Assessment of Trained Hand Hygiene Observers Using Parallel Observations

Objectives: To validate hand hygiene (HH) observers following training and determine the concordance between the observers and the Kappa index. Methods: This study was conducted during June 2017. HH observers from 15 hospital units received eight-hours training including a two-hour workshop conducted by the infection control practitioner and hospital epidemiologist. After its completion, parallel observations were conducted by trained nurses from each respective unit for a maximum of 20 minutes per session at any time or day. Results: A total of 789 parallel observations were performed. In observed HH actions, the percentage of agreement between trained and experienced observers was 75.4%, with a Kappa index of agreement of 0.61 (95% confidence interval (CI): 0.57−0.66). For the observed HH moments, the agreement among observers was 83.8% with a Kappa index of 0.71 (95% CI: 0.66−0.75). Conclusions: HH observers were validated after a dedicated training in correspondence with the recommendation to improve HH monitoring. Additional studies should focus on evaluating the sustainability of the agreement, the requirement of retraining, and other alternatives for observers’ validation