Abstract
Background: Direct observation of hand hygiene is the standard practice recommended by the World Health Organization to monitor its compliance. Objective: To evaluate the accuracy of hand hygiene observation performed by units' observers. Methods: A descriptive study was carried out in seven patient care units in a 75-bed community hospital in Qatar. Four trained nurses performed hand hygiene observation in May 2016, any day of the week and in different shifts, following the same methodology as routine units' observers. Hand hygiene opportunities were registered, including hand hygiene moments, staff category, and actions (handrubs, hand washing, missed hand hygiene, and gloves without hand hygiene). Results: During January–May 2016, routine monitoring reported 25,319 opportunities with a compliance of 89.2%, and 91.6% for nurses, 89.6% for physicians, and 85.1% for ancillary staff. Trained external observers reported 815 opportunities and compliance of 54.7%, with the highest compliance observed after blood and body fluid exposure (80.0%) and after patient contact (85.5%), and the lowest figures before patient contact (34.2%) and before aseptic procedure (34.0%). Conclusion: This study provides essential information about the accuracy of the monitoring procedure and the compliance of hand hygiene that requires immediate action to protect patients and staff from healthcare-associated infections.
Highlights
Hand hygiene (HH) constitutes the principal prevention practice for healthcare-associated infections, and the monitoring of compliance is a fundamental quality indicator in healthcare facilities.[1,2] Evidence shows that HH compliance ranges from 5% to 89%, with an average of 38.7%.1 Similar figures have been reported in recently published papers from Brazil, Australia, and India.[3,4,5]The monitoring of HH can be performed using different methods, including direct observations of practices, measuring the product use, conducting a survey, and more recently through video monitoring and electronic surveillance.[6]
Direct observation of hand hygiene is the standard practice recommended by the World Health Organization to monitor its compliance
Direct observation is the standard practice recommended by the World Health Organization, which is limited by the Hawthorne effects and interobserver variation.[7,8]
Summary
The monitoring of HH can be performed using different methods, including direct observations of practices, measuring the product use, conducting a survey, and more recently through video monitoring and electronic surveillance.[6] Direct observation is the standard practice recommended by the World Health Organization, which is limited by the Hawthorne effects and interobserver variation.[7,8] Despite its limitation, direct observation of practices is the most feasible methodology to monitor HH for healthcare systems with increased financial pressures. Four trained nurses performed hand hygiene observation in May 2016, any day of the week and in different shifts, following the same methodology as routine units’ observers. Results: During January –May 2016, routine monitoring reported 25,319 opportunities with a compliance of 89.2%, and 91.6% for nurses, 89.6% for physicians, and 85.1% for ancillary staff. Conclusion: This study provides essential information about the accuracy of the monitoring procedure and the compliance of hand hygiene that requires immediate action to protect patients and staff from healthcare-associated infections
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