Ways to measure hand hygiene compliance

The Institute of Healthcare Improvement's (IHI) free How-to Guide: Improving Hand Hygiene, includes monitoring checklists. To monitor hand hygiene compliance, IHI suggests the following measures.

1. The percentage of caregivers who answer all five questions correctly on a standardized hand hygiene knowledge assessment survey.

Consider selecting a random sample of 10 clinical providers from diverse disciplines each month (or at other intervals specified by the hospital) to answer a five-question survey along with a competency check. (A sample survey is available in Appendix One of the resource at www.shea-online.org/Assets.)

An alternative strategy is to assess knowledge using an intranet-based system. Facilities could require employees to take an annual online test for or could conduct more frequent sampling.

An alternative strategy is to assess knowledge by using an intranet-based system. Facilities could require employees to take an annual online test or could conduct more frequent sampling.

2. The percentage of caregivers who perform all three key hand hygiene procedures correctly.

Randomly select a sample of 10 clinical providers from diverse disciplines each month (or at other intervals specified by the facility) and observe them to determine if they perform the three key hand hygiene procedures correctly: hand washing, alcohol-based hand rub, and gloves. (See more on three steps, below.) This method has the strength of direct evaluation and feedback, but is time-consuming. It also provides an opportunity to ensure that providers are not wearing artificial nails or nail extenders and have their nails trimmed to less than ¼ inch.

Alternatively, competence can be assessed by monitoring hand hygiene practices during actual work. This has the advantage of being unobtrusive and integrated with other monitoring activities, but precludes direct feedback and adds complexity to the monitoring process.

3 Key Hand Hygiene Procedures

3. The percentage of bed spaces at which there are clean gloves in appropriate sizes and dispensers (wall-mounted or freestanding bottles) for alcohol-based hand rub/gel/foam that contain product, are functional, and dispense an appropriate volume of product.

Make direct observations monthly (or at other intervals specified by the facility) on the same nursing units where Measures 1 and 2 are monitored. Alternatively, availability can be assessed periodically as part of routine multidisciplinary rounds.

Dispenser of alcohol-based product must be present, readily accessible at the point of care, not empty, functional, and capable of delivering the appropriate volume of product. If hand/pocket bottles are used, an adequate supply must be readily available and accessible on the ward.

At least two sizes of gloves should be available and readily accessible at the point of care.

The guide was developed with the Centers for Disease Control and Prevention, the Society of Healthcare Epidemiology of America, and the Association for Professionals in Infection Control and Epidemiology. (Editor's note: To access the guide, go to www.shea-online.org/Assets.)