Transcript Hand hygiene observation and analysis

Hand Hygiene
Observation and Analysis
Version 1.4
Instructions
• This presentation should be used to teach observers how to conduct
observations. After reviewing slides 1-25 observers should complete
activities on slide 26
• Observers must complete training on Your 4 Moments for Hand Hygiene
before this presentation
• Following reviewing this presentation, the observer should practice in the
clinical setting or by simulation.
• An Excel workbook is provided to enter and analyze data from the
observation tool. The individual responsible for this activity should review
the Instructions for Observation Tool analysis available on
justcleanyourhands.ca website
2
Overview
1. Practical training for observers on how to observe
hand hygiene compliance and complete
Observation Tool
2. Overview of audit process
3. Overview of analysis and reporting process
3
Adapted from WHO
How to observe hand hygiene?
• Direct observation using a consistent approach and validated tool,
is the most accurate methodology
• The observer must familiarize him/herself with the methods and
tools used in the Just Clean Your Hands program and must be
trained (and validated) to identify and distinguish the indications for
hand hygiene occurring during health care practices at the point of
care
• The observer must conduct observations openly, without interfering
with the ongoing work, and keep the identity of the health care
providers confidential
• Compliance should be detected according to the four indications for
hand hygiene recommended by Just Clean Your Hands program.
4
Adapted from WHO
Crucial concepts for observing hand hygiene
Health care activity = a succession of tasks during which health care providers'
hands touch different types of surfaces: the patient, his/her body fluids, objects
or surfaces located in the patient environment.
Each contact is a potential source of contamination for health care providers'
hands
… contact 1  indication(s)  contact 2   indication(s)]  contact 3   indication(s) …
Indications
Indication: the reason why hand hygiene is necessary at a given moment. It is
justified by a risk of organism transmission from one surface to another.
5
Adapted from WHO
Opportunity
RISK OF TRANSMISSION
INDICATION
OPPORTUNITY
HAND
HYGIENE
Opportunity: the need to perform hand hygiene, whether there are single or multiple indications.
Hand hygiene must correspond to each opportunity.
Multiple indications may come together to create a single opportunity.
6
Terminology: Moment, Indication and Opportunity
•
Moment/Indication: The terminology of indications and moments are used
interchangeably to refer to the four times it is essential that hand hygiene be
performed by health care providers (ie. before initial patient/patient environment
contact, after aseptic procedure, after body fluid exposure risk, after patient/patient
environment contact).
•
Moments: is usually referred to when teaching or for use on public materials such as
posters and brochures.
•
Indications: is always used when discussing audits. An Indication is the reason why
hand hygiene is necessary at a given moment. It is justified by a risk of organism
transmission from one surface to another
•
Opportunity: is the need to perform hand hygiene, whether there are single or
multiple indications. Hand hygiene action must correspond to each opportunity.
Multiple indications may come together to create a single opportunity. The
opportunity block on the observation tool is used to record single or multiple
indications that provide a single opportunity for hand hygiene.
7
Preparing to Audit
General Recommendations for Observation:
• Determine how to best identify the types of health care providers
you may be observing.
 Accurate identification of health care provider is critical to
ensure reliability of data.
• Introduce yourself to the observed health care provider(s) and
patients as appropriate and explain your role.
8
Preparing to Audit
Positioning for observation:
• Find a convenient place to observe without disturbing care
activities; you can move to follow the health care provider, but
never interfere with their work. However you can provide
feedback after the session using “On- the-Spot” form.
• It is important to take into account any concerns the health care
providers may have with your presence. Your presence should
be as discreet as possible and in no way infringe on the actions
of the health care provider. If a health care provider feels
uncomfortable with your presence he/she has the right to ask
you to leave and you must do so if asked.
9
Preparing to Audit (continued)
• You may observe up to three health care providers
simultaneously provided you are an experienced observer and
are very careful not to miss opportunities. Note: Multiple health
care providers performing sequential tasks quickly may
preclude accuracy of missed hand hygiene opportunities.
• You may include more health care providers sequentially
during one observation session.
• One observation session is for 20 minutes (+/- 10 minutes);
prolong the session if you get the chance to observe a care
sequence to its end.
10
11
How to use the form
• Use a pencil to fill in the form and an eraser to correct. Use a clipboard to hold
the form.
• First, fill in the head of the form by indicating your ID number (Observer-ID), the
date, the current time including am/pm (Start time), the number of the form used
for a single session using the format 1, 2, 3, etc. (Form-No.) (See also point 19
on reverse of Observation Tool), the identity of the facility (Facility-ID), the
identity of the patient care unit (Patient Care Unit)
Observer-ID: |___|___|___|___|
Date (mm.dd.yyyy) |___|___|.|___|___|.|___|___|___|___|
Day of Week
___________________
Start time (hh:mm:AM/PM) |___|___|:|___|___| |:|___|
End time (hh:mm) |___|___|:|___|___|
Form-No.
|___|___|
Facility-ID
|___|___|___|
Patient Care Unit ________________
12
How to use the form (acute care categories)
• Indicate any rooms where Additional/Isolation Precautions are in place by entering in the Comments
section. (Observe outside the room.)
• Indicate the type of health care provider being observed by entering the number that corresponds with the
categories listed at the top of the form. The coding system is a number followed by a letter (e.g., first
physician in the room is 1A, if second physician enters the room he/she is 1B).
13
How to use the form (LTC categories)
• Indicate any rooms where Additional/Isolation Precautions are in place by
entering in the Comments section. (Observe outside the room.)
• Indicate the type of health care provider being observed by entering the number that
corresponds with the categories listed at the top of the form. The coding system is a
number followed by a letter (e.g., first physican in the room is 1A,
if second physician enters the room he/she is 1B).
14
How to use the form (continued)
• Each column is for recording hand hygiene opportunities of one health care
provider only. Use additional columns for each additional health care provider being
observed simultaneously or sequentially. The health care provider may interact with
more than one patient during the time you are observing.
Note: The Long-Term Care Observation Tool uses “Category” instead of HCP.
HCP: _________
HCP: _________
HCP: _________
HCP: _________
• As soon as you observe the first indication for hand hygiene, indicate the
corresponding information in the first of the numbered opportunity sections in the
column corresponding to the health care provider being observed.
15
Before Initial Patient/Patient Environment Contact
BEF-PAT/ ENV = “before initial patient/patient environment contact”
a) if the health care provider touches the patient’s environment and then touches the patient
or
b) goes directly to touch the patient after having touched the hospital environment (= any
other surface not in the patient’s environment) or another patient’s environment
c) if the health care provider enters the patient’s environment from the hospital environment
and touches only the patient’s environment (does not touch patient) and then leaves the
patient’s environment.
HCP: _________
1
2
 BEF-PAT/
ENV
T:
 BEF-ASP
 Rub
 Wash
 Gloves
 Bracelets
 AFT-PAT/
ENV
T:
 AFT-BFL
 BEF-PAT/
ENV
T:
 BEF-ASP
 Rub
 Wash
 Gloves
 AFT-PAT/
ENV
T:
 AFT-BFL
HCP: _________
1
 Missed
 Nails
 Rings
 Missed
2
 BEF-PAT/
ENV
T:
 BEF-ASP
 Rub
 Wash
 Gloves
 Bracelets
 AFT-PAT/
ENV
T:
 AFT-BFL
 BEF-PAT/
ENV
T:
 BEF-ASP
 Rub
 Wash
 Gloves
 AFT-PAT/
ENV
T:
 AFT-BFL
HCP: _________
1
 Missed
 Nails
 Rings
 Missed
2
 BEF-PAT/
ENV
T:
 BEF-ASP
 Rub
 Wash
 Gloves
 Bracelets
 AFT-PAT/
ENV
T:
 AFT-BFL
 BEF-PAT/
ENV
T:
 BEF-ASP
 Rub
 Wash
 Gloves
 AFT-PAT/
ENV
T:
 AFT-BFL
 Missed
 Nails
 Rings
 Missed
HCP: _________
1  BEF-PAT/
ENV
T:
 BEF-ASP
 Rub
 Wash
 Gloves
 Bracelets
 AFT-PAT/
ENV
T:
 AFT-BFL
2  BEF-PAT/
ENV
T:
 BEF-ASP
 Rub
 Wash
 Gloves
 AFT-PAT/
ENV
T:
 AFT-BFL
 Missed
 Nails
 Rings
 Missed
16
Before Aseptic Procedure
BEF-ASP = “before aseptic procedure” if the health care provider is to perform any of the
following after having touched any other surface including the concerned patient himself/herself
and his/her environment:
a) touch/manipulate a body site that should be protected against any colonization (e.g.,
wound care including dressing change and wound assessment)
b) manipulate an invasive device that could result in colonization of a body area that should
be protected against colonization (e.g., priming intravenous infusion set, inserting spike
into opening of IV bag, flushing line, adjusting intravenous site, administering medication
through IV port, changing IV tubing).
HCP: _________
1  BEF-PAT/
ENV
T:
 BEF-ASP
 Rub
 Wash
 Gloves
 Bracelets
 AFT-PAT/
ENV
T:
 AFT-BFL
 Missed
 Nails
 Rings
HCP: _________
1  BEF-PAT/
ENV
T:
 BEF-ASP
 Rub
 Wash
 Gloves
 Bracelets
 AFT-PAT/
ENV
T:
 AFT-BFL
 Missed
 Nails
 Rings
HCP: _________
1  BEF-PAT/
ENV
T:
 BEF-ASP
 Rub
 Wash
 Gloves
 Bracelets
 AFT-PAT/
ENV
T:
 AFT-BFL
 Missed
 Nails
 Rings
HCP: _________
1  BEF-PAT/
ENV
T:
 BEF-ASP
 Rub
 Wash
 Gloves
 Bracelets
 AFT-PAT/
ENV
T:
 AFT-BFL
 Missed
 Nails
 Rings
17
After Body Fluid Exposure Risk
AFT-BFL = “after body fluid exposure risk” if the health care provider has
been engaged in a care activity involving a risk of body fluid exposure
and before touching any other surface including the concerned patient
himself/herself and his/her environment (e.g., contact with blood or blood
products, emptying urinal/catheter bag and suctioning oral/nasal secretions).
HCP: _________
1  BEF-PAT/
ENV
T:
 BEF-ASP
 Rub
 Wash
 Gloves
 Bracelets
 AFT-PAT/
ENV
T:
 AFT-BFL
 Missed
 Nails
 Rings
HCP: _________
1  BEF-PAT/
ENV
T:
 BEF-ASP
 Rub
 Wash
 Gloves
 Bracelets
 AFT-PAT/
ENV
T:
 AFT-BFL
 Missed
 Nails
 Rings
HCP: _________
1  BEF-PAT/
ENV
T:
 BEF-ASP
 Rub
 Wash
 Gloves
 Bracelets
 AFT-PAT/
ENV
T:
 AFT-BFL
 Missed
 Nails
 Rings
HCP: _________
1  BEF-PAT/
ENV
T:
 BEF-ASP
 Rub
 Wash
 Gloves
 Bracelets
 AFT-PAT/
ENV
T:
 AFT-BFL
 Missed
 Nails
 Rings
18
After Patient/Patient Environment Contact
AFT-PAT/ ENV = “after patient/patient environment contact”
a) if the health care provider is leaving the patient and his/her environment to go on
working in the hospital environment or with another patient
b) if the health care provider is leaving the patient area after touching objects in the patient
environment (without touching the patient) to go on working in the hospital environment
or with another patient.
HCP: _________
1  BEF-PAT/
ENV
T:
 BEF-ASP
 Rub
 Wash
 Gloves
 Bracelets
 AFT-PAT/
ENV
T:
 AFT-BFL
2  BEF-PAT/
ENV
T:
 BEF-ASP
 Rub
 Wash
 Gloves
 AFT-PAT/
ENV
T:
 AFT-BFL
 Missed
 Nails
 Rings
 Missed
HCP: _________
1  BEF-PAT/
ENV
T:
 BEF-ASP
 Rub
 Wash
 Gloves
 Bracelets
 AFT-PAT/
ENV
T:
 AFT-BFL
2  BEF-PAT/
ENV
T:
 BEF-ASP
 Rub
 Wash
 Gloves
 AFT-PAT/
ENV
T:
 AFT-BFL
 Missed
 Nails
 Rings
 Missed
HCP: _________
1  BEF-PAT/
ENV
T:
 BEF-ASP
 Rub
 Wash
 Gloves
 Bracelets
 AFT-PAT/
ENV
T:
 AFT-BFL
2  BEF-PAT/
ENV
T:
 BEF-ASP
 Rub
 Wash
 Gloves
 AFT-PAT/
ENV
T:
 AFT-BFL
 Missed
 Nails
 Rings
 Missed
HCP: _________
1  BEF-PAT/
ENV
T:
 BEF-ASP
 Rub
 Wash
 Gloves
 Bracelets
 AFT-PAT/
ENV
T:
 AFT-BFL
2  BEF-PAT/
ENV
T:
 BEF-ASP
 Rub
 Wash
 Gloves
 AFT-PAT/
ENV
T:
 AFT-BFL
 Missed
 Nails
 Rings
 Missed
19
If there is more than one indication on one
opportunity, mark them all
Note: If several indications fall together on the same hand hygiene opportunity, tick all.
• Example 1: health care provider enters room, cleans hands with alcohol and
immediately performs aseptic procedure; this would result in checking
• BEF-PAT/ENV and BEF-ASP.
HCP: _________
1  BEF-PAT/
ENV
T:
 BEF-ASP
 Rub
 Wash
 Gloves
 Bracelets
 AFT-PAT/
ENV
T:
 AFT-BFL
 Missed
 Nails
 Rings
HCP: _________
1  BEF-PAT/
ENV
T:
 BEF-ASP
 Rub
 Wash
 Gloves
 Bracelets
 AFT-PAT/
ENV
T:
 AFT-BFL
 Missed
 Nails
 Rings
HCP: _________
1  BEF-PAT/
ENV
T:
 BEF-ASP
 Rub
 Wash
 Gloves
 Bracelets
 AFT-PAT/
ENV
T:
 AFT-BFL
 Missed
 Nails
 Rings
HCP: _________
1  BEF-PAT/
ENV
T:
 BEF-ASP
 Rub
 Wash
 Gloves
 Bracelets
 AFT-PAT/
ENV
T:
 AFT-BFL
 Missed
 Nails
 Rings
20
For each opportunity, indicate the hand hygiene
action of the health care provider
• Mark whether the health care provider used alcohol-based hand rub (RUB), soap
and water (WASH) or did not do hand hygiene (MISSED)
• If a health care provider used soap and water and then alcohol-based hand rub
(or vice-versa), mark both.
HCP: _________
1  BEF-PAT/
ENV
T:
 BEF-ASP
 Rub
 Wash
 Gloves
 Bracelets
 AFT-PAT/
ENV
T:
 AFT-BFL
 Missed
 Nails
 Rings
HCP: _________
1  BEF-PAT/
ENV
T:
 BEF-ASP
 Rub
 Wash
 Gloves
 Bracelets
 AFT-PAT/
ENV
T:
 AFT-BFL
 Missed
 Nails
 Rings
HCP: _________
1  BEF-PAT/
ENV
T:
 BEF-ASP
 Rub
 Wash
 Gloves
 Bracelets
 AFT-PAT/
ENV
T:
 AFT-BFL
 Missed
 Nails
 Rings
HCP: _________
1  BEF-PAT/
ENV
T:
 BEF-ASP
 Rub
 Wash
 Gloves
 Bracelets
 AFT-PAT/
ENV
T:
 AFT-BFL
 Missed
 Nails
 Rings
21
Gloves
•
For each opportunity, tick if the health care provider was wearing gloves when the opportunity
occurred.
•
In this audit, wearing gloves does not change the number of opportunities for health care providers
to clean their hands.
•
Hand hygiene done with gloves on is incorrect; therefore, it is marked as a missed opportunity.
•
Examples when gloves may be used: when handling blood and body fluids, mucous membranes,
wound care, contact with non-intact skin and where indicated for additional precautions/isolation.
1
2
 BEF-PAT/
ENV
T:
 BEF-ASP
 Rub
 Wash
 Gloves
 Bracelets
 AFT-PAT/
ENV
T:
 AFT-BFL
 BEF-PAT/
ENV
T:
 BEF-ASP
 Rub
 Wash
 Gloves
 AFT-PAT/
ENV
T:
 AFT-BFL
1
 Missed
 Nails
 Rings
 Missed
2
 BEF-PAT/
ENV
T:
 BEF-ASP
 Rub
 Wash
 Gloves
 Bracelets
 AFT-PAT/
ENV
T:
 AFT-BFL
 BEF-PAT/
ENV
T:
 BEF-ASP
 Rub
 Wash
 Gloves
 AFT-PAT/
ENV
T:
 AFT-BFL
1
 Missed
 Nails
 Rings
 Missed
2
 BEF-PAT/
ENV
T:
 BEF-ASP
 Rub
 Wash
 Gloves
 Bracelets
 AFT-PAT/
ENV
T:
 AFT-BFL
 BEF-PAT/
ENV
T:
 BEF-ASP
 Rub
 Wash
 Gloves
 AFT-PAT/
ENV
T:
 AFT-BFL
 Missed
 Nails
 Rings
 Missed
1  BEF-PAT/
ENV
T:
 BEF-ASP
 Rub
 Wash
 Gloves
 Bracelets
 AFT-PAT/
ENV
T:
 AFT-BFL
2  BEF-PAT/
ENV
T:
 BEF-ASP
 Rub
 Wash
 Gloves
 AFT-PAT/
ENV
T:
 AFT-BFL
 Missed
 Nails
 Rings
 Missed
22
Technique: Nails, Rings and Bracelets
• Tick the corresponding boxes if the health care provider does not meet the
guidelines regarding:
 correct nail length (3-4 mm, ¼ inch)
 no nail extensions/artificial nails
 no rings or bracelets.
• It is necessary to do this only once for each health care provider.
HCP: _________
1  BEF-PAT/
ENV
T:
 BEF-ASP
 Rub
 Wash
 Gloves
 Bracelets
 AFT-PAT/
ENV
T:
 AFT-BFL
 Missed
 Nails
 Rings
HCP: _________
1  BEF-PAT/
ENV
T:
 BEF-ASP
 Rub
 Wash
 Gloves
 Bracelets
 AFT-PAT/
ENV
T:
 AFT-BFL
 Missed
 Nails
 Rings
HCP: _________
1  BEF-PAT/
ENV
T:
 BEF-ASP
 Rub
 Wash
 Gloves
 Bracelets
 AFT-PAT/
ENV
T:
 AFT-BFL
 Missed
 Nails
 Rings
HCP: _________
1  BEF-PAT/
ENV
T:
 BEF-ASP
 Rub
 Wash
 Gloves
 Bracelets
 AFT-PAT/
ENV
T:
 AFT-BFL
 Missed
 Nails
 Rings
23
Technique: Timing of hand hygiene
•
Timing of the duration of hand hygiene
•
T = “timing” This is the duration of hand hygiene performed by the health
care provider when hand hygiene occurs for:
 BEF-PAT/ ENV and AFT-PAT/ ENV indications.
•
Use a wristwatch or stopwatch to record duration (seconds) of hand
hygiene before patient/patient environment contact and after
patient/patient environment contact. Begin timing when the health care
providers start rubbing his/her hands with the product, and stop timing
when he/she completes the motion of rubbing their hands with the
product.
•
Note: Rinsing of hands with water does not constitute a hand wash –
this would be coded as a missed opportunity.
24
Important Notes
• Each column is for recording hand hygiene opportunities of one health care provider only.
Use additional columns for each additional health care provider being observed
simultaneously or sequentially. The health care provider may interact with more than one
patient during the time you are observing.
• Note: Multiple health care providers sequentially performing tasks quickly may make it
difficult to maintain accurate observation of missed hand hygiene opportunities.
• If you observe more than four opportunities for one health care provider, use another form,
numbering them sequentially in the variable Form-No. Remember to code the health care
provider in the same way (e.g., if they were 2A on the first form, they are 2A on the second
form).
• At the end of the session, do not forget to fill in the End time and check the form(s) for
missing values before handing it in.
• End the observation if the privacy curtain is drawn around the patient’s bed or if a health
care provider asks you to leave.
• Record any additional qualitative data in the Comments section E.g., Additional
Precautions/Isolation.
25
Activities for Observers
.
•
Review Training Scenarios 1-4 on Training DVD and record
the appropriate observation results for each scenario.
•
Debrief with others when first learning how to use the
Observation Tool, to assist with consistency and
understanding of the audit process.
•
Review Observer Scenarios 5-8 on Training DVD and record
the appropriate observation results for each scenario.
•
Discuss your results as a group or compare your recorded
observations with the answers for each scenario in the Hand
Hygiene DVD Answer Key
26
Selecting a Sample Size
•
It is important to have a large enough sample size to be
meaningful.
•
Not collecting enough data means the rates are not reliable
as any changes could be due to chance alone rather than
the effect of the intervention.
•
For 100 beds it is estimated that 56 observation sessions of
20 minutes each is needed to collect enough data for
reliable compliance rates. (This provides for approximately
200 observed opportunities)
•
The time frame for the audit period should be no less than a
2 week period.
Note: Ideally, the baseline observations should be completed before the “Implementation
Phase” of the program starts.
27
Sample Hand Hygiene Observation Schedule used
to audit 80 beds in a pilot site
• Friday, January 19, 2008 - 8:00 a.m. (eight 20-minute observation)
• Sunday, January 21, 2008 - 12:00 p.m. (eight 20-minute observations)
• Tuesday, January 23, 2008 - 4:00 p.m. (eight 20-minute observations)
• Thursday, January 25, 2008 - 8:00 p.m. (eight 20-minute observations)
• Saturday, January 27, 2008 - 12:00 a.m. (eight 20-minute observations)
• Monday, January 29, 2008 - 4:00 a.m. (eight 20-minute observations)
• Wednesday, January 31, 2008 - 8:00 a.m. (eight 20-minute observations)
28
Sample size for smaller facilities
•
To ensure data is valid a hospital with 50 beds should complete at
least 100 observed opportunities
•
The minimum number of observed opportunities is 50 (ie. For 10
beds you would still require 50 observed opportunities to ensure
statistical validity)
•
Data may need to be collected over a longer period of time
29
Feedback: “Aggregate Data”
• An Excel workbook tool has been provided to assist with
analyzing observation results
• Using individual workbooks for each unit, floor or program
area allows you to provide feedback specific to those areas.
• The data entry can be done by the observer or another
resource may be assigned
• Predefined reports have been included to analyze data
using four different methods
• Report table and charts can be pasted into presentations to
support feedback of progress to health care providers,
management and hospital board
30
Analyzing compliance rates
•
Compliance rates analyze “when” hand hygiene was performed as
compared to the number of times that were indicated to perform
hand hygiene.
4 specific
indications
Action
Performed
HCP:_________
1 BEF-PAT/
ENV
T:
BEF-ASP
Rub
Wash
Gloves
Bracelets
AFT-PAT/
ENV
T:
AFT-BFL
Missed
Nails
Rings
HCP:_________
1 BEF-PAT/
ENV
T:
BEF-ASP
Rub
Wash
Gloves
Bracelets
AFT-PAT/
ENV
T:
AFT-BFL
Missed
Nails
Rings
HCP:_________
1 BEF-PAT/
ENV
T:
BEF-ASP
Rub
Wash
Gloves
Bracelets
AFT-PAT/
ENV
T:
AFT-BFL
Missed
Nails
Rings
Opportunity
Block
HCP:_________
1 BEF-PAT/
ENV
T:
BEF-ASP
Rub
Wash
Gloves
Bracelets
AFT-PAT/
ENV
T:
AFT-BFL
Missed
Nails
Rings
Calculation:
# times hand hygiene was performed for a specific indication by all categories of HCP x 100 = % compliance
# observed hand hygiene indications for a specific indication by all categories of HCP
31
Analyzing technique
•
The compliance rate is not impacted by technique or the “how”
hand hygiene was performed. (i.e. time, rings, watches, nails are
not calculated in the rate)
Timing indications 1 and 4 (chosen
arbitrarily) is optional but can provide
helpful data on technique which can be
used to inform ongoing education.
HCP
: _________
1 BEF-PAT/
ENV
T:
BEF-ASP
Rub
Wash
Gloves
Bracelets
AFT-PAT/
ENV
T:
AFT-BFL
Missed
Nails
Rings
HCP:_________
1 BEF-PAT/
ENV
T:
BEF-ASP
Rub
Wash
Gloves
Bracelets
AFT-PAT/
ENV
T:
AFT-BFL
Missed
Nails
Rings
HCP
: _________
1 BEF-PAT/
ENV
T:
BEF-ASP
Rub
Wash
Gloves
Bracelets
AFT-PAT/
ENV
T:
AFT-BFL
Missed
Nails
Rings
HCP
: _________
1 BEF-PAT/
ENV
T:
BEF-ASP
Rub
Wash
Gloves
Bracelets
AFT-PAT/
ENV
T:
AFT-BFL
Missed
Nails
Rings
32
Observation Analysis Tool – Data and Reports
33
Observation Analysis Tool – Data Entry Page
34
Methods of analysis
Data can be analyzed as follows:
1.
Analyzing one type of “indication” for each health care provider category at a
time to provide for accurate information to compare over time (most accurate
method)
2.
Combine health care providers, categories for a specific “indication” to obtain a
generalized compliance rate for that “indication”
3.
Combine the opportunities for each category of health care provider (HCP) to
obtain a generalized compliance rate for each HCP category
4.
Compare alcohol-based hand rub with soap and water to assess behaviour
change
*Note: for 2 and 3 the information may not be comparative over time as the mix of “type of indication”
gathered in opportunities in “2” or the category of health care provider” in “3“may vary and therefore
not provide for accurate comparative rates.
35
Calculating reliable hand hygiene compliance rates
• An overall hand hygiene compliance rate does not provide for reliable and
comparative rates over time as compliance rates for the different types of
health care provider and for the each of the four indications are frequently
different.
• If a generalized rate is to be provided, reliability will increase if the same
number is used for the overall analysis:
 for each category of health care provider and
 for the number of observations of each indication
36
Reports 1a – d: Preferred Method: Calculating reliable hand
hygiene compliance rates
• Compliance rates are to be calculated separately for each type of indication and each
health care provider category (e.g., Nurses BEF-PAT/ENV 70 per cent; Physicians AFTPAT/ENV 70 per cent; Respiratory Therapist AFT-BFL-85 per cent)
 Compliance rates must be reported by:
√ Each hand hygiene indication
√ Each health care provider (HCP) category
# times hand hygiene was performed for a specific indication /specific HCP category x 100%
# observed hand hygiene indications for specific indication/specific HCP category
(The number of observations to make the information meaningful will depend on unit size, patient
population and hospital size)
• Breakdown of the compliance rates by indication and health care provider category
provides data for developing targeted and appropriate interventions to improve
compliance.
• Overall generalized compliance rate combining health care providers and/or combining
types of indications will not provide for reliability.
37
Report 1 a - sample
Hand Hygiene Compliance Before Initial Patient/Patient Environment Contact
by Category of Health Care Provider
60%
41%
29%
48%
40%
22%
28%
29%
Other
60%
40%
20%
Physicians
80%
Patient
Transporters
% Compliance
100%
15%
PSA,PSW,PCA
Nursing
Students
Nurses
Medical
Students
Environmental
Services
Allied HCPs*
0%
*Allied health care prov iders include Radiology Tech, Dieticians, Social Worker, IV Team/Blood
Collection,Pastoral Care, Phy siotherapists, and Respiratory Therapists
Calculation:
# times hand hygiene was performed for BEF-PAT/ENV by specific HCP category X 100 = % compliance
# observed hand hygiene indications for BEF-PAT/ENV by specific HCP category
Note: Categories of provider differ for LTC homes.
38
Report 1 b – sample
PSA,PSW,PCA
Nursing
Students
22%
28%
29%
Other
40%
Physicians
48%
15%
Nurses
29%
Medical
Students
41%
Patient
Transporters
60%
Environmental
Services
100%
80%
60%
40%
20%
0%
Allied HCPs*
% Compliance
Hand Hygiene Compliance Before Aseptic Procedure
by Category of Health Care Provider
*Allied health care prov iders include Radiology Tech, Dieticians, Social Worker, IV Team/Blood Collection,
Pastoral Care, Phy siotherapists, and Respiratory Therapists
Calculation:
# times hand hygiene was performed for BEF-ASP by specific HCP category X 100 = % compliance
# observed hand hygiene indications for BEF-ASP by specific HCP category
Note: Categories of provider differ for LTC homes.
39
Report 1 c - sample
Hand Hygiene Compliance After Body Fluid Exposure Risk
by Category of Health Care Provider
41%
29%
48%
40%
15%
22%
28%
29%
Other
60%
40%
20%
60%
Physicians
80%
Patient
Transporters
% Compliance
100%
PSA,PSW,PCA
Nursing
Students
Nurses
Medical
Students
Environmental
Services
Allied HCPs*
0%
*Allied health care prov iders include Radiology Tech, Dieticians, Social Worker, IV Team/Blood Collection,
Pastoral Care, Phy siotherapists, and Respiratory Therapists
Calculation:
# times hand hygiene was performed for AFT-BFL by specific HCP category X 100 = % compliance
# observed hand hygiene indications for AFT-BFL by specific HCP category
Note: Categories of provider differ for LTC homes.
40
Report 1 d - sample
Hand Hygiene Compliance After Patient/Patient Environment Contact
by Category of Health Care Provider
41%
29%
48%
40%
15%
22%
28%
29%
Other
60%
40%
20%
60%
Physicians
80%
Patient
Transporters
% Compliance
100%
PSA,PSW,PCA
Nursing
Students
Nurses
Medical
Students
Environmental
Services
Allied HCPs*
0%
*Allied health care prov iders include Radiology Tech, Dieticians, Social Worker, IV Team/Blood Collection,
Pastoral Care, Phy siotherapists, and Respiratory Therapists
Calculation:
# times hand hygiene was performed for AFT-PAT/ENV by specific HCP category X 100 = % compliance
# observed hand hygiene indications for AFT-PAT/ENV by specific HCP category
Note: Categories of provider differ for LTC homes.
41
Report 2 – Hand Hygiene by type of indication – sample
Hand Hygiene by Type of Indication
% Compliance
100%
80%
75%
75%
50%
60%
40%
25%
20%
0%
B e f o re init ia l B e f o re a s e pt ic
A f t e r bo dy
A fter
pa t ie nt / pa t ie nt
pro c e dure
f luid e xpo s ure pa t ie nt / pa t ie nt
e nv iro nm e nt
ris k
e nv iro nm e nt
c o nt a c t
c o nt a c t
Calculation:
# times hand hygiene was performed for a specific indication by all categories of HCP x 100 = % compliance
# observed hand hygiene indications for a specific indication by all categories of HCP
42
Report 2 – table detail
Example: Compliance for Before initial patient/patient environment contact:
3 x 100 = 75% compliance for BEF-PAT/ENV
Compliance
4
Numerator
Compliance
Denominator
% Compliance
# times hand
hygiene was
performed
# observed hand
hygiene indications
Before initial patient/patient
environment contact
75%
3
4
Before aseptic procedure
25%
1
4
After body fluid exposure risk
50%
2
4
After patient/patient environment
contact
75%
3
4
Type of Indications
43
Report 3 – Compliance by health care provider type –
combined indications
40%
PSA,PSW,PCA
Nursing
Students
Patient
Transporters
22%
28%
29%
Other
48%
15%
Nurses
29%
Medical
Students
41%
Physicians
60%
Environmental
Services
100%
80%
60%
40%
20%
0%
Allied HCPs*
% Compliance
Hand Hygiene Compliance by Category of Health Care Provider
*Allied health care prov iders include Radiology Tech, Dieticians, Social Worker, IV Team/Blood
Collection,pastoral care, Phy siotherapists, and Respiratory Therapists
Calculation:
# opportunities hand hygiene performed by specific HCP category
Total # observed hand hygiene opportunities for a specific HCP category
x 100 = % compliance
Note: Categories of provider differ for LTC homes.
44
Report 3 - table detail
Provides detail on numbers of providers observed as well as total number of observed
hand hygiene opportunities
Sum of column 4 will provide
total number of observed hand
hygiene opportunities
(1)
Type of Health Care Provider
(2)
% Compliance
(3)
# Opportunities hand
hygiene performed by
HCP
(4)
Total # observed hand
hygiene opportunities
by HCP
Allied HCPs*
0%
0
0
Environmental Services
0%
0
0
Medical Students
0%
0
0
Nurses
0%
0
0
Nursing Students
0%
0
0
PSA, PSW, PCA
0%
0
0
Patient Transporters
0%
0
0
Physicians
0%
0
0
Other
0%
0
0
Note: Categories of provider differ for LTC homes.
45
Report 4 - sample
Hand Hygiene Technique
20%
5%
rub
wash
both
75%
Calculation:
# of opportunities hand rub was used to clean hands x 100 = % rub
Total number of opportunities hand hygiene was observed
# of opportunities soap and water was used to clean hands X 100 = % wash
Total number of opportunities hand hygiene was observed
# of opportunities hand rub and soap and water were both used to clean hands X 100 = % both
Total number of opportunities hand hygiene was observed
46
Acknowledgement
•
The Ministry of Health and Long-Term Care would like thank the WHO World Alliance
for Patient Safety for sharing its Clean Care is Safer Care materials. This presentation
includes slides from annex 16 and concepts from the Observers Manual of Clean Care is
Safer Care, the WHO multimodal hand hygiene improvement strategy developed by the
World Alliance for Patient Safety.
47