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TST for Hand Hygiene Frequently Asked Questions

Using the TST

Questions And Answers

Using the TST

Who do I contact with questions about the TST?

Contact with your name, organization name, organization location, and, if possible, your International Health Care Organization identification number (IHCO ID). JCI staff will respond to your email within two business days.

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What is the Targeted Solutions Tool® (TST®)?

The TST is a unique online application that simplifies the process for solving persistent health care quality and safety problems. Introduced in 2010, the TST was developed by the Joint Commission Center for Transforming Healthcare to enhance efforts that accredited organizations are making to tackle these difficult and pressing problems. The TST guides health care organizations through a step-by-step process to measure their organization’s actual performance, identify barriers to excellent performance, and direct them to proven solutions that are customized to address their particular barriers.

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How are Targeted Solutions identified at the Center?

Participating health care organizations use process improvement methods to identify targeted solutions. First, they measure the problems with rigor. In many cases they learn that they are not doing as well as they thought they were. Then they identify exactly why the processes are failing, create solutions that address the most critical contributing factors, and prove the effectiveness of those solutions. 

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Who can use the TST?

The TST is available to all JCI-accredited organizations. It can be accessed via JCI Direct Connect.

The Hand Hygiene module is targeted toward hospitals, but can be used by any organization where hand hygiene impacts patient care. 

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Is there a cost or fee associated with the TST?

No. The TST is available to all JCI-accredited organizations at no charge.

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Why should I use the TST for Hand Hygiene?

The TST provides the foundation and framework for an improvement method that, if implemented as directed, will improve an organization’s hand hygiene compliance and contribute to its efforts in reducing the frequency of health care-associated infections. The leading United States hospitals and health care systems that developed the hand hygiene solutions have achieved and continue to show major and sustained gains in hand hygiene.

In 2012 an international pilot with JCI–accredited organizations began and, although data are still being collected and analyzed, a 72% improvement in hand hygiene practices was reported. 

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Do I need to have RPI experience?

No, there is no requirement to have Robust Process Improvement™ (RPI) expertise or experience. The TST is designed so that any health care professional can conduct a project, regardless of process improvement or project facilitation experience. The tool involves practical steps to improve processes and measure progress.

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How do I access the TST?

You can access the TST through JCI Direct Connect. Look under the Resources tab.


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Will information that I enter into the TST be made public?

No. Organization-specific information will not be made public. It is confidential and for your organization’s use only. It will not be used in the accreditation process. Aggregated (de-identified) compliance information may be made available.

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Will using or not using the TST affect my JCI accreditation?

No. Any information entered into the TST is kept confidential and will not be used in the accreditation process. An accreditation surveyor has no way of knowing that an organization is using the TST unless the organization shares this voluntarily.

However, if an organization chooses to use TST work as part of its annual proactive risk assessment, then proof of use will be necessary.

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Is there a time limit to complete my use of the TST?

No, using the TST is voluntary and self-paced.

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How long will a hand hygiene project take to complete?

The duration of a hand hygiene project varies from organization to organization. Unit-based projects have generally lasted from six to 12 weeks, depending on the resources and experience of the organization.

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How many staff members should be on a hand hygiene project team?

A core team of three to seven people is recommended.

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What type of staff should be on a hand hygiene project team?

The team should include a strong physician champion and a project leader to facilitate meetings and help gain buy-in from stakeholders. Include the manager of the pilot unit and people who work in the area, including ancillary staff, when appropriate (for example, housekeeping, lab, respiratory therapy). It is important to identify and involve the project stakeholders.

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How much staff time and commitment will a hand hygiene project require?

You will need to obtain management support for your project and assemble a project team. Project teams can be expected to spend up to four hours a week collecting and entering compliance data, attending team meetings, and implementing solutions during the first 12 weeks of the project. You can expect to spend four hours each month to sustain the gains achieved by the hand hygiene improvement strategies.

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What is a project charter?

A project charter is a written document that defines the scope, team members, goals, and completion dates of the hand hygiene pilot project. The project charter is signed by the project team members as a demonstration of their support for the project and their agreement on the project’s goals and scope.

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Why is hand hygiene defined as “wash in/wash out?”

This observation was chosen as the method to determine baseline and post-solution hand hygiene compliance rates. However, it is nearly impossible to accurately observe hand hygiene compliance when washing occurs in a patient’s room. The Center decided to adopt the philosophy of “wash in/wash out” which directs health care personnel to wash their hands upon entry and exit from a patient’s room. This allows for accurate measurement, while still promoting the philosophy of washing before and after patient contact.

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WHO and CDC guidelines address hand hygiene when a health care worker touches a patient or the health care environment and this is what our policy reflects. How do we reconcile this with "wash in/wash out?"

The concept of “wash in/wash out” describes a minimum number of times a health care worker should conduct hand hygiene when entering and exiting a patient’s room. If patient care necessitates the additional washing of hands (more than is required with “wash in/wash out”), this should be done in accordance with WHO, CDC, or other recognized hand-hygiene guidelines.

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Have TST users measured and tried to improve the hand washing compliance of patients and visitors?

The TST does not measure hand washing compliance of patients and visitors. CDC and WHO guidelines are directed toward health care personnel only. The CDC definition of health care personnel excludes patients, family members, and other visitors, but does include students, volunteers, and other health care workers with direct patient contact. Studies have shown a greater risk of disease transmission from health care personnel compared to non-health care personnel such as patients and family members.

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Did TST users attempt to reduce infections related to the use of medical equipment such as stethoscopes or clothing (e.g., lab coats and neckties)?

The TST does not assess procedures for disinfecting medical equipment or evaluate the impact of clothing of caregivers on transmission of infection. There are multiple factors that contribute to the effectiveness of infection prevention and control programs.

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What software is needed to use the TST?

The TST works best with the following applications and settings. You may want to consult with your organization’s technical support before making changes to your computer or if you are unsure about your current settings.

Preferred Browser
Internet Explorer 7.0 or above. If you have earlier versions of IE, some features may not work.

Windows Requirements
Windows 2003 or above (XP, Vista, Windows 7)
Microsoft Office 2003 or above (for some downloads)
High-speed internet connection is preferred

Required Plug-ins
Adobe Reader 8 or above
Adobe Flash Player
Windows Media Player
Without these, you may not have access to videos or PDFs.

Supported Tablets

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How do I correct errors on screen displays in the TST?

Older internet browsers may not display TST windows properly. Determine if your computer browser is Internet Explorer 7 or above; if it is not, contact your organization’s technology service department for a browser upgrade.

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Who do I contact with technical/computer questions about the TST?

Send an email to with your name, organization name, and organization location. Staff will respond to your email within two business days.

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