Researchers Caution Against Bias in Hand Hygiene Compliance Reporting

In a research brief in the August 2010 issue of Infection Control & Hospital Epidemiology, Sorabh Dhar, MD, and colleagues at Detroit Medical Center and Wayne State University in Detroit, describe the results of their study addressing differences in reported hand hygiene compliance rates. Dhar, et al. (2010) acknowledge, "Despite the widely accepted importance of hand hygiene, achieving good compliance is challenging. One factor that complicates efforts is the difficulty in measuring compliance rates. Hospitals use various methods, but the most common is direct observation of healthcare workers during patient-care activities."

There are several methods, such as using unit-based observers who work on the same unit as the healthcare workers who are being observed, as well as non unit-based observers, such as infection preventionists, who might work elsewhere. The researchers sought to determine if a bias toward greater hand hygiene compliance measurements existed among unit-based observers as opposed to non unit-based observers.

According to the researchers, these rates were assessed on the basis of the unit affiliation of observers in two hospitals in Michigan, Detroit Receiving Hospital and Huron Valley-Sinai. The researchers add that all observers were "undercover" and that their role was unknown to unit staff. A total of 6,984 observations from 19 units were reviewed; there were 4,771 observations in which healthcare workers were compliant (the overall hand hygiene rate was 68.3 percent); 3,025 of the observations were conducted by unit-based observers while 3,659 observations were conducted by non unit-based observers.

Dhar, et al. (2010) report that unit-based observers more often reported higher compliance rates than did non unit-based observers (79 percent vs 58.6 percent; difference, 20.4 percent; P<.001), and say that non-standardized data collection methods contribute to the variability in hand hygiene compliance rates.

The researchers write, "Because more process data and infection-related outcomes are being made public, hospitals are being held accountable more and more for their hand hygiene practices. More than ever, differences in applied methods and the resulting process measurements need to be recognized and standardized. The unit-based affiliation of the observers should be factored into the analysis and interpretation of hand hygiene compliance data."

Reference: Dhar S, Tansek R, Toftey EA, Dziekan BA, Chevalier TC, Bohlinger CG, Fitch M, Flanagan ME, Chopra T, Marchaim D and Kaye KS. Research Brief: Observer Bias in Hand Hygiene Compliance Reporting. Infect Control Hosp Epidemiol 2010;31:869870.