Our Stories

Supercharge your hand-hygiene education: Are you a Tough Scrubber?

Toronto, October 16, 2017

By the Heart and Vascular Program’s Quality and Safety Leaders Group

OT Laura Shapiro and PT Rebecca Bunston
Occupational therapist Laura Shapiro (left) and physiotherapist Rebecca Bunston (right) helped develop Tough Scrubber at St. Michael’s.

Fun, fast, challenging, hilarious. Is this how your staff would describe their hand-hygiene education? Try Tough Scrubber and they just might.

In the St. Michael’s Heart and Vascular Program, our traditional hand hygiene interventions were feeling a bit stale. Engagement was low – and honestly, it showed in our compliance rates.

We needed more than a poster. We needed a sensation! Enter Tough Scrubber, the brainchild of our program’s Quality and Safety Leaders Group. A play on the Tough Mudder concept, front-line staff go through a fast-paced, over-the-top simulation that’s tailored for their clinical area. There’s a quick quiz before they start and a quick debrief after they finish… and that’s it. The whole process takes 10 minutes or less. We’re happy to report, it was a huge hit!

This five-minute video will tell you more about how Tough Scrubber works. We’ve also put together a toolkit to help hand-hygiene champions implement Tough Scrubber in their own hospitals and health-care organizations.

For our staff, Tough Scrubber opened the door to a new way of thinking about hand hygiene. It’s OK to ask questions and to give your colleagues feedback – we’re all learning. Doing hand hygiene correctly can be tough, but it’s much easier when we help each other out.

To date, 43 Heart and Vascular staff have completed Tough Scrubber, and our hope is that you will too. All it takes is our toolkit, 4-5 hand-hygiene leaders (to run the activity and pose as patients), an empty patient room with two beds, and the everyday equipment described in the scenarios (e.g. a wheelchair, a basin).

In our Heart and Vascular Units, we’ve improved our compliance rate for Moment 1 by 27% in three years. This is certainly the result of a combination of years of education, hard work and many different kinds of interventions. However our Tough Scrubber sessions truly felt like the tipping point.

For more information on Tough Scrubber and to download the toolkit, visit

Try it, and let us know how it worked for you! If you have any questions or feedback, please contact us at and

About St. Michael's Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 29 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

See More of Our Stories in 2017