How to Measure Hand Hygiene Adherence & Overcome the Challenges

Hand hygiene, a term used in health care settings that refers to cleaning hands with soap and water or antiseptics, is the best way to prevent infections in hospitals and other health care facilities such as nursing homes. Adherence to hand hygiene practices should become part of a culture of patient safety. However, measuring hand hygiene adherence is not a simple task. In health care, three methods are primarily used to measure hand hygiene adherence: direct observation, measurement of product use, and surveys.

Things You'll Need

• Water
• Soap
• Hand sanitizer
• Paper towels
• Latex gloves

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Instructions

Direct Observation

• 1

  Determine who you want to observe, who will conduct the observations and when, where and how often to observe. Develop a standardized procedure for direct observation of workers by trained observers, as well as a standardized form for documenting observations.

• 2

  Recruit people to observe workers' hand hygiene behaviors. To alleviate observer bias, enlist independent observers, such as individuals typically on the floor for other purposes that are not part of the health care team.

• 3

  Instruct observers to record the hand hygiene products that workers use, the thoroughness of cleansing, techniques used for drying, the use of gloves and whether workers are practicing hand hygiene at all opportunities. Since the biggest challenge of this method is that observers' presence may influence the behavior of those being observed, instruct observers to make their presence as unobtrusive as possible.

• 4

  Divide the number of patient encounters where all hand hygiene procedures were performed correctly by the number of patient encounters observed and multiply by 100 to calculate the percentage compliance rate.

Product Measurement

• 5

  Observe workers long enough to witness approximately 200 hand hygiene practices. Divide that by the total time observed to obtain a mean number of practices per hour. Multiply that number by 24 to obtain a mean number of practices per day.

• 6

  Obtain the patient census for the period that observations were made. Calculate the mean number of hand hygiene practices per day per patient by dividing the mean number of practices per day by the patient census.

• 7

  Acquire data on volume of hand hygiene products--soap and alcohol-based products--used per month for the particular unit. Divide the total volume used by the approximate amount of product dispensed for each "hit" (each time product is used).

• 8

  Compute the number of hand hygiene practices per month. Multiply the number of hand hygiene practices per day per patient by the number of days in the month. Then multiply that number by the mean patient census. Calculate a hand hygiene adherence rate by dividing the total number of hits per month by the total number of practices for the month.

• 9

  Note challenges to this method. Inaccuracy in measurement of product volume is frequently caused by factors such as waste or spillage, disposal of containers before they are empty or patient and family use of products.

Surveys

• 10

  Determine the best format of the survey--whether it should be administered on paper, electronically or by telephone or through in-person interviews and focus groups. Factors to consider include the number of people you plan to reach, their location and complexity of the sample.

• 11

  Administer survey among health care workers, and possibly to patients and their families. Gather information on perceptions, attitudes, and practices related to hand hygiene and compliance by health care workers.

• 12

  Achieve a high enough response rate so that the sample is not biased. A low response rate will make survey results less useful, as information cannot be generalized to the population of interest.

• 13

  Compile survey results. Be mindful of the challenges posed by surveys, as information is self-reported by respondents. For instance, some respondents may overestimate their hand hygiene practices. Share results with those who completed surveys. This demonstrates that their input is valued.