Hand Hygiene Data Research Articles

A Quality Improvement Initiative to Increase Hand Hygiene Awareness and Compliance in a Neonatal Intensive Care Unit in Haiti.

Healthcare-associated infections (HCAI) are major causes of morbidity, mortality, increased lengths of stay and are an economic burden on healthcare systems in resources-limited settings. This is especially true for neonates, who are more susceptible with underdeveloped immune systems. Hand hygiene (HH) is a key weapon against HCAI, yet globally, HH compliance remains substandard. This study sought to determine the compliance with HH among healthcare workers (HCWs) in a children's hospital neonatal intensive care unit (NICU) in Haiti. A HH educational intervention was performed in the NICU, including lectures and posters. Pre- and post-intervention HH data were collected on HCWs and parents using the World Health Organization '5 Moments for HH'. Data were analyzed using standard statistical analysis. HH increased in all HCW roles but not in parents. Correct HH increased in all groups, including parents. HH was more likely to occur prior to patient contact than after patient contact. Correct HH was more likely to occur with alcohol-based hand rub than with soap and water. This study demonstrates that an inexpensive and simple intervention can significantly increase HH compliance in a resource-limited NICU, which may lead to decreased rates of hospital-acquired sepsis. Parents, however, due to cultural norms as well as literacy and language barriers, need targeted educational interventions distinct from those that HCW benefit from.

Impact of an automated hand hygiene monitoring system combined with a performance improvement intervention on hospital-acquired infections.

Hand hygiene adherence has been associated with reductions in nosocomial infection. We assessed the effect of improvements in electronically measured hand hygiene adherence on the incidence of hospital-acquired infections. This quasi-experimental study was conducted in a 555-bed urban safety-net level I trauma center. The preintervention period was January 2015 through June 2016. Baseline electronic hand hygiene data collection took place from April through June 2016. The intervention period was July 2016 through December 2017. An electronic hand hygiene system was installed in 4 locations in our hospital. Performance improvement strategies were implemented that included education, troubleshooting, data dissemination, and feedback. Adherence rates were tracked over time. Rates of hospital-acquired infections were evaluated in the intervention units and in control units selected for comparison. The intervention period was subdivided into the initial and subsequent 9-month periods and were compared to the baseline period. Electronically measured hand hygiene rates improved significantly from baseline to intervention, from 47% 77% adherence. Rates >70% continued to be measured 18 months after the intervention. Interrupted time series analysis indicated a significant effect of hand hygiene on healthcare facility-onset Clostridioides difficile infection rates during the first 9 months of the intervention. This trend continued during the final 9 months of the intervention but was nonsignificant. No effects were observed for other hospital-acquired infection rates. Implementation of electronic hand hygiene monitoring and performance improvement interventions resulted in reductions in hospital-onset Clostridioides difficile infection rates.

A family empowerment strategy is associated with increased healthcare worker hand hygiene in a resource-limited setting.

Guidelines recommend empowering patients and families to remind healthcare workers (HCWs) to perform hand hygiene (HH). The effectiveness of empowerment tools for patients and their families in Southeast Asia is unknown. We performed a prospective study in a pediatric intensive care unit (PICU) of a Vietnamese pediatric referral hospital. With family and HCW input, we developed a visual tool for families to prompt HCW HH. We used direct observation to collect baseline HH data. We then enrolled families to receive the visual tool and education on its use while continuing prospective collection of HH data. Multivariable logistic regression was used to identify independent predictors of HH in baseline and implementation periods. In total, 2,014 baseline and 2,498 implementation-period HH opportunities were observed. During the implementation period, 73 families were enrolled. Overall, HCW HH was 46% preimplementation, which increased to 73% in the implementation period (P < .001). The lowest HH adherence in both periods occurred after HCW contact with patient surroundings: 16% at baseline increased to 24% after implementation. In multivariable analyses, the odds of HCW HH during the implementation period were significantly higher than baseline (adjusted odds ratio [aOR], 2.94; 95% confidence interval [CI], 2.54-3.41; P < .001) after adjusting for observation room, HCW type, time of observation (weekday business hours vs evening or weekend), and HH moment. The introduction of a visual empowerment tool was associated with significant improvement in HH adherence among HCWs in a Vietnamese PICU. Future research should explore acceptability and barriers to use of similar tools in low- and middle-income settings.

1189. Effectiveness of Multimodal Intervention Strategies to Improve Hand Hygiene Compliance at an Academic Medical Center

BackgroundSince the early 19th century, hand hygiene (HH) has been recognized as the most important factor in preventing healthcare-associated infections (HAI). Still, improving HH compliance is a major hurdle for most healthcare facilities. Our study objective was to evaluate effectiveness of bundled intervention tools in increasing hand hygiene (HH) compliance.MethodsThe study was performed at the University of Mississippi Medical Center located in Jackson, MS. A multidisciplinary HH team was established in January 2016. Team members included infection prevention, nurse managers, physician, resident, housekeeping, process engineers, and ancillary staff. Hand hygiene compliance was determined based on room entry and exit observations. Intervention strategies were based on Joint Commission Center’s Targeted Solutions Tool (TST) to identify barriers in HH compliance, standardization of data collection, covert observer training and Just-in-time training of providers. Other strategies implemented included education and feedback, rewards and recognition, and system change measures during the 3-year study period (timeline in Table 1). Hand hygiene compliance was calculated based on number of compliance opportunities/total number of observations. One-way Analysis of Variance (ANOVA) was performed to analyze HH data. We did not assess the concomitant reduction in HAI rates as simultaneous HAI prevention strategies confounded analysis.ResultsBased on total 95,491 observations performed (January 2016- December 2018), there was a statistically significant improvement in HH compliance during the study period from 66.5% in 2016 to 73% in 2017 and 79.5% in 2018 (P = 0.04).ConclusionAt our institution, we observed a 56% improvement in hand hygiene compliance over 36-months timeframe. Multidisciplinary team involvement and multimodal intervention strategies play crucial role in improvement and sustainment of HH compliance. Disclosures All authors: No reported disclosures.

Korean National Healthcare-Associated Infections Surveillance (KONIS): Hand hygiene surveillance

Although hand hygiene (HH) monitoring by direct observation is considered to be a reliable method, it is labor intensive. The purpose of this study was to confirm regular HH use by collecting and analyzing HH data for Web- and mobile-application-based HH monitoring, as well as to establish a nationwide HH monitoring system. Users evaluated the Web-based report as being useful with regard to ease of access and use, data collection and analysis, and especially data comparison with other hospitals. Mobile applications were considered more difficult to use than the Web-based system.

Video observation of hand-hygiene compliance in a manufacturer of ready-to-eat pie and pastry products

ABSTRACTFood-handler hand-hygiene can be a contributory factor for food-borne illness. Cognitive data (knowledge/attitudes/self-reported practices), while informative, are not indicative of behaviour, and are subject to biases. Consequently, observation of behaviour is superior to survey data. However, researcher presence in direct observation increases reactivity, whereas video observation gives comprehensive analysis over a longer period, furthermore, familiarity reduces reactivity. Although video observation has been used to assess food safety at retail/foodservice, this valuable method is under-utilized in food-manufacturing environments. For the study, footage (24 h) was reviewed to assess compliance in a food-manufacturing site with company protocol. Video observation of food-handlers entering production (n = 674) was assessed; upon 70 occasions no attempt to implement hand-hygiene was observed. Of attempted hand-hygiene practices (n = 604), only 2% implemented compliant practices. Although 78% of attempts utilized soap, only 42% included sanitizer. Duration ranged from 1 to 69 s (Median 17 s). The study provides hand-hygiene data in an area that observational data is seldom captured.

1156. Observation of Stethoscope Sanitation Practices in an Emergency Department Setting

BackgroundNosocomial infections pose significant risk to patients and hygienic standards may be easily overlooked, especially in fast-paced emergency department settings. Studies have shown that stethoscopes can harbor pathogens, which can be transferred to patients when proper sanitary measures are not taken. Survey-based studies have mostly assessed stethoscope hygiene, but they may not accurately represent cleaning practice. This study aimed to accurately assess cleaning practice through observation of stethoscope cleaning and hand hygiene among medical providers in an emergency department setting.MethodsFour hundred twenty-six provider–patient encounters were observed in the emergency department of the VA San Diego Healthcare System. The frequency and methods of stethoscope and hand hygiene practices were anonymously observed and recorded. Stethoscope hygiene was recorded during and after each encounter if cleaning took place for at least 15 seconds. Hand hygiene data were also gathered before and after each encounter. Data analysis was performed to determine the frequency of these practices.ResultsOf 426 encounters, 115 involved the use of a personal stethoscope. In 15 of 115 encounters (13.0%), the provider placed a glove over the stethoscope before patient contact. Following patient interaction, 13 of 115 encounters (11.3%) involved stethoscope hygiene with an alcohol swab. Stethoscope hygiene with water and hand towel before patient interaction was observed in 5 of 115 encounters (4.3%). Hand sanitizer use or hand washing was observed in 213 of 426 encounters (50.0%) before patient interaction. Gloves were also used prior to patient interaction in 206 of 426 (48.4%) encounters, some overlapping with those who used hand sanitizer or washed their hands. Hand sanitizer or hand washing was used in 332 of 426 encounters (77.9%) after patient interaction.ConclusionOnly 11.3% of encounters involving the use of a personal stethoscope had stethoscope sanitation with an alcohol swab. In 4.3% post-encounters, there was an attempt to clean stethoscopes with water and towel. Rates of appropriate hand hygiene were also lower than expected. Stethoscope and hand hygiene standards need to be raised to reduce infection risk and further studies need to be conducted to set guidelines for adequate stethoscope sanitation.Disclosures All authors: No reported disclosures.

Evaluation of Barriers to Audit-and-Feedback Programs That Used Direct Observation of Hand Hygiene Compliance

Audit and feedback based on direct observation is a common strategy to improve hand hygiene compliance, but the optimal design and delivery of this intervention are poorly defined. To describe barriers encountered by audit-and-feedback programs for hand hygiene across acute care hospitals within the Veterans Health Administration. A qualitative study was conducted at a geographically diverse convenience sample of 10 acute care hospitals within the Veterans Health Administration. Participants included 108 infection prevention team personnel and frontline staff. All data were collected between June 30, 2014, and March 18, 2015. Data were analyzed between September 6, 2017, and January 5, 2018. Barriers to audit and feedback for hand hygiene compliance were evaluated. Semistructured interviews of key personnel were performed through site visits at 6 locations and telephone interviews with 4 sites. Focus groups were conducted with frontline staff. Interviews and focus groups were audio recorded and transcribed. All transcripts were analyzed using thematic content analysis. Overall, 108 individuals participated in the study. Semistructured interviews were conducted with 38 individuals, who were predominantly infection prevention team members. Focus group interviews were conducted with 70 frontline hospital staff members. Surveillance activities at all 10 sites made use of a variety of staff members with the intention of covertly collecting direct observations on hand hygiene compliance. Monitoring programs were challenging to maintain because of constraints on time and personnel. Both auditors and frontline staff expressed skepticism about the accuracy of compliance data based on direct observations. Auditors expressed concern about the Hawthorne effect, while frontline staff were worried that their compliance was not visible to auditors. In most hospitals, approaches to monitoring hand hygiene compliance produced friction between frontline staff and infection prevention teams. The feedback process for audit results did not consistently reach frontline staff and, in many hospitals, did not seem to facilitate improvement efforts. Auditing hand hygiene compliance with direct observation was problematic across these acute care hospitals. Auditing was perceived to collect inaccurate data and created tension with frontline staff, and the feedback process did not appear to encourage positive change. Strategies are needed to collect more reliable hand hygiene data and facilitate multidisciplinary collaboration toward improved compliance.

Secondary measures of hand hygiene performance in health care available with continuous electronic monitoring of individuals

Hand hygiene (HH) compliance in health care is usually measured against versions of the World Health Organization's "Your 5 Moments" guidelines using direct observation. Such techniques result in small samples that are influenced by the presence of an observer. This study demonstrates that continuous electronic monitoring of individuals can overcome these limitations. An electronic real-time prompting system collected HH data on a musculoskeletal rehabilitation unit for 12 weeks between October 2016 and October 2017. Aggregate and professional group scores and the distributions of individuals' performance within groups were analyzed. Soiled utility room exits were monitored and compared with performance at patient rooms. Duration of patient room visits and the number of consecutive missed opportunities were calculated. Overall, 76,130 patient room and 1,448 soiled utility room HH opportunities were recorded from 98 health care professionals. Aggregate unit performance for patient and soiled utility rooms were both 67%, although individual compliance varied greatly. The number of hand wash events that occurred while inside patient rooms increased with longer visits, whereas HH performance at patient room exit decreased. Eighty-three percent of missed HH opportunities occurred as part of a series of missed events, not in isolation. Continuous collection of HH data that includes temporal, spatial, and personnel details provides information on actual HH practices, whereas direct observation or dispenser counts show only aggregate trends.

The use of privacy-protected computer vision to measure the quality of healthcare worker hand hygiene.

(i) To demonstrate the feasibility of automated, direct observation and collection of hand hygiene data, (ii) to develop computer visual methods capable of reporting compliance with moment 1 (the performance of hand hygiene before touching a patient) and (iii) to report the diagnostic accuracy of automated, direct observation of moment 1. Observation of simulated hand hygiene encounters between a healthcare worker and a patient. Computer laboratory in a university. Healthy volunteers. Sensitivity and specificity of automatic detection of the first moment of hand hygiene. We captured video and depth images using a Kinect camera and developed computer visual methods to automatically detect the use of alcohol-based hand rub (ABHR), rubbing together of hands and subsequent contact of the patient by the healthcare worker using depth imagery. We acquired images from 18 different simulated hand hygiene encounters where the healthcare worker complied with the first moment of hand hygiene, and 8 encounters where they did not. The diagnostic accuracy of determining that ABHR was dispensed and that the patient was touched was excellent (sensitivity 100%, specificity 100%). The diagnostic accuracy of determining that the hands were rubbed together after dispensing ABHR was good (sensitivity 83%, specificity 88%). We have demonstrated that it is possible to automate the direct observation of hand hygiene performance in a simulated clinical setting. We used cheap, widely available consumer technology and depth imagery which potentially increases clinical application and decreases privacy concerns.

Googling your hand hygiene data: Using Google Forms, Google Sheets, and R to collect and automate analysis of hand hygiene compliance monitoring

Hand hygiene is one of the most important interventions in the quest to eliminate healthcare-associated infections, and rates in healthcare facilities are markedly low. Since hand hygiene observation and feedback are critical to improve adherence, we created an easy-to-use, platform-independent hand hygiene data collection process and an automated, on-demand reporting engine. A 3-step approach was used for this project: 1) creation of a data collection form using Google Forms, 2) transfer of data from the form to a spreadsheet using Google Spreadsheets, and 3) creation of an automated, cloud-based analytics platform for report generation using R and RStudio Shiny software. A video tutorial of all steps in the creation and use of this free tool can be found on our YouTube channel: https://www.youtube.com/watch?v=uFatMR1rXqU&t. The on-demand reporting tool can be accessed at: https://crsp.louisville.edu/shiny/handhygiene. This data collection and automated analytics engine provides an easy-to-use environment for evaluating hand hygiene data; it also provides rapid feedback to healthcare workers. By reducing some of the data management workload required of the infection preventionist, more focused interventions may be instituted to increase global hand hygiene rates and reduce infection.

Hand Hygiene and Tuberculosis Risk in Korea: An Ecological Association.

Hand hygiene is a basic but effective strategy against infectious disease. This study investigated an ecological association between hand hygiene and tuberculosis (TB) risk in Korea. Hand hygiene data were obtained from the 2015 Community Health Survey. Information on TB incidence and mortality in 2015 were obtained from the National Infectious Diseases Surveillance System and death monitoring database, respectively. In multiple linear regression analysis, frequent hand washing rates after using the restroom (B = -0.78, P = .037), after returning from the outdoors (B = -0.28, P = .049), and with soap or hand sanitizer (B = -0.54, P = .018) were negatively associated with TB incidence. TB mortality were associated with frequent hand washing rates after returning from the outdoors (B = -0.05, P = .035), and with soap or hand sanitizer (B = -0.10, P = .010), respectively. Hand washing was associated with lower TB incidence and mortality at the community level. These results could contribute to develop community-based health promotion strategies.

A study of hand hygiene technique in intensive care unit of a tertiary care hospital

Introduction: Hand hygiene (HH) has been characterized as the keystone and starting point in all infection control programs, with the hands of health-care faculty being the handler and advocates of infection in critically ill patients. Materials and Methods: This was a cross-sectional observational study using direct observation technique. A single observer collected all HH data. This single-observer study was conducted in the 45-bedded intensive care unit (ICU) of Mahatma Gandhi Hospital. HH compliance was monitored using the hand hygiene observation form developed by the World Health Organization. A nonidentified observer was used for monitoring compliance with HH. Results and Discussion: A total of 900 observations were recorded from health-care personnel in ICU. With respect to the personnel, the nursing department had the highest number of observations as 400 circulating nurses were sampled. There were also 110 senior consultants, 250 resident doctors, and 140 paramedical staffs. Of the total opportunities, nurses had the highest number of contacts (67%), followed by allied health-care workers (82.94%). The average compliance was about 75%, which differed significantly among health-care workers, with higher compliance among the nursing staff (82.9%) followed by allied staff (67%). Of the average overall compliance of 75%, maximum compliance was seen for moment 3, that is, the staffs were very careful after body fluid contact as it was perceived important for self-protection. The HH instances after patient contact (86.29%) also suggested similarly. The nurses' compliance was 64.40% before patient contact and 68.35% after touching surroundings. Conclusion: The observance of HH is still low in our local environment. Handwashing practices in our study show that health-care workers pay attention to HH, when it appears, there is a direct observable threat to their well-being. Educational programs need to be developed to address the issue of poor HH.

Improving Hand Hygiene:Anonymously Validated Data Driven Approach Producing Sustainable Culture Change Utilizing “One and Up” Accountability Agents across a Healthcare System- a Cost-effective National Best Practice.

Abstract Background Inadequate hand hygiene is a major contributor to hospital infections worldwide. Before 2012, in our healthcare system, hand hygiene was monitored by unit managers, nurses, and infection control staff with reported compliance rates of &amp;gt;90%. A five month independent audit by an anonymous observer revealed actual rates of 14–33%. This discordant result was typical of hospitals across the country then and now who have provided intensive education, used peer feedback, and maximized physical hand hygiene supplies. A commitment was made to rigorously improve hand hygiene utilizing validated data, social psychology with disciplinary consequence, and no additional expensive technology. Methods Employed dedicated “secret shopper”/anonymous observers were deployed across five hospitals, all units and all shifts, and all job roles to collect valid anonymous hand hygiene observations without local bias. Twice monthly hand hygiene data was shared by hospital, unit, shift, and job role to executive leadership and down to frontline unit staff for daily huddles. Additionally, over 100 “One and Up” Accountability Agents from management ranks were recruited, trained, and performed weekly standardized unit- based hand hygiene obervations openly, giving feedback real-time to non-compliant employess and medical staff; noncompliance was reported to the hospital epidemiologist; and emails on his behalf were sent to the employee’s manager, and the manager’s manager “One and Up”. A four step disciplinary process was begun. The same process was applied to the medical staff. Results Over 188, 000 anonymous secret shopper validation observations, and hundreds of thousands of Accountability Agent observations have been performed. Hand hygiene compliance has been &amp;gt;94% for 22 months and ≥97 % for the last 6 months in all five hospitals. No employee or medical staff member advanced beyond the second disciplinary step. Conclusion This model represents a national best performance model, with validated and sustained results, accomplished with cultural change and aligned multitier accountability (not technology). It is truly a low cost blueprint for other healthcare systems that seek rapid, honest, and sustained hand hygiene improvement across all job roles, shifts, and different sized hospitals and cultures. Disclosures All authors: No reported disclosures.

The influence of spatial configuration on the frequency of use of hand sanitizing stations in health care environments

The lack of user-friendly, accessible, and visible hand sanitizing stations (HSSs) in health care environments are significant factors affecting low hand hygiene compliance rates among caregivers. To determine whether the simulated parameters of visibility and global traffic flow score for an HSS can influence the frequency of use of that HSS. Space syntax was used to measure virtual simulation of spatial layouts of 3 units to provide quantitative visibility and global traffic flow scores for each HSS. The frequency of use of HSSs was measured for 2 weeks in 3 units in a community hospital through electronic tracking with self-developed motion sensors. Behavioral observations were also conducted during the same period to validate hand hygiene data obtained through electronic tracking. Linear models were used to tests how much variance in use is accounted for when visibility and/or global traffic flow are included in the model. When the visibility score for an HSS increases (decrease), frequency of use of the HSS will increase (decrease) (F [5, 65] = 13.877; P < .001). When the global traffic flow score for an HSS increases (decrease), frequency of use of the HSS will increase (decrease) (F [5, 65] = 13.877; P < .001). This study proposed and validated a novel approach of using space syntax simulations to predict and optimize hand hygiene behavior.

Barriers, perceptions, and adherence: Hand hygiene in the operating room and endoscopy suite.

We examined the perceptions and barriers to nonsurgical scrubbed hand hygiene in the operating room and endoscopy procedure room using 2 anonymous Likert-scale surveys. Results indicated poor role modeling, inconvenience, and the need to monitor hand hygiene and feedback data to providers because of poor self-awareness of hand hygiene practices.

Successful development of a direct observation program to measure health care worker hand hygiene using multiple trained volunteers

Direct observation of health care worker (HCW) hand hygiene (HH) remains the gold standard, but implementation is challenging. Our objective was to develop an accurate HH observation program using multiple HCW volunteers. HH compliance was defined as correct HH performed before and after contact with a patient or a patient's environment. HCW volunteers from each unit at our children's hospital were trained by infection preventionists to covertly collect HH observations during routine care using an electronic tool. Questionnaires sent to observers in February and December 2014 recorded demographic characteristics, observation time, and scenarios assessing accuracy. HCWs were surveyed regarding their awareness that their HH behavior was being recorded. There were 146 HH observers. The majority of observers reported making 1-2 observations per shift (65%) and taking ≤10 minutes recording an observation (85%). Between January 2012 and December 2014 there were 22,484 HH observations (average, 622 per month), including nurses (46%), physicians (21%), and other HCWs (33%). Observers correctly recorded HH behavior more than 90% of the time in 5 of the 6 scenarios. Most HCWs (86%) were unaware they were being observed. A direct observation program staffed by multiple HCW volunteers can inexpensively and accurately collect HCW HH data.

Hand Hygiene Compliance in an Emergency Department: The Effect of Crowding.

Emergency department (ED) crowding results from the need to see high volumes of patients of variable acuity within a limited physical space. ED crowding has been associated with poor patient outcomes and increased mortality. The authors evaluated whether ED crowding is also associated with reduced hand hygiene compliance among health care workers. A trained observer measured hand hygiene compliance using standardized definitions for 22 months in the 40-bed ED of a 475-bed academic hospital in Toronto, Ontario, Canada. ED crowding measures, including mean daily patient volumes, time to initial physician assessment, and daily nursing hours, were obtained from hospital administrative and human resource databases. Known predictors of hand hygiene compliance, including the indication for hand hygiene and the health care workers' professions, were also measured. Hand hygiene data, measured during 20-minute observation sessions, were linked to aggregate daily results for each crowding metric. Crowding metrics and known predictors of hand hygiene compliance were then included in a multivariate model if associated with hand hygiene compliance at a p-value of <0.20. Hand hygiene compliance was 29% (325 of 1,116 opportunities). Alcohol-based hand rinse was used 66% of the time. Nurses accounted for 68% of hand hygiene opportunities and physicians for 18%, with the remaining 14% attributed to nonphysician, nonnurse health care workers. The most common indications for hand hygiene were hand hygiene prior to (35%) and hand hygiene following (52%) contact with the patient or his or her environment. In multivariate analysis, time to physician assessment>1.5 hours was associated with lower compliance (odds ratio [OR]= 0.67, 95% confidence interval [CI] =0.51 to 0.89). Additionally, compliance was lower for nonnurse, nonphysician health care workers (OR= 0.51, 95% CI=0.33 to 0.79) and higher for hand hygiene performed after contact with the patients or his/her environment, compared to hand hygiene performed before contact with the patient or his/her environment (OR= 2.0, 95% CI=1.5 to 2.7). Daily patient volumes and nursing hours were not associated with hand hygiene compliance. ED hand hygiene compliance was low. Increased time to physician assessment was associated with reduced compliance, suggesting an association between crowding and compliance. Strategies that minimize ED crowding may improve ED hand hygiene compliance.

Assessment of hand hygiene resources and practices at the 2 children's hospitals in Greece.

Hand hygiene (HH) is the most effective way to prevent health care-associated infections and the spread of antimicrobial-resistant pathogens. The aim of our study was to assess the existing HH resources and current HH practices at 2 hospitals in Athens, Greece. Observational HH data and an inventory of HH resources were collected from 13 wards including medical/surgical, oncology/transplant and intensive care units, during 65, 1-hour observations periods. A total of 1271 HH opportunities were observed during the study period, including 944 of Health Care Workers (HCW) and 327 of visitors and parents. The nursing HH compliance was highest (49%) followed by medical compliance (24%, P < 0.001). HCW HH compliance was highest in intensive care units and the transplant unit (64-87%). The rate of appropriate HH for HCW was 22.6%. HCW most commonly used soap and water (76.1%). The HH procedure was more likely to be appropriate when soap and water were used as compared with alcohol based hand rub (64.6% and 47.5%, P = 0.006). A marginally significant association was identified between the HH compliance rate and the number of alcohol based hand rub dispensers per room (P = 0.057). In visitors and parents, the HH compliance was found to be 19%, whereas the rate of appropriate HH was 8.9%. Low levels of HH were observed.

Observer accuracy and behavior analysis: Data collection procedures on hand hygiene compliance in a neurovascular unit

Although observational studies are popular, little has been done to study the integrity of human observers and the data collection process. Issues of data collection integrity threaten functional findings, leading to problematic interpretation and decreased replication. In our study the response effort associated with hand hygiene data collection in a hospital setting was manipulated using an altered data collection tool. A counterbalanced ABAB design was implemented across 2 semesters of a hand hygiene data collection practicum course. When response effort increased, compliant audits decreased and when response effort decreased, compliant audits increased. These results were statistically significant, with an overall level change z that had a P value of .001 (first semester) and .007 (second semester). These findings may warrant an increased awareness of data collection procedures where recording options include a less effortful response. The results of our study support basic research on response effort and choice behavior in an applied setting, bringing into question the integrity of data collection procedures and the integrity of the data collected. These results also suggest the need for standardizing reporting systems to ensure hand hygiene collection and reporting procedures are comparable across settings.