An examination of covert observation and solution audit as tools to measure the success of hand hygiene interventions

Background: Many studies have examined hand hygiene (HH) frequency and adherence in response to various interventions This study used 2 methods to determine HH frequency and adherence to see how well the outcomes correlated. Methods: HH frequency was measured over 4, 1-month periods (phases 1-4), using 2 methods: an audit of HH solution used during each phase adjusted for patient-days and covert observation of HH adherence The number of x-ray technician contacts with patients (a known quantity) across the study period was retrospectively compared with the number of observations made of x-ray technicians' HH behavior to see what proportion of contacts were observed Results: HH solution use doubled in phase 2 and was 65% and 55% higher than the baseline level in phases 3 and 4, respectively Observed HH adherence fell from 51% to 37% in phase 2 and then rose to 58% in phases 3 and 4. Three percent of x-ray technicians' patient contacts were observed across the 4 phases. Conclusion: Observation of HH may not adequately sample patient contacts to provide an accurate measure of HH adherence. Further studies are needed to confirm this finding.