Ideas That Work: Rethinking Hand Hygiene Auditing

Practical pearls from your colleagues.

A study recently published in the American Journal of Infection Control, “Right-sizing Expectations for Hand Hygiene Observation Collection”, argues that hand hygiene monitoring in hospitals can be reduced significantly.

Specifically, it finds hospitals could reduce their number of hand hygiene observations from 200 to as few as 50 per unit per month without compromising data quality.

The authors from The Association for Professionals in Infection Control and Epidemiology (APIC)’s Center for Research, Practice & Innovation — Sara M. Reese, PhD, MPH, CIC, FAPIC; Bryan Knepper, MPH, MS, CIC, FAPIC; and Rebecca Crapanzano-Sigafoos, DrPH, CIC, FAPIC — note that hand hygiene monitoring remains essential for infection prevention, as adherence among healthcare workers is often low, and survey and accrediting bodies use the data to assign quality safety grades. However, they believe more monitoring is not always better.

They note that the Leapfrog Group added a new standard to its 2019 hospital survey that required facilities to collect 200 direct hand hygiene observations per month per patient care unit, based on a 2009 World Health Organization method. In 2021, Leapfrog reduced the standard to 100 observations per unit per month if hospitals met all the other domains in the standard.

The authors say Leapfrog’s updated standard remains challenging for healthcare facilities. That’s especially true for ASCs that might not even employ a dedicated infection preventionist, due to the significant resources needed to gather so many observations. They sought to determine a statistically comparable number of observations below the current Leapfrog standard.

Analyzing 390,371 hand hygiene observations collected in 2023 across 29 facilities within large U.S. hospital systems, the authors evaluated sample sizes of 25, 50, 100 and 150 observations to determine if there was a statistical difference in adherence with the 200-observation standard within a 95% confidence interval. Their power analysis found that a sample size of 50 observations was comparable to 200 for assessing hand hygiene compliance.

The money saved by adjusting hand hygiene observation requirements can be significant. The authors provide the example of a hospital with 12 departmental units collecting 100 to 200 direct hand hygiene observations per month. They estimate it would require 67 to 127 hours per month at an annual cost of $36,288 to $68,688.

Switching to 50 hand hygiene observations per unit per month, that hospital could save more than $50,000 annually, they say. Ultimately, the authors believe reduced observation requirements can free up more time for education about hand hygiene as well as other infection prevention activities. OSM