What is the optimal period for measuring hand hygiene compliance: Are longer periods better than 20-minute periods?

摘要

Direct observation of hand hygiene is considered the gold standard for measuring healthcare worker (HCW) hand hygiene compliance (HHC) for clinical audit and hand hygiene intervention trials. Many studies and audits observe for 20-30 minutes, but systematic review shows that others observe for 1-4 hours or more, without explaining the rationale for this longer observation period.1 World Health Organization (WHO) guidance recommends observation for 20 minutes (with an additional 10 minutes of observation if necessary).2 HCW hand hygiene may improve when HCWs are aware of being observed,3 but it is unclear whether this reactivity increases or decreases over time or introduces systematic bias. Short periods of observation may not reflect 24-hour, 7-days-per-week behavior.3 In addition, short observation periods may not provide enough observations to meet previously identified criteria for interobserver reliability, because compliance levels differ between observers by over 10% if less than 15 hand hygiene moments are observed.