Skip to main content Accessibility help
×
Home

Monitoring Hand Hygiene via Human Observers: How Should We Be Sampling?

  • Jason Fries (a1), Alberto M. Segre (a1), Geb Thomas (a2), Ted Herman (a1), Katherine Ellingson (a3) and Philip M. Polgreen (a4) (a5)...

Abstract

Objective.

To explore how hand hygiene observer scheduling influences the number of events and unique individuals observed.

Design.

We deployed a mobile sensor network to capture detailed movement data for 6 categories of healthcare workers over a 2-week period.

Setting.

University of Iowa Hospital and Clinic medical intensive care unit (ICU).

Methods.

We recorded 33,721 time-stamped healthcare worker entries to and exits from patient rooms and considered each entry or exit to be an opportunity for hand hygiene. Architectural drawings were used to derive 4 optimal line-of-sight placements for observers. We ran simulations for different observer movement schedules, all with a budget of 1 hour of total observation time. We considered observation times of 1–15, 15–30, 30, and 60 minutes per station. We stochastically generated healthcare worker hand hygiene compliance on the basis of all data and recorded the total unit compliance as it would be reported by each simulated observer.

Results.

Considering a 60-minute total observation period, aggregate simulated observers captured 1.7% of the average total number of opportunities per day at best and 0.5% at worst. The 1–15-minute schedule captures, on average, 16% fewer events than does the 60-minute (ie, static) schedule, but it samples 17% more unique individuals. The 1–15-minute schedule also provides the best estimator of compliance for the duration of the shift, with a mean standard deviation of 17%, compared with 23% for the 60-minute schedule.

Conclusions.

Our results show that observations are sensitive to different observers' schedules and suggest the importance of using data-driven approaches to schedule hand hygiene audits.

Copyright

Corresponding author

Division of Infectious Diseases, Department of Internal Medicine, University of Iowa, Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242 (philip-polgreen@uiowa.edu)

References

Hide All
1. Boyce, JM, Pittet, D. Guidelines for hand hygiene in health-care settings: recommendations of the healthcare infection control practices advisory committee and the HICPAC/SHEA/APIC/IDSA hand hygiene task force. Infect Control Hosp Epidemiol 2002;23:S3S41.
2. Allegranzi, B, Sax, H, Bengaly, L, et al. Successful implementation of the World Health Organization hand hygiene improvement strategy in a referral hospital in Mali, Africa. Infect Control Hosp Epidemiol 2010;31:133141.
3. Pittet, D, Allegranzi, B, Boyce, JM; World Health Organization World Alliance for Patient Safety First Global Patient Safety Challenge Core Group of Experts. The World Health Organization guidelines on hand hygiene in health care and their consensus recommendations. Infect Control Hosp Epidemiol 2009; 30:611622.
4. Maskerine, C, Loeb, M. Improving compliance to hand hygiene among health care workers. J Contin Edu Health Prof 2006;26: 244251.
5. Haas, JP, Larson, EL. Measurement of compliance with hand hygiene. J Hosp Infect 2007;66:614.
6. Joint Commission on Accreditation of Healthcare Organizations. Patient safety goals, http://www.jcaho.org/accredited+organizations/patient+safety/npsg.htm. Accessed December 2, 2009.
7. Adair, JG. The Hawthorne effect: a reconsideration of the methodological artifact. J Appi Psychol 1984;69:334345.
8. Eckmanns, T, Bessert, J, Behnke, M, Gastmeier, P, Rüden, H. Compliance with antiseptic hand rub use in intensive care units: the Hawthorne effect. Infect Control Hosp Epidemiol 2006;27: 931934.
9. Boscart, VM, McGilton, KS, Levchenko, A, Hufton, G, Holliday, P, Fernie, GR. Acceptability of a wearable hand hygiene device with monitoring capabilities. J Hosp Infect 2008;70:216222.
10. Boyce, JM, Cooper, T, Dolan, MJ. Evaluation of an electronic device for real-time measurement of alcohol-based hand rub use. Infect Control Hosp Epidemiol 2009;30:10901095.
11. Kinsella, G, Thomas, AN, Taylor, RJ. Electronic surveillance of wall-mounted soap and alcohol gel dispensers in an intensive care unit. J Hosp Infect 2007;66:3439.
12. Larson, EL, Albrecht, S, O'Keefe, M. Hand hygiene behavior in a pediatric emergency department and a pediatric intensive care unit: comparison of use of 2 dispenser systems. Am J Crit Care 2005;14:304311.
13. Swoboda, SM, Earsing, K, Strauss, K, Lane, S, Lipsett, PA. Isolation status and voice prompts improve hand hygiene. Am J Infect Control 2007;35:470476.
14. Venkatesh, AK, Lankford, MG, Rooney, DM, Blachford, T, Watts, CM, Noskin, GA. Use of electronic alerts to enhance hand hygiene compliance and decrease transmission of vancomycin-resistant Enterococcus in a hematology unit. Am J Infect Control 2008;35:199205.
15. Polgreen, PM, Hlady, CS, Severson, MA, Segre, AM, Herman, T. Method for automated monitoring of hand hygiene compliance without radio-frequency identification. Infect Control Hosp Epidemiol 2010;31:12941297.
16. Sax, H, Allegranzi, B, Chram', MN, Boyce, J, Larson, E, Pittet, D. The World Health Organization hand hygiene observation method. Am J Infect Control 2009;37(10):827834.
17. Lloyd, RC. The search for a few good indicators. In: Ransom, SC, Joshi, MS, Nash, DN, eds. The Healthcare Quality Booh Vision Strategy and Tools. Chicago: Health Administration Press, 2005: 103110.
18. Rupp, ME, Fitzgerald, T, Puumala, S, et al. Prospective, controlled, cross-over trial of alcohol-based hand gel in critical care units. Infect Control Hosp Epidemiol 2008;29(1):815.
19. van de Mortel, T, Murgo, M. An examination of covert observation and solution audit as tools to measure the success of hand hygiene interventions. Am J Infect Control 2006;34:9596.

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed