508. Measurement of Hand Hygiene Compliance in Healthcare by Direct Observation
Session: Poster Abstract Session: Infection Control and Skin Hygiene
Friday, October 21, 2011
Room: Poster Hall B1
  • 508_AhmadAshfaq.pdf (459.1 kB)

    Background: Hand hygiene (HH) is the most important element of infection control practice. Failure in HH results in healthcare- associated infections. The best data on HH performance may be acquired by direct observation.

    Methods: A prospective observational study was conducted at the University of Texas Medical Branch at Galveston (UTMB). Students from UTMB professional schools were recruited and trained by one trainer for making unannounced observations of health care workers (HCWs) HH practices in 23 inpatient units. Simultaneously, students also collected data on infection control practices and use of sharps by HCWs. Students recorded observations for HCW’s specialty, gender, and the type of HH opportunity as before or after patient contact, the opportunity for HH met or not, the type of HH (hand washing or alcohol hand rub) performed and glove use. Inter-observer variability was tested using the kappa statistic with κ= 0.675. Prior to starting the study, the Department of Healthcare Epidemiology had been collecting HH self assessment data from the inpatient units. This data was compared with the results from the direct observation method.

    Results: Students monitored 3414 HH opportunities from January 24, 2011 to April 1, 2011. 1201 opportunities for HH were met. The probability of meeting a HH opportunity was 0.3535 (95% confidence interval of 0.3374-0.3699). Among units, the Burn Unit had the highest HH compliance (60%) and a Medicine Unit had the lowest (7%). The probability of opportunity met was significantly higher for nurses (0.389, p= 0.00046) and significantly lower for physicians (0.267, p= 3.723x10⁻⁶). Females were 1.307 times as likely to meet the HH opportunity (p= 0.0024) compared to males. The probability of opportunity met was much higher after patient contact (p= 4.06x10⁻27) than before contact. The mean of overall self reporting compliance was 98% during this period.

    Conclusion: We successfully established a HH compliance monitoring system using the direct observation technique. We also demonstrated that self assessment was not a reliable method for measuring HH compliance. The next phase of the study will measure changes in HH practice based on feedback of HH performance to HCWs by nursing unit, service and professional group.

    Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

    Ahmad Ashfaq, MD, Infectious Diseases, The University of Texas Medical Branch Galveston, Galveston, TX and C. Glen Mayhall, MD, University of Texas Medical Branch, Galveston, TX


    A. Ashfaq, None

    C. G. Mayhall, None

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.