Correlation of Hand Hygiene Compliance Measured by Direct Observation with Estimates Obtained from Product Usage
Background: Direct observation (DO) is the current standard for evaluating hand hygiene (HH) compliance but is labor-intensive and may overestimate compliance. Calculating HH rates indirectly by measuring product usage may be used to approximate HH compliance. We sought to characterize the correlation between HH by DO with product usage measured in two different ways.
Methods: HH data from Jan 2011 - Mar 2014 was included in the analysis. DO is performed by trained independent observers who record HH upon room entry/exit to obtain an average percent compliance (DO%). Observations are performed 3-4 times quarterly in intensive care units (ICUs) and 3-4 times yearly in medical/surgical units (non-ICUs). Empty soap and alcohol hand rub containers are collected and counted weekly. HH events are calculated as the volume of product used divided by the standard aliquot per HH event. HH product usage rate (PUR) is calculated as the number of events per patient-days for each unit and quarter. A standardized HH product usage percentage (PU%) is calculated using a standardized rate based on a study of room traffic (120 HH/patient/day for non-ICUs and 240 for ICUs). All 3 HH parameters were calculated by unit for each quarter. PUR and PU% were correlated to DO% using Pearson's correlation coefficient and generalized linear models controlling for unit type, fiscal year and quarter.
Results: Eighty-two periods were included, 62 (75.6%) ICU periods and 20 (24.4%) non-ICU periods. DO% ranged from 38.3% to 95.5% (median 83.3%); PUR ranged from 31.8 to 437.0 HH/patient/day (median 203.7); PU% ranged from 26.5 to 100% (median 86.7%). All 3 parameters were significantly higher in ICUs than non-ICUs. There was a significant positive correlation between DO% and PUR (r=0.74, p<0.001) and DO% and PU% (r=0.76; p< 0.001). When stratified by unit type, adjusted correlations of DO% with PUR and PU% remained strong for non-ICUs (p<0.0001) but not for ICUs (see Figure).
Conclusion: HH compliance by DO correlates well with HH by product usage measured by crude rates or standardized percentages. The latter allows presentation of data that is more easily interpreted by front-line staff. A weaker correlation in units with high HH compliance may highlight the need for more discriminating methods to measure HH compliance in top performers.
R. V. Araujo-Castillo,
A. D. Holyoak, None
L. M. Baldini, None
K. Dooley, None
D. S. Yassa, None
S. B. Wright, None