| dc.description.abstract | Background: Healthcare-associated infections are burdensome to patients, increase antibiotic resistance, and raise healthcare costs. Hand hygiene is one of the most effective practices to prevent healthcare-associated infections. Direct observation of hand hygiene practices is considered the gold standard to assess hand hygiene compliance but requires training, competence, and experience to minimise potential selection and observer biases. It is unknown whether hand hygiene assessments by direct observation in daily practice are reliable and valid.
Aim: To evaluate reliability and validity of hand hygiene assessments performed by nurses.
Method: Twenty nurses of a university medical centre participated in a quantitative observational study. Reliability was determined by twenty parallel observation sessions with an experienced observer and a nurse, assigned to perform hand hygiene assessments. The experienced observer and the nurses observed the same healthcare workers and care sequence, using a structured observation form. Validity was assessed by the presence of selection and/or observer bias using a structured questionnaire about the observation method and nurses’ knowledge.
Results: Reliability analysis, using paired samples t-test, showed no significant difference between the observed hand hygiene compliance of nurses and the experienced observer. Inter-observer agreement of hand hygiene indications was moderate (κ = .46). As for validity, variation was found in the data collection process, nurses’ training, and knowledge gaps regarding hand hygiene indications and opportunities.
Conclusion and implications: The hand hygiene compliance assessments in daily practice are reliable. However, the validity of the assessments is affected by observer bias and selection bias. Observer bias can be reduced by training observers on hand hygiene indications, and the HH observation method in daily practice, as well as validating their observations. Selection bias can be diminished by random selection of observation times. Direct observation of hand hygiene technique should be part of the hand hygiene compliance assessments in daily practice. | |
