Hand hygiene.pdf

ability, data will be credible, and compliance trends can be monitored over time. Examples
of hand hygiene compliance monitoring tools can be obtained from reference 693 or at:
www.handhygiene.org/downloads/HHMonitoring%20Tool.doc.
There have been some attempts to improve hand hygiene by empowering patients 694 . The
value of patient involvement has been assessed by McGuckin 569,695 . In two studies, patients
were encouraged to find out if HCWs had washed their hands before patient contact. These
studies recommended that patients should be empowered to take responsibility for their
health care, including infection control. Patient monitoring of hand hygiene compliance
is not well documented, however, and has never been objectively evaluated 696 . Patients
may not feel comfortable monitoring an HCW’s compliance with hand hygiene 697,698 .
Furthermore, patient empowerment is not possible for the critically ill.
Self-assessment by HCWs can be carried out. It has been demonstrated, however, that
self-reports of compliance do not correlate well with compliance actually measured by
direct observation, and self-assessment tends to overestimate compliance with hand
hygiene 153,155,507,508,518,545 .
1.2 INDIRECT MONITORING
Indirect monitoring includes counting used paper hand towels 699 , monitoring the amount
of alcohol-based handrub or liquid soap used 261,262,360,363,489,535,568,592 , or estimating the
required amount using a computerized database of nursing activities 591 . These methods
are not as consuming of time and resources as direct observation, but can be affected
by a number of biases, such as lack of adjustment for patient case-mix and workload 583 .
Some studies 261,262,360 have shown that the consumption of products used for hand hygiene
correlated with observed hand hygiene compliance; thus, the use of this measure as a surrogate
for monitoring hand hygiene practices deserves further validation. Other studies found
that feedback by measuring soap and paper towel levels did not have an impact on hand
hygiene 567,699 .
1.3 ELECTRONIC MONITORING
The use of sinks in patient rooms and in hospital lavatories can be monitored electronically.
A recent study 489 tested an electronic monitoring system that monitored entry and exit
into patient rooms and tracked the use of sinks and hand hygiene materials. A computer
system linked each entry and exit with the presence or absence of a hand hygiene activity.
Although useful for assessing general personal hygiene, these systems are not appropriate
for measuring hand hygiene compliance with patient care, as such devices do not take into
account the number of hand hygiene opportunities. Table III.1.1 lists the advantages and
disadvantages of direct and indirect monitoring of hand hygiene compliance.
These guidelines include recommendations relating to the wearing of rings, wrist watches,
bracelets, nail polish and artificial nails (see Part I, Section 20). Monitoring adherence to
these policies can also involve direct and indirect observation, self-assessment and patient
assessment, though little work has been carried out to assess the validity or correlation of
these monitoring methods in terms of infection prevention.