course and the measurement instrument are discussed in regards to their fit to the competence model and the related perspectives for research and teaching.