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Establishing Evidence-Based Criteria for Directly Observed Hand Hygiene Compliance Monitoring Programs: A Prospective, Multicenter Cohort Study

Published online by Cambridge University Press:  10 May 2016

Jun Yin ,
Heather Schacht Reisinger ,
Mark Vander Weg ,
Marin L. Schweizer ,
Andrew Jesson ,
Daniel J. Morgan ,
Graeme Forrest ,
Margaret Graham ,
Lisa Pineles  and
Eli N. Perencevich
Jun Yin*
Affiliation:
Department of Biostatistics, University of Iowa, College of Public Health, Iowa City, Iowa
Heather Schacht Reisinger
Affiliation:
Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
Mark Vander Weg
Affiliation:
Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa Department of Psychology, University of Iowa, Iowa City, Iowa
Marin L. Schweizer
Affiliation:
Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
Andrew Jesson
Affiliation:
Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
Daniel J. Morgan
Affiliation:
University of Maryland School of Medicine, Baltimore, Maryland Veterans Affairs Maryland Health Care System, Baltimore, Maryland
Graeme Forrest
Affiliation:
Portland Veterans Affairs Medical Center, Portland, Oregon
Margaret Graham
Affiliation:
Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
Lisa Pineles
Affiliation:
University of Maryland School of Medicine, Baltimore, Maryland
Eli N. Perencevich
Affiliation:
Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
*
Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IA 52246 (eli-perencevich@uiowa.edu).
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Extract

Objective

Hand hygiene surveillance programs that rely on direct observations of healthcare worker activity may be limited by the Hawthorne effect. In addition, comparing compliance rates from period to period requires adequately sized samples of observations. We aimed to statistically determine whether the Hawthorne effect is stable over an observation period and statistically derive sample sizes of observations necessary to compare compliance rates.

Design

Prospective multicenter cohort study.

Setting

Five intensive care units and 6 medical/surgical wards in 3 geographically distinct acute care hospitals.

Methods

Trained observers monitored hand hygiene compliance during routine care in fixed 1-hour periods, using a standardized collection tool. We estimated the impact of the Hawthorne effect using empirical fluctuation processes and F tests for structural change. Standard sample-size calculation methods were used to estimate how many hand hygiene opportunities are required to accurately measure hand hygiene across various levels of baseline and target compliance.

Results

Exit hand hygiene compliance increased after 14 minutes of observation (from 56.2% to 60.5%; P < .001) and increased further after 50 minutes (from 60.5% to 66.0%; P < .001). Entry compliance increased after 38 minutes (from 40.4% to 43.4%; P = .005). Between 79 and 723 opportunities are required during each period, depending on baseline compliance rates (range, 35%–90%) and targeted improvement (5% or 10%).

Conclusions

Limiting direct observation periods to approximately 15 minutes to minimize the Hawthorne effect and determining required number of hand hygiene opportunities observed per period on the basis of statistical power calculations would be expected to improve the validity of hand hygiene surveillance programs.

Infect Control Hosp Epidemiol 2014;35(9):1163-1168

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 9 , 01 September 2014 , pp. 1163 - 1168
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved.

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