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Development of an observational measure of healthcare worker hand-hygiene behaviour: the hand-hygiene observation tool (HHOT)

McAteer, J; Stone, S; Fuller, C; Charlett, A; Cookson, B; Slade, R; ... NOSEC FIT Grp,; + view all (2008) Development of an observational measure of healthcare worker hand-hygiene behaviour: the hand-hygiene observation tool (HHOT). J HOSP INFECT , 68 (3) 222 - 229. 10.1016/j.jhin.2007.12.009.

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Abstract

Previous observational measures of healthcare worker (HCW) hand-hygiene behaviour (HHB) fail to provide adequate standard operating procedures (SOPs), accounts of inter-rater agreement testing or evidence of sensitivity to change. This study reports the development of an observational too[ in a way that addresses these deficiencies. Observational categories were developed systematically, guided by a clinical guideline, previous measures and pilot hand-hygiene behaviour observations (HHOs). The measure, a simpler version of the Geneva too[, consists of HHOs (before and after tow-risk, high-risk or unobserved contact), HHBs (soap, alcohol hand rub, no action, unknown), and type of HCW. Inter-observer agreement for each category was assessed by observation of 298 HHOs and HHBs by two independent observers on acute elderly and intensive care units. Raw agreement (%) and Kappa were 77% and 0.68 for HHB; 83% and 0.77 for HHO; and 90% and 0.77 for HCW. Inter-observer agreement for overall compliance of a group of HCWs was assessed by observation of 1191 HHOs and HHBs by two pairs of independent observers. Overall agreement was good (intraclass correlation coefficient = 0.79). Sensitivity to change was examined by autoregressive time-series modelling of longitudinal observations for 8 months on the intensive therapy unit during an Acinetobacter boumannii outbreak and subsequent strengthening of infection control measures. Sensitivity to change was demonstrated by a rise in compliance from 80 to 98% with an odds ratio of increased compliance of 7.00 (95% confidence interval: 4.02-12.2) P < 0.001. (c) 2008 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.

Type:Article
Title:Development of an observational measure of healthcare worker hand-hygiene behaviour: the hand-hygiene observation tool (HHOT)
DOI:10.1016/j.jhin.2007.12.009
Keywords:hand-hygiene behaviour, healthcare-associated infection, observational measurement
UCL classification:UCL > School of Life and Medical Sciences > Faculty of Life Sciences

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