Qualitative interview study exploring frontline managers’ contributions to hand hygiene standards and audit: Local knowledge can inform practice

•Hand hygiene is a key component of any infection prevention program.•Ward mangers play an important role implementing strategies to promote hand hygiene but little is known about how they go about this aspect of their work.•This study demonstrates that ward managers could identify many of the issues currently emerging as important in contemporary hand hygiene practice and research and adapted organizational strategies to meet ward needs.•These views should be represented when hand hygiene guidelines are reviewed and updated. Frontline managers promote hand hygiene standards and adherence to hand hygiene protocols. Little is known about this aspect of their role. Qualitative interview study with frontline managers on 2 acute admission wards in a large National Health Service Trust in the United Kingdom. Managers reported that hand hygiene standards and audit were modeled on World Health Organization guidelines. Hand hygiene outside the immediate patient zone was not documented but managers could identify when additional indications for hand hygiene presented. They considered that audit was worthwhile to remind staff that hand hygiene is important but did not regard audit findings as a valid indicator of practice. Managers identified differences in the working patterns of nurses and doctors that affect the number and types of hand hygiene opportunities and barriers to hand hygiene. Ward managers were accepted as the custodians of hand-hygiene standards. Frontline managers identified many of the issues currently emerging as important in contemporary infection prevention practice and research and could apply them locally. Their views should be represented when hand hygiene guidelines are reviewed and updated.