8
Recommendations
Table 3. Methods to Measure Hand Hygiene
Method Use Strength
Direct overt
observation
• Gold standard for
evaluation of technique.
• Monitoring prevalence
of hand conditions,
adherence to facility or
unit specific policies.
• Inclusion in prevention
bundle checklists can
ensure appropriate hand
hygiene prior to high-risk
procedures (e.g., central-
line insertion).
• Immediate feedback with
correction of lapses.
• Those completing
prevention bundle checklists
are empowered to speak up
for patient safety.
• Can be used as a form of
engagement among peers.
Direct covert
observation
• Establishment of
performance baseline.
• Gauge progress towards
facility established goals.
• Evaluation of technique.
Barriers and facilitators
to hand hygiene can be
identified.
Automated hand-
hygiene monitoring
systems (AHHMSs)
• Supplements direct
observation.
• Establishment of
performance baseline.
• Gauge progress toward
facility-established goals.
• Provides trends in hand
hygiene performance.
• More complete data
regarding compliance due to
continuous monitoring of
all shifts and days of week.
• HCP-specific adherence
rates can be monitored
using some systems.
• Systems may provide real-
time reminders to ensure
adherence.
