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Measuring Rates of Hand Hygiene Adherence in the Intensive Care Setting: A Comparative Study of Direct Observation, Product Usage, and Electronic Counting Devices

Published online by Cambridge University Press:  02 January 2015

Alexandre R. Marra ,
Denis Faria Moura Jr ,
Ângela Tavares Paes ,
Oscar Fernando Pavão dos Santos  and
Michael B. Edmond
Alexandre R. Marra*
Affiliation:
Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
Denis Faria Moura Jr
Affiliation:
Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
Ângela Tavares Paes
Affiliation:
Statistics Department, Instituto Israelita de Ensino e Pesquisa, São Paulo, Brazil
Oscar Fernando Pavão dos Santos
Affiliation:
Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
Michael B. Edmond
Affiliation:
Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond
*
Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627/701, Intensive Care Unit, 5th Floor, Morumbi, São Paulo, Brazil05651-901 (alexmarra@einstein.br)
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Abstract

Objective.

To compare 3 measures of hand hygiene adherence—direct observation, product usage, and electronic counting devices—in an intensive care unit.

Design.

A 12-week observational study.

Setting.

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.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 8 , August 2010 , pp. 796 - 801
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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