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Measurement of Hand Hygiene ComplianceDr. Sanjeewani WeerakoonMBBS, Dip. Micro, MD MicrobiologySBSCH, Peradeniya1Measuring HandHygiene ComplianceWhy do you measure?what are your organizations goals? What elements of hand hygiene to measure? How to measure? Measuring HandHygiene ComplianceDirectly observing Measuring product use Conducting surveysDirect ObservationDirectly watching and recording the hand hygiene behavior of health care workers and the physical environment

Direct ObservationHow to perform? Select a unitDecide time periodSelect target group- Dr/NO/Physiotherapist/ Minor staff/others.Conducted by trained observersDecide what to observe-opportunities/ actions, product use/ thoroughness of HH/ gloves useDirect ObservationHow to perform ?......contConduct recording with validated Auditing toolObserve 20 min from open space/ minimum 200 opportunitiesObserver should not interfere the routine work of the unitConfidentialMeasure compliance according to the HH guidelines

Direct Observation Gold Standard Reliable if performed well Can pin point problem areas, staff, times and improvement opportunities Able to detect all opportunities for hand hygiene Must define opportunity for hand hygiene

Strengths of Direct Observation

Can precisely designate areas for improvement and target efforts and resources Person (s)/ Time of Day/ Shift/ Unit

Can evaluate thoroughness of cleansing /technique Application/ Time of process/ opportunities Glove use/ Jewelry, Nails

Strengths of Direct Observation Observers could give prompt feedback when improvement is needed.Evaluate facility-specific factors that may influence hand hygiene guideline adherence Allows for a denominator, rate and comparison over timeAdherence rate = Total number of acts of hand hygiene when the opportunity existed --------------------------------------------------------------------------------- Total number of hand hygiene opportunities

Direct Observation - Challenges

Labor intensive Requires a presenceRequires observer time many hours Trained and validated observers Costly many hours to obtainsufficient observations for analysisDirect Observation ChallengesBias Observer Selection Bias Sample Size Timing Variation in Staff Behaviors( Hawthorne effect)Standardizing ObservationThe Importance of Observer Training and Assessing Reliability. Interrater reliability or interobserver reliability (Reliability among observers).User-friendly forms with clear instructions.Other Direct ObservationMethods Video Cameras

Patients as Observers of Staff Hand Hygiene

Patients as Observers of Staff Hand Hygiene

MEASURING PRODUCT USEmeasure Product utility by health care workers in a unit or organization

Indirect Measurement of Hand Hygiene

Measuring Product Usetwo primary ways to measure product use. measure the amount of a product that is used measure the frequency with which the product is usedMeasuring the Amount of Product UsedWeigh or measure the height of soap or alcohol-based hand rub remaining in the dispenserMeasure the height of a stack of paper towels from one period of time to another.Count the number of soap or alcohol-based hand rub containers, the stacks of paper towels placed on a unit Number of empty containers removed from the unit. Calculate the amount of product used at the specific unit, departmentMeasuring the Amount of Product Usedby looking at purchasing or inventory data of entire health care organization. Data on the quantity of products ordered or supplied throughout the organization at regular intervals (e.g. monthly, quarterly, annually)

Measuring the Frequency of Product Use

automated toolsElectronic counting devices attached in Alcohol hand rub dispensers

Electronic monitoring devicesElectronic Monitoring of Sink UseEmit sounds as reminders to perform HH. Able to track and record individual HCW.New and expensive

Strengths of Measuring Product UseLess resource intensive, less expensiveMore efficient than the observation methodCan be done either manually or electronically.Allows organization wide trends to be tracked over time.UnobtrusiveReduces Hawthorne effectReduces sampling bias

Strengths of Measuring Product UseProduct use can be measured across all shifts, 24 hours a day, 7 days a week.Minimal staff training.Can be done in many different health care settings. The validity has not been well established.Does not reveal whether health care workers perform hand hygiene when indicated. Product use does not provide any information aboutwhen and why hand hygiene does not occur. technique

Limitations of Measuring Product Use

Limitations of Measuring Product Useinaccurate and misleading results can be producedWaste/spillageProduct use by patients and family membersExchange product between unitsNo. of opportunities vary with units, pt population..CONDUCTING SURVEYSSurveys gather information on health care worker perceptions, attitudes, and practices related to hand hygiene, as well as patients and families attitudes and perceptions of the hand hygiene practices of health care workers Indirect method

CONDUCTING SURVEYSSurveys can be done:Over the telephoneElectronically (over a computer network or via the Internet), On paper (on-site or via mail) Through interviews (personal or focus groups)CONDUCTING SURVEYSSurveying health care workers can assess: Staff knowledgeStaff attitudes and beliefsStaff perceptions of their own, or their colleagues on HH behaviorStructural factors that can facilitate or inhibit staff for HHStaff satisfaction with productsAssessment of staff skin conditionStructural issues, availability of products, product accessibility

CONDUCTING SURVEYSSurveying patients and families can assess: attitudes and perceptions of hand hygiene practices of health care workers.

HCWs perception of HH is match with the perception of patient and family?Surveying patients.

Strengths of Using Surveys

Reasons for non- adherence to HH guidelinesInexpensiveNot resource intensiveLimitations of Using SurveysInadequate validity or reliability for self-respect of adherenceHCW tend to overestimate complianceValidity depends on the quality of the surveys development and testing Recall biasMeasuring HandHygiene Compliance

Using more than one method >> > using a single method.

Yield reliable results Help to validate the results Uncover additional informationAreas need improvement Target interventions

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