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

Methods of obtaining data on hand hygiene practices have not been well validated. The purpose of this study was to compare two methods of assessment of hand hygiene practices--direct observation and self-report using diaries. For 22 months, nursing staff (n = 119) from two neonatal ICUs recorded their hand hygiene practices on a diary card one shift/month (n = 1,071 diary cards). The same data were collected in monthly 1-hour direct observation sessions (n = 206 hours). Amount of time in gloves and total hand hygiene episodes/hour did not differ significantly by diary or observation, but four other specific parameters were significantly different. If hand hygiene practices are to be assessed over time, the same method must be used. Given these measurement limitations, more valid, practical, and less costly methods are needed.