title: Measuring rates of hand hygiene adherence in the intensive care setting: a comparative study of direct observation, product usage, and electronic counting devices.
abstract: OBJECTIVE
  To compare 3 measures of hand hygiene adherence-direct observation, product usage, and electronic counting devices-in an intensive care unit.
  
  
  METHODS
  A 12-week observational study.
  
  
  METHODS
  A 40-bed medical-surgical intensive care unit at a private tertiary care hospital. METHODS. Over a 12-week period, we assessed hand hygiene adherence by 3 different methods: direct observation of practice, collection of data from electronic counters for dispensers of alcohol-based hand rub, and measurement of the amount of product used (alcohol-based hand rub and chlorhexidine).
  
  
  RESULTS
  There were 2,249 opportunities for hand hygiene observed, and the overall rate of hand hygiene adherence was 62.3% (representing 1,402 cleansing episodes). A total of 76,389 dispensing episodes were recorded by the electronic devices. The mean number of dispensing episodes per patient-day was 53.8. There was 64.1 mL of alcohol-based hand rub used per patient-day (representing 65.5% of total product used) and 33.8 mL of chlorhexidine used per patient-day (representing 34.5%). There was no significant correlation between observed hand hygiene adherence and total product used per patient-day (r=0.18; P=.59).
  
  
  CONCLUSIONS
  Direct observation cannot be considered the gold standard for assessing hand hygiene, because there was no relationship between the observed adherence and the number of dispensing episodes or the volume of product used. Other means to monitor hand hygiene adherence, such as electronic devices and measurement of product usage, should be considered.
authors.affiliation: Intensive Care Unit, Hospital Israelita Albert Einstein, Statistics Department, Instituto Israelita de Ensino e Pesquisa, São Paulo, Brazil. alexmarra@einstein.br
authors.forename: Alexandre R
authors.initials: AR
authors.lastname: Marra
authors.forename: Denis Faria
authors.initials: DF
authors.lastname: Moura
authors.forename: Angela Tavares
authors.initials: AT
authors.lastname: Paes
authors.forename: Oscar Fernando Pavão
authors.initials: OF
authors.lastname: dos Santos
authors.forename: Michael B
authors.initials: MB
authors.lastname: Edmond
mesh_terms: D000438:Alcohols / Q000008:administration & dosage; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D001938:Brazil; D002710:Chlorhexidine / Q000008:administration & dosage; D004581:Electronics / Q000295:instrumentation*; D019983:Guideline Adherence; D006235:Hand Disinfection / Q000379:methods* / Q000592:standards; D006801:Humans; D006920:Hygiene; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D019370:Observation / Q000379:methods*; D010564:Personnel, Hospital
chemical_list: D000438:Alcohols; D000891:Anti-Infective Agents, Local; D002710:Chlorhexidine