Assessing nurses' hand hygiene practices by direct observation or self-report

Area of Science:

• Healthcare quality improvement
• Infection prevention and control
• Nursing research methodology

Background:

• Accurate assessment of hand hygiene practices is vital for infection control.
• Current methods for evaluating hand hygiene compliance lack robust validation.
• Variability in data collection can impact the reliability of findings.

Purpose of the Study:

• To compare the validity of direct observation versus self-report diaries for assessing hand hygiene.
• To identify discrepancies between two common methods of measuring hand hygiene compliance.
• To inform the selection of appropriate methods for future hand hygiene research.

Main Methods:

• A 22-month comparative study involving 119 nursing staff in two neonatal ICUs.
• Data collection through monthly diary entries (1,071 total) and direct observation sessions (206 hours).
• Analysis of specific hand hygiene parameters, time in gloves, and total hand hygiene episodes per hour.

Main Results:

• No significant differences were found in time spent gloved or total hand hygiene episodes per hour between methods.
• Four specific hand hygiene parameters demonstrated significant differences between diary self-reports and direct observation.
• The findings highlight measurement limitations inherent in each assessment method.

Conclusions:

• Direct observation and self-report diaries yield different results for key hand hygiene parameters.
• Consistent use of a single assessment method is essential for longitudinal studies of hand hygiene.
• Development of more valid, practical, and cost-effective hand hygiene assessment tools is needed.