Direct Observation Not Always the Best Way to Assess Hand Hygiene

Researchers from Brazil and the United States report on results from their study suggesting that direct observation cannot be considered to be the "gold standard" for assessing hand hygiene compliance. Marra, et al. (2010) compared three measures of hand hygiene adherence -- direct observation of practice, product usage (alcohol-based handrub and chlorhexidine), and collection of data from electronic counting devices on dispensers -- in an intensive care unit during a 12-week observational study at a tertiary-care hospital. Their researcher was published in the August issue of Infection Control & Hospital Epidemiology.

The researchers report that there were 2,249 opportunities for hand hygiene observed, and the overall rate of hand hygiene adherence was 62.3 percent (representing 1,402 cleansing episodes). A total of 76,389 dispensing episodes were recorded by the electronic devices. The average number of dispensing episodes per patient-day was 53.8. There was 64.1 mL of alcohol-based handrub used per patient-day (representing 65.5 percent of total product used) and 33.8 mL of chlorhexidine used per patient-day (representing 34.5 percent). The researchers say that there was no significant correlation between observed hand hygiene adherence and total product used per patient-day.

Marra, et al. (2010) conclude that "direct observation cannot be considered the gold standard for assessing hand hygiene, because there was no relationship between the observed adherence and the number of dispensing episodes or the volume of product used. Other means to monitor hand hygiene adherence, such as electronic devices and measurement of product usage, should be considered."

Reference: Marra AR, Moura DF, Paes AT, Pavão dos Santos OF, Edmond MB. Measuring Rates of Hand Hygiene Adherence in the Intensive Care Setting: A Comparative Study of Direct Observation, Product Usage, and Electronic Counting Devices. Infect Control Hosp Epidemiol 2010;31:796-801.