NOSEC: National Observation Study of the Effectiveness of the
cleanyourhands Campaign
January 2005 - December 2009

Click here to see a study summary and some latest results.

Click here for a powerpoint presentation entitled 'NOSEC - Results from the first, second and third questionnaires'.


Hand Hygiene Observation Tool

Following a workshop presentation at the NPSA, it became clear that there is a need for a standardised and reliable observation tool for use in hospital wards for audit and feedback. We have developed the Hand-hygiene Observation Tool (HHOT) and the corresponding standard operating procedures (SOPs) in response to this need. In developing our observation tool, we have tried to simplify categories, described the ‘rules’ for classifying hand-hygiene behaviour more completely, and assessed inter-rater reliability for each observational category.

Our research team are using this tool as part of a randomised controlled trial of a behavioural intervention to improve hand-hygiene compliance, the Feedback Intervention Trial (FIT), funded by the Patient Safety Research Programme. The tool has been successfully used for almost 400 hours worth of observation in 60 wards as part of the FIT trial and adopted by 25 senior managers at the Royal Free who use it in their regular “walk-abouts” to monitor hand-hygiene compliance.

Click here to download the full version of our Standard Operating Procedures.

Click here to download the short summary of our Standard Operating Procedures.

Click here to download the hand-hygiene observation tool.

Click here for a document with directions on using the hand hygiene tool.


NOSEC publications

  • S Stone Slade R, Fuller C et al Early communication: Does a national campaign to improve hand hygiene in the NHS work? Initial English and Welsh experience from the NOSEC study (National Observational Study to Evaluate the CleanYourHandsCampaign J Hospital Infection 2007 ;66(3); 288-9

    Click here to access this online.
  • J. McAteer, S. Stone , C. Fuller , A. Charlett , B. Cookson , R. Slade , S. Michie, and the NOSEC/FIT group Development of an observational measure of healthcare worker hand-hygiene behaviour: the hand-hygiene observation tool (HHOT), Journal of Hospital Infection (2008) 68, 222-229

    Click here to access this online.

Comments and feedback are welcomed.
Please direct feedback to Dr Sheldon Stone

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