WHO Guidelines on Hand Hygiene in Health Care - Safe Care ...

<strong>WHO</strong> GUIDELINES ON HAND HYGIENE IN HEALTH CARE
development. These methods allow precise quantitative results
on hand hygiene activity to be obtained, with the only costs
being the installation and maintenance of the system. Changes
over time can be assessed. Some studies have attempted to
measure the need for hand hygiene by monitoring patient room
entries and linking each entry to the use of a sink or a handrub
dispenser. For the moment, no comparative studies exist to
validate the appropriateness of electronic detection of hand
hygiene opportunities.
Wireless devices placed inside handrub or soap dispensers
can provide useful information regarding patterns of hand
hygiene frequency. A recent study evaluated wireless devices
that were placed inside handrub dispensers on a general
medical ward and in a surgical intensive care unit. 1040 During
a 3-month trial period, 17 304 hand hygiene episodes using
handrub were recorded on the medical ward for a rate of 9.4
hand hygiene episodes/patient-day. A total of 50 874 hand
hygiene episodes using handrub were recorded in the ICU
for a rate of 47.7 hand hygiene episodes/patient-day. Average
usage was highest between 10:00 and 19:00; the lowest was at
05:00. By mapping the location of each device, it was observed
that dispensers located in rooms with patients on contact
precautions were used significantly less often than those
located in other rooms on the ward (P = 0.006).
Table III.1.1
Advantages and disadvantages of various hand hygiene monitoring approaches
Monitoring approach Advantages Disadvantages
Direct observations
by expert observers
Self-report by healthcare
workers
Direct observations
by patients
Consumption of
hygiene products
such as towels, soap,
and alcohol-based
handrub
Automated monitoring
systems
• Only way to reliably capture all hand
hygiene opportunities
• Details can be observed
• Unforeseen qualitative issues can be
detected while observing hand hygiene
• Inexpensive
• Inexpensive
• Inexpensive
• Reflects overall hand hygiene activity
(no selection bias)
• Validity may be improved by surrogate
denominators for the need for hand
hygiene (patient-days, workload
measures, etc.)
• Absence of observer may reduce
observation bias
• May potentially produce valuable
detailed information about hand hygiene
behaviour and infectious risks
• Time-consuming
• Skilled and validated observers required
• Prone to observation, observer, and selection bias
• Overestimates true compliance
• Not reliable
• Potential negative impact on patient–HCW relationship
• Reliability and validity required and remains to be
demonstrated
• Does not reliably measure the need for hand hygiene
(denominator)
• No information about the appropriate timing of hand hygiene
actions
• Prolonged stocking of products at ward level complicates and
might jeopardize the validity
• Validity threatened by increased patient and visitor usage
• No possibility to discriminate between individuals or
professional groups
• Scarce real world experience so far
• Potential ethical issues with tracking of individual activity
• Unknown impact on staff and patient behaviour
• Systems may be costly and failure-prone
162