The utility of patient observations to measure hand hygiene compliance of health care workers

Background: The Centers for Disease Control and Prevention (CDC) recommends hand hygiene compliance by health care workers as a primary way to prevent the transmission of healthcare associated infections (HAI). A new strategy to measure hand hygiene compliance involves using patient surveys during healthcare visits to report on hand hygiene compliance. This study evaluated the feasibility of using patient surveys to monitor hand hygiene compliance in outpatient clinics of a US Department of Defense medical center. Methods: A cross sectional study was used to compare patient observations to a nurse researcher\u27s observations. Patients (n=112) were asked to complete a brief questionnaire after an outpatient visit. Data on hand hygiene compliance of the health care provider(s) present at the outpatient visit were recorded on the questionnaire. A nurse researcher, who served as the validation standard, was present during the healthcare visit and recorded observations of hand hygiene practices of the health care practitioner. Results: Cohen\u27s kappa analysis of inter-rater agreement showed consistent agreement with a kappa of 0.57 (0.47-0.66, 95%CI) for hand hygiene compliance, and a kappa of 0.85 (0.78-0.92, 95%CI) for healthcare worker identification. Odds ratio for hand hygiene by healthcare workers before and after patient contact is 4.86 (2.30-10.30, 95% CI). Conclusion: Using patient observations as part of a hand hygiene surveillance program in an outpatient clinic is feasible. Patient observations of individual healthcare worker hand hygiene compliance and healthcare worker identification are more reliable than self-reporting, and slightly less accurate than peer observations and trained observer inter-agreement. Using patient observations as part of a hand hygiene surveillance program in an outpatient clinic is feasible. Healthcare worker hand hygiene compliance before patient contact is a reliable predictor of hand hygiene compliance after patient contact