Measuring hand hygiene compliance rates in different special care settings: a comparative study of methodologies.
OBJECTIVE
The purpose of this study was to compare methods for assessing compliance with hand hygiene in an intensive care unit (ICU), a step-down unit (SDU), and a hematology-oncology unit.


METHODS
Over a 20-week period, we compared hand hygiene compliance measurements by three different methods: direct observation, electronic handwash counter for alcohol gel, and measuring the volume of product used (alcohol gel) in an ICU, an SDU, and a hematology-oncology unit of a tertiary care, private hospital.


RESULTS
By direct observation we evaluated 1078 opportunities in the ICU, 1075 in the SDU, and 517 in the hematology-oncology unit, with compliance rates of 70.7%, 75.4%, and 73.3%, respectively. A total of 342,299, 235,914, and 248,698 hand hygiene episodes were recorded by the electronic devices in the ICU, SDU, and hematology-oncology unit, respectively. There were also 127.2 ml, 85.3 ml, and 67.6 ml of alcohol gel used per patient-day in these units. We could find no correlation between the three methods.


CONCLUSIONS
Hand hygiene compliance was reasonably high in these units, as measured by direct observation. However, a lack of correlation with results obtained by other methodologies brings into question the validity of direct observation results, and suggests that periodic audits using other methods may be needed.
Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil.
Thyago Pereira
TP
Magnus
Instituto Israelita de Ensino e Pesquisa Albert Einstein, Av. Albert Einstein, 627/701, 1st floor, Room 108, Bloco A1, Morumbi, Sao Paulo 05651-901, Brazil. Electronic address: alexmarra@einstein.br.
Alexandre R
AR
Marra
Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil.
Thiago Zinsly Sampaio
TZ
Camargo
Instituto Israelita de Ensino e Pesquisa Albert Einstein, Av. Albert Einstein, 627/701, 1st floor, Room 108, Bloco A1, Morumbi, Sao Paulo 05651-901, Brazil.
Elivane da Silva
Eda S
Victor
Onco-Hematology Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil.
Lidiane Soares Sodré
LS
da Costa
Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil.
Vanessa Jonas
VJ
Cardoso
Division of Medical Practice, Hospital Israelita Albert Einstein, São Paulo, Brazil.
Oscar Fernando Pavão
OF
dos Santos
Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA.
Michael B
MB
Edmond
D019983:Guideline Adherence; D063373:Hand Hygiene / Q000592:standards* / Q000706:statistics & numerical data; D006405:Hematology; D006801:Humans; D007362:Intensive Care Units; D008495:Medical Oncology; D011785:Quality Assurance, Health Care / Q000379:methods; D063128:Tertiary Health Care
Alcohol-based hand-rub; Electronic handwash counter; Handwash; Hematology–oncology unit; Intensive care unit; Step-down unit