Handhygiene Adherence Monitoring: How to Capture and Improve the 'True' Rates

Abstract

Observation of hand-hygiene practices and alcohol-based hand rub consumption surveillance are the two major methods widely used in Japanese hospitals to evaluate hand hygiene adherence. To capture an accurate picture of hand-hygiene practices, unobtrusive direct observation of various departments and professions, at various times of the day by a trained observer is necessary. Some studies have found poor correlation between alcohol-based hand rub consumption and hand-hygiene rates, suggesting the former to be an inappropriate indicator of hand hygiene adherence. Although it is ideal to observe all five hand-hygiene moments recommended by the WHO, it is often not feasible to unobtrusively observe practices performed at the bedside. Therefore, some hospitals choose to observe hand hygiene before and after patient contact. It is reported this before/after-contact monitoring method can be used as a surrogate indicator of rates based on all five moments, if certain conditions are met. Offering real time feedback of hand-hygiene rates is the first step toward improvement. Tables and graphs showing trends and comparing rates between departments offer bedside staff an incentive to improve their hand-hygiene practices. Involving patients and recruiting hand-hygiene champions are also effective. Their activities must always be endorsed by the hospital leadership who is responsible for fostering safety culture, which is crucial for improving hand-hygiene adherence.