Î Measure hand hygiene adherence via direct observation (human
observers), product volume measurement, or automated monitoring (II).
• Decide on the type of measurement system on the basis of resource availability and
commitment to using the data collected productively. Consider the advantages and
limitations of each type of monitoring.
▶ Use direct observation to elucidate contextual barriers to and facilitators of
hand hygiene and to provide corrective feedback to individuals.
▶ Use product volume measurement for large-scale benchmarking but
complement with direct observation when possible.
▶ Use automated systems to provide real-time reminders and generate feedback
for quality improvement.
Note: Be aware that such systems have been mainly used in research settings. They
may be limited in their capacity to accurately measure opportunities within each
patient care encounter. These systems can, however, measure a large sample of
hand hygiene opportunities and can be useful for measuring trends over time and
generating real-time displays for feedback.
Î Provide feedback to HCPs on hand hygiene performance (III).
• Provide feedback in multiple formats and on more than one occasion.
• Provide meaningful data with clear targets and an action plan in place for
improving adherence.
▶ Meaningful data may include unit- or role-based adherence data rather than
overall performance.
▶ Real-time displays of hand hygiene adherence may provide some incentive for
improvement on a shift-by-shift basis.
Special Approaches for Hand Hygiene Practices
Î During norovirus outbreaks, in addition to contact precautions
requiring the use of gloves, consider preferential use of soap and
water after caring for patients with known or suspected norovirus
infection (III).
Î During C. difficile outbreaks or in settings with hyperendemic CDI, in
addition to contact precautions requiring the use of gloves, consider
preferential use of soap and water after caring for patients with known
or suspected CDI (III).
Hand Hygiene
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