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

Department of Psychology, University College London, London, UK.
Journal of Hospital Infection (Impact Factor: 2.54). 03/2008; 68(3):222-9. DOI: 10.1016/j.jhin.2007.12.009
Source: PubMed


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 tool 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 tool, consists of HHOs (before and after low-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 baumannii 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.

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

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    Current Opinion in Infectious Diseases 06/2014; DOI:10.1097/QCO.0000000000000080 · 5.01 Impact Factor
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    • "The development of the intervention, using an appropriate behavioural theoretical framework [16] and the MRC framework for complex interventions [22], is described elsewhere [21]–[25], and included an exploratory trial [23] on 7 wards in 3 hospitals (none of which participated in the definitive trial). "
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    PLoS ONE 10/2012; 7(10):e41617. DOI:10.1371/journal.pone.0041617 · 3.23 Impact Factor
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    • "Peer reviewed article of a hand hygiene intervention ( McAteer et al, 2008 ) targeting HCWs. Hand hygiene might therefore be better in these wards either because of the intervention or because the wards and/or their trusts were suffi ciently interested in hand hygiene to volunteer for the trial. "
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