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

Click here for the study's final published results and click here to see the study summary.

Click here for the finalised technical report.

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.

Feedback Intervention trial 

Feedback Intervention Trial is a three year long stepped wedge cluster randomised controlled trial of a behaviourally designed feedback intervention to improve hand hygiene compliance  of Healthcare workers on intensive care units and acute care of the elderly wards in on 60 wards in 16 hospitals in England and Wales

Click here for worked examples of the FIT forms.

Click here for the final results of the study.

Click here to download the Feedback Intervention Trial Protocol

Click here to download the Feedback Intervention training materials.


NOSEC publications

  • Stone S, Fuller C, Savage J et al. (2012). Evaluation of the national Cleanyourhands campaign to reduce Staphylococcus aureus bacteraemia and Clostridium difficile infection in hospitals in England and Wales by improved hand hygiene: four year, prospective, ecological, interrupted time series study.: BMJ 344:e3005 .
    Click here to access this online.
  • 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.
Statement on data-sharing

Data bases from the study are described on NOSEC’s website, where it is clear that data sharing arrangements can be entered into. The IDRN has agreed to facilitate this, thus reaching a wider audience within the infection control research community

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

This page is created and hosted by the Infectious Disease Research Network