Adherence to hand hygiene guidelines - significance of measuring fidelity.
OBJECTIVE
The aim was to evaluate the usability of fidelity measures in compliance evaluation of hand hygiene.


BACKGROUND
Adherence to hand hygiene guidelines is important in terms of patient safety. Compliance measures seldom describe how exactly the guidelines are followed.


METHODS
A cross-sectional observation study in a university hospital setting was conducted. Direct observation by trained staff was performed using a standardised observation form supplemented by fidelity criteria. A total of 830 occasions were observed in 13 units. Descriptive statistics (frequency, mean, percentages and range) were used as well as compliance rate by using a standard web-based tool. In addition, the binomial standard normal deviate test was conducted for comparing different methods used in evaluation of hand hygiene and in comparison between professional groups.


RESULTS
Measuring fidelity to guidelines was revealed to be useful in uncovering gaps in hand hygiene practices. The main gap related to too short duration of hand rubbing. Thus, although compliance with hand hygiene guidelines measured using a standard web-based tool was satisfactory, the degree of how exactly the guidelines were followed seemed to be critical.


CONCLUSIONS
Combining the measurement of fidelity to guidelines with the compliance rate is beneficial in revealing inconsistency between optimal and actual hand hygiene behaviour.


CONCLUSIONS
Evaluating fidelity measures is useful in terms of revealing the gaps between optimal and actual performance in hand hygiene. Fidelity measures are suitable in different healthcare contexts and easy to measure according to the relevant indicators of fidelity, such as the length of hand rubbing. Knowing the gap facilitates improvements in clinical practice.
Nursing Research Foundation, Helsinki, Finland.
Anne
A
Korhonen
Oulu University Hospital, Oulu, Finland.
Helena
H
Ojanperä
Oulu University Hospital, Oulu, Finland.
Teija
T
Puhto
Oulu University Hospital, Oulu, Finland.
Raija
R
Järvinen
Oulu University Hospital, Oulu, Finland.
Pirjo
P
Kejonen
Nursing Research Foundation, Helsinki, Finland.
Arja
A
Holopainen
D003428:Cross Infection / Q000451:nursing / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D005387:Finland; D019983:Guideline Adherence; D006235:Hand Disinfection; D006785:Hospitals, University; D006801:Humans; D009726:Nurses; D010820:Physicians; D017410:Practice Guidelines as Topic
compliance evaluation; fidelity measures; hand hygiene; healthcare staff; observation study