309. The Utility of Patient Observations to Measure Hand Hygiene Compliance of Health Care Workers
Session: Poster Abstract Session: Hand Hygiene in Healthcare Settings
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C

The Centers for Disease Control and Prevention (CDC) recommends hand hygiene compliance by health care workers as a primary way to prevent the transmission of healthcare associated infections (HAI). A new strategy to measure hand hygiene compliance involves using patient surveys during healthcare visits to report on hand hygiene compliance. The purpose of this study was to evaluate the feasibility of using patient surveys to monitor hand hygiene compliance in outpatient clinics of a United States Department of Defense medical center.


A cross-sectional study was used to compare patient observations to a nurse researcher’s observations. Patients (n=112) were asked to complete a brief questionnaire on hand hygiene compliance before and after the provider visit at the end of their appointment. Data on hand hygiene compliance of the health care provider(s) present at the outpatient visit were recorded on the questionnaire.  A nurse researcher, who served as the validation standard, was present during the healthcare visit and recorded observations of hand hygiene practices of the health care practitioner.


Cohen’s kappa analysis of inter-rater agreement showed consistent agreement with a kappa of 0.57 (0.47-0.66, 95%CI) for hand hygiene compliance, and a kappa of 0.85 (0.78-0.92, 95%CI) for healthcare worker identification.  The odds ratio for hand hygiene by healthcare workers before and after patient contact is 4.86 (2.30-10.30, 95% CI).


Using patient observations as part of a hand hygiene surveillance program in an outpatient clinic is feasible. Patient observations of individual healthcare worker hand hygiene compliance and healthcare worker identification in this study indicate higher reliability than self-reporting from other studies. These results also suggest that patient observations are slightly less accurate than peer observations and trained observer inter-agreement. Healthcare worker hand hygiene compliance before patient contact is a reliable predictor of hand hygiene compliance after patient contact.

Donnalee Pollack, RN, MSN, MPH1, Gary Holmes, MD2 and Harold Kohl III, PhD1,3, (1)University of Texas Health Science Center, Austin Regional Campus, Austin, TX, (2)Darnall Army Community Hospital, Fort Hood, TX, (3)University of Texas at Austin, Austin, TX


D. Pollack, None

G. Holmes, None

H. Kohl III, None

Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.