Last hand hygiene step: Who complies with all?

According to How-to Guide: Improving Hand Hygiene, the Institute of Healthcare Improvement (IHI) says you should measure the percentage of patient encounters in which there is compliance by health care workers with all components of appropriate hand hygiene and glove practices.

Compliance is monitored with direct observation by a trained observer using a standardized procedure and form. Independent observers are strongly recommended, preferably individuals who routinely are on the ward for other purposes and are not part of the care team. (This independent monitoring can be reinforced with monitoring by the care team during routine multidisciplinary rounds, which permits immediate assessment and feedback.) Observation periods should be 20-30 minutes (repeated if necessary) so that about 25-30 patient encounters are observed.

The emphasis should be on observing complete encounters so that the proper measure of complete compliance with all components of the hand hygiene and glove intervention package can be calculated. Divide the number of encounters in which all components were performed correctly by the number of encounters observed and multiply by 100 to calculate the percentage compliance rate.

Gloves should be worn for all types of contact if the patient is on isolation precautions that require the use of gloves for contact with the patient and the environment, or if there is a unit-based procedure for universal gloving (wearing gloves for contact with all patients and their immediate environment).

The following additional measure also can be used, but it does not replace direct observation of health care worker compliance during patient encounters:

Volume of alcohol-based hand hygiene product consumed per week (or per month) divided by the number of patient days in the corresponding time period.

Self-reporting by personnel or patients is not a reliable measure of compliance.