title: An examination of covert observation and solution audit as tools to measure the success of hand hygiene interventions.
abstract: BACKGROUND
  Many studies have examined hand hygiene (HH) frequency and adherence in response to various interventions. This study used 2 methods to determine HH frequency and adherence to see how well the outcomes correlated.
  
  
  METHODS
  HH frequency was measured over 4, 1-month periods (phases 1-4), using 2 methods: an audit of HH solution used during each phase adjusted for patient-days and covert observation of HH adherence. The number of x-ray technician contacts with patients (a known quantity) across the study period was retrospectively compared with the number of observations made of x-ray technicians' HH behavior to see what proportion of contacts were observed.
  
  
  RESULTS
  HH solution use doubled in phase 2 and was 65% and 55% higher than the baseline level in phases 3 and 4, respectively. Observed HH adherence fell from 51% to 37% in phase 2 and then rose to 58% in phases 3 and 4. Three percent of x-ray technicians' patient contacts were observed across the 4 phases.
  
  
  CONCLUSIONS
  Observation of HH may not adequately sample patient contacts to provide an accurate measure of HH adherence. Further studies are needed to confirm this finding.
authors.affiliation: School of Nursing and Health Care Practices, Southern Cross University, Lismore, Australia. tvandemo@scu.edu.au
authors.forename: Thea
authors.initials: T
authors.lastname: van de Mortel
authors.forename: Margherita
authors.initials: M
authors.lastname: Murgo
mesh_terms: D001315:Australia; D003625:Data Collection / Q000379:methods; D019983:Guideline Adherence; D006235:Hand Disinfection / Q000379:methods*; D006801:Humans; D006920:Hygiene; D019370:Observation; D010564:Personnel, Hospital; D011872:Radiology Department, Hospital