Should self-assessment methods be used to measure compliance with handwashing recommendations? A study carried out in a French university hospital

Background: Implementation of a hand hygiene promotion program in a large university hospital required that we find a suitable method to assess health care workers' (HCWs) hand hygiene practices. This study aims at comparing direct observation and self-assessment methods. Methods: Hand hygiene practices of 206 HCWs (physicians, nurses, and nurse assistants) in 25 care units were directly observed by trained auditors for I day. A week later, 1050 HCWs filled out a self-assessment questionnaire on their compliance with handwashing indications (participation rate was 83%). Results: Average global self-reported compliance rate (SRR) after patient care was similar to the observed rate (OBR) (74%). According to the type of care, differences between SRR and OBR were nonsignificant, except for change of infusion bag by nurses and nursing care by nurse assistants. Physicians and nurse assistants tended systematically to over evaluate their compliance, whereas nurses tended to under evaluate their compliance with hand hygiene recommendations. Conclusions: Mean compliance rates were higher than those reported in the literature but varied as a function of patient care activity and occupation of the HCW A reinforced in-service educational program will be implemented that will target especially physicians and medical students. Self-assessment method, easy to use and inexpensive, gave encouraging results. The development of a broad-based, routine, self-assessment program is underway at Nantes University Hospital, but, before such a program can be implemented, reproducibility of these self-assessment indicators must be further confirmed.