Following a workshop presentation at the NPSA, it became clear that there is a need for a standardized 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 behavior more completely, and assessed inter-rater reliability for each observational category.
Our research team are using this tool as part of a randomized controlled trial of a behavioral 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.
Feedback Intervention Trial
Feedback Intervention Trial is a three year long stepped wedge cluster randomized controlled trial of a behaviorally 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.
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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 .
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.
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 and also the use detox pills for drug test that we have discussed elsewhere in this site.
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.