Automated hand hygiene count devices may better measure compliance than human observation.
BACKGROUND
Hand hygiene is considered a critical factor in the prevention of health care-associated infections, and there have been many studies on ways to measure hand hygiene compliance.


OBJECTIVE
Our objective was to evaluate the utility of estimating hand hygiene compliance using automated count technology versus direct human observation before and after a feedback intervention. We used a before and after quasi-experimental study over 30 weeks, in the setting of one 12-bed neurocare intensive care unit (NCICU) and one 15-bed cardiac intensive care unit (CCU) in a university, tertiary care hospital.


METHODS
We assessed hand hygiene through a quasi-experimental study comparing estimated compliance using automated count technology and direct observation by a secret shopper with a feedback intervention at month 3. We used Poisson segmented regression and χ(2) tests to compare trends before and after the intervention.


RESULTS
Over 30 weeks, we collected 424,682 dispenser counts and 338 hours of human observations that included 1,783 room entries. Electronic hand hygiene dispenser counts increased significantly in the post-intervention period relative to the pre-intervention period (average count/patient-day increased 22.7 in the NCICU and 7.3 in the CCU, both P < .001), but direct observation of compliance did not change significantly (percent compliant increased by 2.9% in the NCICU and decreased by 6.7% in the CCU, P = .47 and P = .07, respectively).


CONCLUSIONS
Passive electronic monitoring of hand hygiene dispenser counts does not closely correlate with direct human observation and was more responsive than observation to a feedback intervention.
School of Medicine, University of Maryland, Baltimore, MD, USA. dmorgan@epi.umaryland.edu
Daniel J
DJ
Morgan
Lisa
L
Pineles
Michelle
M
Shardell
Atlisa
A
Young
Katherine
K
Ellingson
John A
JA
Jernigan
Hannah R
HR
Day
Kerri A
KA
Thom
Anthony D
AD
Harris
Eli N
EN
Perencevich
D001331:Automation / Q000379:methods; D003428:Cross Infection / Q000517:prevention & control; D004812:Epidemiologic Methods; D019983:Guideline Adherence / Q000592:standards*; D063373:Hand Hygiene / Q000706:statistics & numerical data*; D006785:Hospitals, University; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units; D062606:Tertiary Care Centers