Direct observation (DO) and alcohol-based handrub (ABHR) consumption (AC) per 1,000 patient days are used to monitor hand hygiene (HH) performance in healthcare, and are increasingly utilized as quality indicators, sometimes for external benchmarking. Infection prevention experts from the University of Geneva Hospitals in Switzerland investigated the common assumption that there is a direct correlation between these two measures.
For the baseline period of a cluster-randomized trial regarding multimodal hand hygiene promotion at a 2,200 bed tertiary-care facility, eight validated infection control nurses performed DO using the WHOs Five Moments method in 65 non-ICU acute care wards for 15 months from April 2009. ABHR usage and patient days per ward were extracted from hospital databases to calculate AC over the same period. Linear regression was used to determine the correlation between these two variables, with each units compliance weighted for the number of HH opportunities observed.
DO captured 4,601 HH opportunities and 2,962 HH actions, 99 percent of which involved ABHR use. HH compliance in individual wards ranged from 38.2 percent to 90.2 percent with a mean of 64.6 percent. A total of 13,939 liters of ABHR was consumed during 459,917 patient days. AC ranged from 10.8 to 62.0 L/1,000 bed days with a mean of 31.4. Both HH compliance and AC were normally distributed, with a weak and non-significant correlation (r=0.13; P=0.21).
The investigators conclude that in their studys setting, DO and AC are not significantly correlated, complicating efforts to monitor HH performance. Further investigation should examine which is a better indicator for relevant clinical outcomes such as microbial colonization and healthcare-associated infection. Their research was presented at the International Conference on Prevention & Infection Control (ICPIC) held in Geneva, Switzerland June 29-July 2, 2011.
Reference: AJ Stewardson, H Attar, S Touveneau, W Zingg, S Longet-Di Pietro, N Vernaz, D Pittet, H Sax. The best way to skin a cat: product consumption versus direct observation for monitoring hand hygiene performance. Presentation at International Conference on Prevention & Infection Control (ICPIC). BMC Proceedings 2011, 5(Suppl 6):P103doi:10.1186/1753-6561-5-S6-P103