Evgeni Brotfain1, Ilana Livshiz-Riven2, Alexander Gushansky3, Alexander Erblat4, Leonid Koyfman4, Tomer Ziv5, Lisa Saidel-Odes3, Moti Klein4, Abraham Borer3. 1. Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel. Electronic address: bem1975@gmail.com. 2. Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Nursing, Recanati School for Community Health Professions, Ben-Gurion University of the Negev, Beer Sheva, Israel. 3. Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel. 4. Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel. 5. Department of Statistical Analysis, Tel Aviv University, Tel Aviv, Israel.
Abstract
INTRODUCTION: A variety of hand hygiene monitoring programs (HHMPs) have come into use in hospitals throughout the world. In the present study, we compare continuous closed circle television (CCTV) with overt observation for monitoring the hand hygiene compliance of health care workers (HCWs) in a general intensive care unit (GICU). METHODS: This is a cross-sectional and comparative study. In this study, we use a novel hand hygiene CCTV monitoring system for hand hygiene performance monitoring. The study population incorporated all the GICU HCWs, including registered nurses, staff physicians, and auxiliary workers. RESULTS: All HCWs of our GICU were observed, including ICU registered nurses, ICU staff physicians, and auxiliary workers participated in the present study. Overall, each observer team did 50 sessions in each arm of the study. Total number of hand hygiene opportunities was approaching 500 opportunities. The compliance rates when only overt observations were performed was higher than when only covert observations were performed with a delta of approximately 10% (209 out of 590 [35.43%] vs 130 out of 533 [24.39%]; P < .001). Both methods of observations (overt and covert [CCTV]) demonstrated excellent reliability (intraclass correlation coefficient [ICC], 0.96 [0.93-0.98] of overt and ICC, 0.81 [0.69-0.89] for covert, respectively). However, the correlation between both methods was found weak in simultaneous sessions (ICC, 0.40 [0.62-0.107]). CONCLUSION: We demonstrated that CCTV is an appropriate, reliable, and neutral method for observation of hand hygiene. However, there is no clear basis for incorporating a CCTV observation modality into a health care system that already operates an overt observation program. We have shown that CCTV methodology records a different distribution of opportunities for performing hand hygiene and of actual performances of hand hygiene compared with overt observation.
INTRODUCTION: A variety of hand hygiene monitoring programs (HHMPs) have come into use in hospitals throughout the world. In the present study, we compare continuous closed circle television (CCTV) with overt observation for monitoring the hand hygiene compliance of health care workers (HCWs) in a general intensive care unit (GICU). METHODS: This is a cross-sectional and comparative study. In this study, we use a novel hand hygiene CCTV monitoring system for hand hygiene performance monitoring. The study population incorporated all the GICU HCWs, including registered nurses, staff physicians, and auxiliary workers. RESULTS: All HCWs of our GICU were observed, including ICU registered nurses, ICU staff physicians, and auxiliary workers participated in the present study. Overall, each observer team did 50 sessions in each arm of the study. Total number of hand hygiene opportunities was approaching 500 opportunities. The compliance rates when only overt observations were performed was higher than when only covert observations were performed with a delta of approximately 10% (209 out of 590 [35.43%] vs 130 out of 533 [24.39%]; P < .001). Both methods of observations (overt and covert [CCTV]) demonstrated excellent reliability (intraclass correlation coefficient [ICC], 0.96 [0.93-0.98] of overt and ICC, 0.81 [0.69-0.89] for covert, respectively). However, the correlation between both methods was found weak in simultaneous sessions (ICC, 0.40 [0.62-0.107]). CONCLUSION: We demonstrated that CCTV is an appropriate, reliable, and neutral method for observation of hand hygiene. However, there is no clear basis for incorporating a CCTV observation modality into a health care system that already operates an overt observation program. We have shown that CCTV methodology records a different distribution of opportunities for performing hand hygiene and of actual performances of hand hygiene compared with overt observation.