Measuring adherence to hand hygiene guidelines: a field survey for examples of effective practices.
BACKGROUND
Measuring adherence to hand hygiene guidelines is resource intensive and complicated by lack of standardized methodology. The multiplicity of approaches in use makes it difficult to meaningfully compare performance across health care organizations. The goal of this project was to identify promising and effective practices for measuring adherence with hand hygiene guidelines across a variety of settings.


METHODS
A cross-sectional survey was conducted electronically in February 2007 to collect information on aspects of hand hygiene measured (eg, frequency, thoroughness of technique, glove use, product consumption), data collection approaches, training and resources, reports, and others. Invitations to respond were widely distributed through Web site announcements and list-serve messages of The Joint Commission and collaborating organizations. A panel of national experts developed and applied criteria for evaluating the methods.


RESULTS
Two hundred forty-two responses were submitted from a variety of settings and countries. Most (approximately 75%) measured frequency of hand hygiene; approximately 50% measured thoroughness, glove use, product usage, patient and provider satisfaction, or other aspects. Seventy-two percent relied exclusively on manual data collection, and most methods (80%) had been in use for less than 3 years. Most (65%) spent less than 1 hour in training data collectors, and few had evidence of reliability or validity. Forty submissions met most criteria for inclusion in an educational monograph.


CONCLUSIONS
Among respondents who considered their approach to be an example of an effective practice, there was substantial variation in methods and little evidence of reliability. Standardization of methods is needed to compare performance across organizations or within an organization over time.
Braun
Barbara I
BI
Division of Quality Measurement and Research, The Joint Commission, One Renaissance Blvd, Oakbrook Terrace, IL 60181, USA. bbraun@jointcommission.org
Kusek
Linda
L
Larson
Elaine
E
D003428:Cross Infection / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D003625:Data Collection; D005260:Female; D017575:Gloves, Protective / Q000592:standards; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006235:Hand Disinfection / Q000379:methods / Q000592:standards*; D006801:Humans; D006920:Hygiene / Q000592:standards*; D017053:Infection Control / Q000379:methods / Q000592:standards; D008297:Male; D017410:Practice Guidelines as Topic / Q000592:standards*; D011795:Surveys and Questionnaires