title: Hospital hand hygiene opportunities: where and when (HOW2)? The HOW2 Benchmark Study.
abstract: BACKGROUND
  Measurement and monitoring of health care workers' hand hygiene compliance (i.e., actions/opportunities) is a key component of strategies to eliminate hospital-acquired infections. Little data exist on the expected number of hand hygiene opportunities (HHOs) in various hospital settings, however. The purpose of this study was to estimate HHOs in 2 types of hospitals--large teaching and small community--and 3 different clinical areas-medical-surgical intensive care units, general medical wards, and emergency departments.
  
  
  METHODS
  HHO data were collected through direct observations using the World Health Organization's monitoring methodology. Estimates of HHOs were developed for 12-hour AM/PM shifts and 24-hour time frames.
  
  
  RESULTS
  During 436.7 hours of observation, 6,640 HHOs were identified. Estimates of HHOs ranged from 30 to 179 per patient-day on inpatient wards and from 1.84 to 5.03 per bed-hour in emergency departments. Significant differences in HHOs were found between the 2 hospital types and among the 3 clinical areas.
  
  
  CONCLUSIONS
  This study is the first to use the World Health Organization's data collection methodology to estimate HHOs in general medical wards and emergency departments. These data can be used as denominator estimates to calculate hand hygiene compliance rates when product utilization data are available.
authors.affiliation: Department of Infection Prevention and Control, Greenville Hospital System University Medical Center, 701 Grove Road, Greenville, SC 29605, USA. csteed@ghs.org
authors.forename: Connie
authors.initials: C
authors.lastname: Steed
authors.forename: J William
authors.initials: JW
authors.lastname: Kelly
authors.forename: Dawn
authors.initials: D
authors.lastname: Blackhurst
authors.forename: Sue
authors.initials: S
authors.lastname: Boeker
authors.forename: Thomas
authors.initials: T
authors.lastname: Diller
authors.forename: Paul
authors.initials: P
authors.lastname: Alper
authors.forename: Elaine
authors.initials: E
authors.lastname: Larson
mesh_terms: D003428:Cross Infection / Q000517:prevention & control*; D006235:Hand Disinfection / Q000379:methods*; D006282:Health Personnel; D006302:Health Services Research / Q000379:methods*; D006761:Hospitals; D006801:Humans; D017053:Infection Control / Q000379:methods*