Measuring Hand Hygiene (HH) requires a substantial dedication of resources and often leads to over-estimation of true HH compliance rates.

Average compliance among hospitals throughout the U.S., reported through direct observation, is around 47% looking only at hand hygiene opportunities defined as “Entering a patient room” and “Exiting a patient room.”  While we strive for an era where all 5 Moments of Hand Hygiene (right) are accurately measured and performed, the current era of direct observation requires focus on increasing hand hygiene performance upon Entering a patient room and Exiting a patient room.

Here at the University of Chicago Medicine, we have implemented innovative approaches to exploring more accurate ways to measure hand hygiene performance:

Direct Observation:
Our Infection Practitioners (IP) as well as “secret shoppers” routinely round throughout the medical center, directly observing and recording hand hygiene compliance. A hand hygiene ‘opportunity’ is defined as Entering or Exiting a patient room. Observations are recorded ONLY if the IP is able to observe the full opportunity. For example, if a HCW walks into a patient room and washes his or her hands behind a curtain, that observation is not counted as the IP cannot see the full opportunity.  This approach allows for over-estimation of hand hygiene performance as the denominator for these unobserved opportunities is thrown out.

Soap and Alcohol-based rub Dispenser Counters:
A more objective trend in measuring hand hygiene is the installation of counting devices into dispensers of both soap and alcohol-based rubs. This approach does not allow for a denominator of all hand hygiene opportunities, but allows for comparison of soap/rub utilization rates on each floor and unit. Patients and visitors who was their hands will increase the numerator of this measurement approach

Electronic Monitoring:
Select units have been chosen for an innovative pilot project using radio frequency technology (RFID) to monitor hand hygiene. This approach allows for an accurate denominator of hand hygiene events for each healthcare worker- entering a patient room and exiting a patient room- as well as an individualized numerator of hand hygiene performance. For more information on this project, please click HERE

Video Surveillance:
Many institutions throughout the country are using video surveillance to monitor hand hygiene performance. While these capabilities exist at the University of Chicago Medicine, the resources required for this measurement approach are cumbersome and as such used only on an as-needed basis.