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					Canada’s Hand Hygiene Challenge




                   Hand Hygiene
                    Compliance:
                Observation & Analysis
                 The Canadian Patient Safety Institute would like to thank the Ontario Ministry of
               Health and Long Term Care for their efforts toward development of training materials
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands


             Instructions for Trainer
  • This presentation should be used to teach health care workers how
    to conduct observations.

  • Observers must complete training on Your 4 Moments for Hand
    Hygiene before this presentation

  • Following the teaching session, practical sessions either at the
    patient bedside or by simulation, can be organized.

  • 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.
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands

                     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
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands


          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 and must be trained to identify and distinguish the indications
    for hand hygiene occurring 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 determined according to the four indications
    for hand hygiene
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands

       Key concepts: Indication & Opportunity
 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

 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.
     … contact 1  indication(s)  contact 2   indication(s)]  contact 3   indication(s)
                                                 …

 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.


  RISK OF TRANSMISSION                    INDICATION                OPPORTUNITY                 HAND
                                                                                               HYGIENE
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands
            Indication and Opportunity
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands


                             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.
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands

                    Preparing to Audit
Positioning for observation:
• Find a convenient place to observe without disturbing care activities
• Move to follow the health care provider, but never interfere with their
  work.
• You can also provide feedback after the session using “On- the-Spot”
  form.
• Take into account any concerns the health care providers may have
  with your presence.
• You 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.
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands

                Preparing to Audit (continued)
   • You may observe up to three health care providers
     simultaneously (with experience)
      • Note: Multiple health care providers performing sequential tasks quickly may
        interfere with audit accuracy.


   • 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.
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands

                Observation Tool
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands

                         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.

  • 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)
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands

                            How to use the form
   • 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).
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands

              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.




   • 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.
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands
  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: _________                 HCP: _________                 HCP: _________               HCP: _________

  1    BEF-PAT/     AFT-PAT/   1    BEF-PAT/     AFT-PAT/   1    BEF-PAT/     AFT-PAT/   1  BEF-PAT/     AFT-PAT/
      ENV           ENV              ENV           ENV              ENV           ENV            ENV           ENV
      T:            T:               T:            T:               T:            T:             T:            T:
       BEF-ASP      AFT-BFL         BEF-ASP      AFT-BFL         BEF-ASP      AFT-BFL       BEF-ASP      AFT-BFL
       Rub                           Rub                           Rub                         Rub
                     Missed                        Missed                        Missed                      Missed
       Wash                          Wash                          Wash                        Wash
       Gloves       Nails           Gloves       Nails           Gloves       Nails         Gloves       Nails
       Bracelets    Rings           Bracelets    Rings           Bracelets    Rings         Bracelets    Rings

  2    BEF-PAT/     AFT-PAT/   2    BEF-PAT/     AFT-PAT/   2    BEF-PAT/     AFT-PAT/   2  BEF-PAT/     AFT-PAT/
      ENV           ENV              ENV           ENV              ENV           ENV            ENV           ENV
      T:            T:               T:            T:               T:            T:             T:            T:
       BEF-ASP      AFT-BFL         BEF-ASP      AFT-BFL         BEF-ASP      AFT-BFL       BEF-ASP      AFT-BFL
       Rub                           Rub                           Rub                         Rub
                     Missed                        Missed                        Missed                      Missed
       Wash                          Wash                          Wash                        Wash
       Gloves                        Gloves                        Gloves                      Gloves
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands

                             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: _________              HCP: _________               HCP: _________               HCP: _________

   1  BEF-PAT/       AFT-PAT/   1  BEF-PAT/     AFT-PAT/   1  BEF-PAT/     AFT-PAT/   1  BEF-PAT/     AFT-PAT/
     ENV             ENV            ENV           ENV            ENV           ENV            ENV           ENV
     T:              T:             T:            T:             T:            T:             T:            T:
      BEF-ASP        AFT-BFL       BEF-ASP      AFT-BFL       BEF-ASP      AFT-BFL       BEF-ASP      AFT-BFL
      Rub                           Rub                         Rub                         Rub
                      Missed                      Missed                      Missed                      Missed
      Wash                          Wash                        Wash                        Wash
      Gloves         Nails         Gloves       Nails         Gloves       Nails         Gloves       Nails
      Bracelets      Rings         Bracelets    Rings         Bracelets    Rings         Bracelets    Rings
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands

              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: _________               HCP: _________               HCP: _________               HCP: _________

   1  BEF-PAT/     AFT-PAT/   1  BEF-PAT/     AFT-PAT/   1  BEF-PAT/     AFT-PAT/   1  BEF-PAT/     AFT-PAT/
     ENV           ENV            ENV           ENV            ENV           ENV            ENV           ENV
     T:            T:             T:            T:             T:            T:             T:            T:
      BEF-ASP      AFT-BFL       BEF-ASP      AFT-BFL       BEF-ASP      AFT-BFL       BEF-ASP      AFT-BFL
      Rub                         Rub                         Rub                         Rub
                    Missed                      Missed                      Missed                      Missed
      Wash                        Wash                        Wash                        Wash
      Gloves       Nails         Gloves       Nails         Gloves       Nails         Gloves       Nails
      Bracelets    Rings         Bracelets    Rings         Bracelets    Rings         Bracelets    Rings
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands

      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
          if the health                  leaving the
      b) HCP: _________ care provider isHCP: _________patient area after touching objects in the patient environment
                                                                       HCP: _________                HCP: _________
          (without touching the patient) to go on working in the hospital environment or with another patient.
   1  BEF-PAT/     AFT-PAT/   1  BEF-PAT/     AFT-PAT/    1  BEF-PAT/     AFT-PAT/    1  BEF-PAT/     AFT-PAT/
     ENV           ENV            ENV           ENV             ENV           ENV             ENV           ENV
     T:            T:             T:            T:              T:            T:              T:            T:
      BEF-ASP      AFT-BFL       BEF-ASP      AFT-BFL        BEF-ASP      AFT-BFL        BEF-ASP      AFT-BFL
      Rub                         Rub                          Rub                          Rub
                    Missed                      Missed                       Missed                       Missed
      Wash                        Wash                         Wash                         Wash
      Gloves       Nails         Gloves       Nails          Gloves       Nails          Gloves       Nails
      Bracelets    Rings         Bracelets    Rings          Bracelets    Rings          Bracelets    Rings

   2  BEF-PAT/     AFT-PAT/   2  BEF-PAT/     AFT-PAT/    2  BEF-PAT/     AFT-PAT/    2  BEF-PAT/     AFT-PAT/
     ENV           ENV            ENV           ENV             ENV           ENV             ENV           ENV
     T:            T:             T:            T:              T:            T:              T:            T:
      BEF-ASP      AFT-BFL       BEF-ASP      AFT-BFL        BEF-ASP      AFT-BFL        BEF-ASP      AFT-BFL
      Rub                         Rub                          Rub                          Rub
                    Missed                      Missed                       Missed                       Missed
      Wash                        Wash                         Wash                         Wash
      Gloves                      Gloves                       Gloves                       Gloves
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands
  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: _________               HCP: _________               HCP: _________               HCP: _________

  1  BEF-PAT/     AFT-PAT/   1  BEF-PAT/     AFT-PAT/   1  BEF-PAT/     AFT-PAT/   1  BEF-PAT/     AFT-PAT/
    ENV           ENV            ENV           ENV            ENV           ENV            ENV           ENV
    T:            T:             T:            T:             T:            T:             T:            T:
     BEF-ASP      AFT-BFL       BEF-ASP      AFT-BFL       BEF-ASP      AFT-BFL       BEF-ASP      AFT-BFL
     Rub                         Rub                         Rub                         Rub
                   Missed                      Missed                      Missed                      Missed
     Wash                        Wash                        Wash                        Wash
     Gloves       Nails         Gloves       Nails         Gloves       Nails         Gloves       Nails
     Bracelets    Rings         Bracelets    Rings         Bracelets    Rings         Bracelets    Rings
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands

 For each opportunity, indicate the action of
               the 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: _________               HCP: _________               HCP: _________               HCP: _________

   1  BEF-PAT/     AFT-PAT/   1  BEF-PAT/     AFT-PAT/   1  BEF-PAT/     AFT-PAT/   1  BEF-PAT/     AFT-PAT/
     ENV           ENV            ENV           ENV            ENV           ENV            ENV           ENV
     T:            T:             T:            T:             T:            T:             T:            T:
      BEF-ASP      AFT-BFL       BEF-ASP      AFT-BFL       BEF-ASP      AFT-BFL       BEF-ASP      AFT-BFL
      Rub                         Rub                         Rub                         Rub
                    Missed                      Missed                      Missed                      Missed
      Wash                        Wash                        Wash                        Wash
      Gloves       Nails         Gloves       Nails         Gloves       Nails         Gloves       Nails
      Bracelets    Rings         Bracelets    Rings         Bracelets    Rings         Bracelets    Rings
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands

                                                        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    BEF-PAT/     AFT-PAT/   1    BEF-PAT/     AFT-PAT/   1    BEF-PAT/     AFT-PAT/   1  BEF-PAT/     AFT-PAT/
       ENV           ENV              ENV           ENV              ENV           ENV            ENV           ENV
       T:            T:               T:            T:               T:            T:             T:            T:
        BEF-ASP      AFT-BFL         BEF-ASP      AFT-BFL         BEF-ASP      AFT-BFL       BEF-ASP      AFT-BFL
        Rub                           Rub                           Rub                         Rub
                      Missed                        Missed                        Missed                      Missed
        Wash                          Wash                          Wash                        Wash
        Gloves       Nails           Gloves       Nails           Gloves       Nails         Gloves       Nails
        Bracelets    Rings           Bracelets    Rings           Bracelets    Rings         Bracelets    Rings

   2    BEF-PAT/     AFT-PAT/   2    BEF-PAT/     AFT-PAT/   2    BEF-PAT/     AFT-PAT/   2  BEF-PAT/     AFT-PAT/
       ENV           ENV              ENV           ENV              ENV           ENV            ENV           ENV
       T:            T:               T:            T:               T:            T:             T:            T:
        BEF-ASP      AFT-BFL         BEF-ASP      AFT-BFL         BEF-ASP      AFT-BFL       BEF-ASP      AFT-BFL
        Rub                           Rub                           Rub                         Rub
                      Missed                        Missed                        Missed                      Missed
        Wash                          Wash                          Wash                        Wash
        Gloves                        Gloves                        Gloves                      Gloves
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands

 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: _________                  HCP: _________                 HCP: _________               HCP: _________

   1  BEF-PAT/     AFT-PAT/     1  BEF-PAT/        AFT-PAT/   1  BEF-PAT/     AFT-PAT/   1  BEF-PAT/     AFT-PAT/
     ENV           ENV              ENV              ENV            ENV           ENV            ENV           ENV
     T:            T:               T:               T:             T:            T:             T:            T:
      BEF-ASP      AFT-BFL         BEF-ASP         AFT-BFL       BEF-ASP      AFT-BFL       BEF-ASP      AFT-BFL
      Rub                           Rub                            Rub                         Rub
                    Missed                           Missed                      Missed                      Missed
      Wash                          Wash                           Wash                        Wash
      Gloves       Nails           Gloves          Nails         Gloves       Nails         Gloves       Nails
      Bracelets    Rings           Bracelets       Rings         Bracelets    Rings         Bracelets    Rings
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands

       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 opportunities.

   •   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 provider starts rubbing his/her
       hands with the product, and stops 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.
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands

                            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 worker 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 worker asks you to leave.
•   Record any additional qualitative data in the Comments section E.g., Additional
    Precautions/Isolation.
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands

             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
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands

        Planning Observation Schedule
   Observation Suggestions:

   • Eight 20-minute observations/day
   • At least seven different days of eight periods of
     observation
   • At different times of the day (different shifts and
     different times within the shift)

     Therefore, there will be approximately 56
     observation sessions for calculating the
     aggregate data.
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands

               Feedback: “Aggregate Data”
   – An Excel workbook tool has been provided to enter and analyze
     observation results

   – 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
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands

           Observation Analysis Tool
             Data Entry Page
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands

                                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.
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands


     Calculating Reliable 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
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands

           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 AFT-PAT/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.
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands

                                                        Report 1 a - sample
                          Hand Hygiene Compliance Before I nitial Patient/Patient Environment Contact
                                           by Category of Health Care Provider
                   100%
                   80%
                                                                           60%
    % Compliance




                   60%      41%                                                         48%
                                                                                                     40%
                   40%                          29%                                                                                28%          29%
                                                                                                                      22%
                                                                15%
                   20%
                    0%
                                               Environmental




                                                                                                                                   Physicians


                                                                                                                                                Other
                                                                            Nurses
                                                               Students




                                                                                       Students




                                                                                                                    Transporters
                            Allied HCPs*




                                                                                                      PSA,PSW,PCA
                                                                                        Nursing
                                                                Medical




                                                                                                                       Patient
                                                 Services




                                           *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
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands

                                            Report 1 b – sample
                                           Hand Hygiene Compliance Before Aseptic Procedure
                                                  by Category of Health Care Provider
                     100%
                      80%
      % Compliance




                                                                        60%
                      60%                                                         48%
                            41%                                                               40%
                      40%                     29%                                                             22%          28%          29%
                                                              15%
                      20%
                       0%
                                             Environmental




                                                                                                                           Physicians


                                                                                                                                        Other
                                                                        Nurses
                                                             Students




                                                                                 Students




                                                                                                            Transporters
                            Allied HCPs*




                                                                                              PSA,PSW,PCA
                                                                                  Nursing
                                                              Medical




                                                                                                               Patient
                                               Services




                              *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
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands

                                                  Report 1 c - sample
                                        Hand Hygiene Compliance After Body Fluid Exposure Risk
                                                  by Category of Health Care Provider
                  100%
                  80%
                                                                    60%
   % Compliance




                  60%    41%                                                  48%
                                                                                           40%
                  40%                     29%                                                                           28%          29%
                                                                                                           22%
                                                          15%
                  20%
                   0%
                                         Environmental




                                                                                                                        Physicians


                                                                                                                                     Other
                                                                    Nurses
                                                         Students




                                                                             Students




                                                                                                         Transporters
                         Allied HCPs*




                                                                                           PSA,PSW,PCA
                                                                              Nursing
                                                          Medical




                                                                                                            Patient
                                           Services




                           *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
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands

                                                    Report 1 d - sample
                               Hand Hygiene Compliance After Patient/Patient Environment Contact
                                             by Category of Health Care Provider
                   100%
                   80%
                                                                    60%
    % Compliance




                   60%    41%                                                  48%
                                                                                            40%
                   40%                    29%                                                                            28%          29%
                                                                                                            22%
                                                          15%
                   20%
                    0%
                                         Environmental




                                                                                                                         Physicians


                                                                                                                                      Other
                                                                    Nurses
                                                         Students




                                                                             Students




                                                                                                          Transporters
                          Allied HCPs*




                                                                                            PSA,PSW,PCA
                                                                              Nursing
                                                          Medical




                                                                                                             Patient
                                           Services




                            *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
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands

                                          Report 2 - sample
                                         Hand Hygiene by Type of Indication

                      100%
                                                          74%
                      80%
       % Compliance




                                                                                57%                    54%
                      60%
                                    31%
                      40%
                      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
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands

                                               Report 3 - sample
                           Hand Hygiene Compliance by Category of Health Care Provider

                    100%
                     80%                                                   60%
     % Compliance




                     60%   41%                                                          48%
                                                                                                      40%
                     40%                        29%                                                                    22%          28%            29%
                                                                15%
                     20%
                      0%
                                               Environmental




                                                                                                                                    Physicians


                                                                                                                                                   Other
                                                                            Nurses



                                                                                       Students




                                                                                                                     Transporters
                            Allied HCPs*




                                                                                                      PSA,PSW,PCA
                                                               Students




                                                                                        Nursing
                                                                Medical




                                                                                                                        Patient
                                                 Services




                                           *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                                                                                 x 100 = %
 compliance
 Total # observed hand hygiene opportunities for a specific HCP category
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands

                          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
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands


             Instructions for Trainer
  • This presentation should be used to teach health care workers how
    to conduct observations.

  • Observers must complete training on Your 4 Moments for Hand
    Hygiene before this presentation

  • Following the teaching session, practical sessions either at the
    patient bedside or by simulation, can be organized.

  • 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.
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands

                     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
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands
             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 and must be trained to identify and distinguish the indications
    for hand hygiene occurring 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 determined according to the four indications
    for hand hygiene
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands
               Key concepts: Indication & Opportunity
 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

 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.
     … contact 1  indication(s)  contact 2   indication(s)]  contact 3   indication(s)
                                                 …

 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.


  RISK OF TRANSMISSION                    INDICATION                OPPORTUNITY                 HAND
                                                                                               HYGIENE
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands
            Indication and Opportunity
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands
                               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.
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands
                     Preparing to Audit

   Positioning for observation:
   • Find a convenient place to observe without disturbing care
     activities
   • Move to follow the health care provider, but never interfere with
     their work.
   • You can also provide feedback after the session using “On-
     the-Spot” form.
   • Take into account any concerns the health care providers may
     have with your presence.
   • You 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.
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands

                Preparing to Audit (continued)
   • You may observe up to three health care providers
     simultaneously (with experience)
      • Note: Multiple health care providers performing sequential tasks quickly may
        interfere with audit accuracy.


   • 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.
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands



               Observation Tool
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands
                 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.

  • 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)
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands

                            How to use the form
   • 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).
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands

              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.




   • 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.
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands
  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: _________                 HCP: _________                 HCP: _________               HCP: _________

   1    BEF-PAT/     AFT-PAT/   1    BEF-PAT/     AFT-PAT/   1    BEF-PAT/     AFT-PAT/   1  BEF-PAT/     AFT-PAT/
       ENV           ENV              ENV           ENV              ENV           ENV            ENV           ENV
       T:            T:               T:            T:               T:            T:             T:            T:
        BEF-ASP      AFT-BFL         BEF-ASP      AFT-BFL         BEF-ASP      AFT-BFL       BEF-ASP      AFT-BFL
        Rub                           Rub                           Rub                         Rub
                      Missed                        Missed                        Missed                      Missed
        Wash                          Wash                          Wash                        Wash
        Gloves       Nails           Gloves       Nails           Gloves       Nails         Gloves       Nails
        Bracelets    Rings           Bracelets    Rings           Bracelets    Rings         Bracelets    Rings

   2    BEF-PAT/     AFT-PAT/   2    BEF-PAT/     AFT-PAT/   2    BEF-PAT/     AFT-PAT/   2  BEF-PAT/     AFT-PAT/
       ENV           ENV              ENV           ENV              ENV           ENV            ENV           ENV
       T:            T:               T:            T:               T:            T:             T:            T:
        BEF-ASP      AFT-BFL         BEF-ASP      AFT-BFL         BEF-ASP      AFT-BFL       BEF-ASP      AFT-BFL
        Rub                           Rub                           Rub                         Rub
                      Missed                        Missed                        Missed                      Missed
        Wash                          Wash                          Wash                        Wash
        Gloves                        Gloves                        Gloves                      Gloves
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands
                            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: _________              HCP: _________               HCP: _________               HCP: _________

   1  BEF-PAT/      AFT-PAT/   1  BEF-PAT/     AFT-PAT/   1  BEF-PAT/     AFT-PAT/   1  BEF-PAT/     AFT-PAT/
     ENV            ENV            ENV           ENV            ENV           ENV            ENV           ENV
     T:             T:             T:            T:             T:            T:             T:            T:
      BEF-ASP       AFT-BFL       BEF-ASP      AFT-BFL       BEF-ASP      AFT-BFL       BEF-ASP      AFT-BFL
      Rub                          Rub                         Rub                         Rub
                     Missed                      Missed                      Missed                      Missed
      Wash                         Wash                        Wash                        Wash
      Gloves        Nails         Gloves       Nails         Gloves       Nails         Gloves       Nails
      Bracelets     Rings         Bracelets    Rings         Bracelets    Rings         Bracelets    Rings
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands

                      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: _________               HCP: _________               HCP: _________               HCP: _________

   1  BEF-PAT/     AFT-PAT/   1  BEF-PAT/     AFT-PAT/   1  BEF-PAT/     AFT-PAT/   1  BEF-PAT/     AFT-PAT/
     ENV           ENV            ENV           ENV            ENV           ENV            ENV           ENV
     T:            T:             T:            T:             T:            T:             T:            T:
      BEF-ASP      AFT-BFL       BEF-ASP      AFT-BFL       BEF-ASP      AFT-BFL       BEF-ASP      AFT-BFL
      Rub                         Rub                         Rub                         Rub
                    Missed                      Missed                      Missed                      Missed
      Wash                        Wash                        Wash                        Wash
      Gloves       Nails         Gloves       Nails         Gloves       Nails         Gloves       Nails
      Bracelets    Rings         Bracelets    Rings         Bracelets    Rings         Bracelets    Rings
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands

   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: _________               HCP: _________                HCP: _________               HCP: _________

   1  BEF-PAT/     AFT-PAT/   1  BEF-PAT/     AFT-PAT/   1  BEF-PAT/     AFT-PAT/   1  BEF-PAT/     AFT-PAT/
     ENV           ENV            ENV           ENV            ENV           ENV            ENV           ENV
     T:            T:             T:            T:             T:            T:             T:            T:
      BEF-ASP      AFT-BFL       BEF-ASP      AFT-BFL       BEF-ASP      AFT-BFL       BEF-ASP      AFT-BFL
      Rub                         Rub                         Rub                         Rub
                    Missed                      Missed                      Missed                      Missed
      Wash                        Wash                        Wash                        Wash
      Gloves       Nails         Gloves       Nails         Gloves       Nails         Gloves       Nails
      Bracelets    Rings         Bracelets    Rings         Bracelets    Rings         Bracelets    Rings

   2  BEF-PAT/     AFT-PAT/   2  BEF-PAT/     AFT-PAT/   2  BEF-PAT/     AFT-PAT/   2  BEF-PAT/     AFT-PAT/
     ENV           ENV            ENV           ENV            ENV           ENV            ENV           ENV
     T:            T:             T:            T:             T:            T:             T:            T:
      BEF-ASP      AFT-BFL       BEF-ASP      AFT-BFL       BEF-ASP      AFT-BFL       BEF-ASP      AFT-BFL
      Rub                         Rub                         Rub                         Rub
                    Missed                      Missed                      Missed                      Missed
      Wash                        Wash                        Wash                        Wash
      Gloves                      Gloves                      Gloves                      Gloves
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands
         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: _________               HCP: _________               HCP: _________               HCP: _________

  1  BEF-PAT/     AFT-PAT/   1  BEF-PAT/     AFT-PAT/   1  BEF-PAT/     AFT-PAT/   1  BEF-PAT/     AFT-PAT/
    ENV           ENV            ENV           ENV            ENV           ENV            ENV           ENV
    T:            T:             T:            T:             T:            T:             T:            T:
     BEF-ASP      AFT-BFL       BEF-ASP      AFT-BFL       BEF-ASP      AFT-BFL       BEF-ASP      AFT-BFL
     Rub                         Rub                         Rub                         Rub
                   Missed                      Missed                      Missed                      Missed
     Wash                        Wash                        Wash                        Wash
     Gloves       Nails         Gloves       Nails         Gloves       Nails         Gloves       Nails
     Bracelets    Rings         Bracelets    Rings         Bracelets    Rings         Bracelets    Rings
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands

For each opportunity, indicate the action of the 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: _________               HCP: _________               HCP: _________               HCP: _________

   1  BEF-PAT/     AFT-PAT/   1  BEF-PAT/     AFT-PAT/   1  BEF-PAT/     AFT-PAT/   1  BEF-PAT/     AFT-PAT/
     ENV           ENV            ENV           ENV            ENV           ENV            ENV           ENV
     T:            T:             T:            T:             T:            T:             T:            T:
      BEF-ASP      AFT-BFL       BEF-ASP      AFT-BFL       BEF-ASP      AFT-BFL       BEF-ASP      AFT-BFL
      Rub                         Rub                         Rub                         Rub
                    Missed                      Missed                      Missed                      Missed
      Wash                        Wash                        Wash                        Wash
      Gloves       Nails         Gloves       Nails         Gloves       Nails         Gloves       Nails
      Bracelets    Rings         Bracelets    Rings         Bracelets    Rings         Bracelets    Rings
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands

                                                        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    BEF-PAT/     AFT-PAT/   1    BEF-PAT/     AFT-PAT/   1    BEF-PAT/     AFT-PAT/   1  BEF-PAT/     AFT-PAT/
        ENV           ENV              ENV           ENV              ENV           ENV            ENV           ENV
        T:            T:               T:            T:               T:            T:             T:            T:
         BEF-ASP      AFT-BFL         BEF-ASP      AFT-BFL         BEF-ASP      AFT-BFL       BEF-ASP      AFT-BFL
         Rub                           Rub                           Rub                         Rub
                       Missed                        Missed                        Missed                      Missed
         Wash                          Wash                          Wash                        Wash
         Gloves       Nails           Gloves       Nails           Gloves       Nails         Gloves       Nails
         Bracelets    Rings           Bracelets    Rings           Bracelets    Rings         Bracelets    Rings

    2    BEF-PAT/     AFT-PAT/   2    BEF-PAT/     AFT-PAT/   2    BEF-PAT/     AFT-PAT/   2  BEF-PAT/     AFT-PAT/
        ENV           ENV              ENV           ENV              ENV           ENV            ENV           ENV
        T:            T:               T:            T:               T:            T:             T:            T:
         BEF-ASP      AFT-BFL         BEF-ASP      AFT-BFL         BEF-ASP      AFT-BFL       BEF-ASP      AFT-BFL
         Rub                           Rub                           Rub                         Rub
                       Missed                        Missed                        Missed                      Missed
         Wash                          Wash                          Wash                        Wash
         Gloves                        Gloves                        Gloves                      Gloves
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands

          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: _________                  HCP: _________               HCP: _________               HCP: _________

   1  BEF-PAT/     AFT-PAT/    1  BEF-PAT/       AFT-PAT/   1  BEF-PAT/     AFT-PAT/   1  BEF-PAT/     AFT-PAT/
     ENV           ENV             ENV             ENV            ENV           ENV            ENV           ENV
     T:            T:              T:              T:             T:            T:             T:            T:
      BEF-ASP      AFT-BFL        BEF-ASP        AFT-BFL       BEF-ASP      AFT-BFL       BEF-ASP      AFT-BFL
      Rub                          Rub                           Rub                         Rub
                    Missed                         Missed                      Missed                      Missed
      Wash                         Wash                          Wash                        Wash
      Gloves       Nails          Gloves         Nails         Gloves       Nails         Gloves       Nails
      Bracelets    Rings          Bracelets      Rings         Bracelets    Rings         Bracelets    Rings
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands

              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 opportunities.

   •   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 provider starts rubbing his/her
       hands with the product, and stops 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.
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands

                          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 worker 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 worker asks you to leave.
   •   Record any additional qualitative data in the Comments section E.g., Additional
       Precautions/Isolation.
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands

              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
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands

              Planning Observation Schedule
   Observation Suggestions:

   • Eight 20-minute observations/day
   • At least seven different days of eight periods of
     observation
   • At different times of the day (different shifts and
     different times within the shift)

     Therefore, there will be approximately 56
     observation sessions for calculating the
     aggregate data.
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands

            Feedback: “Aggregate Data”
   – An Excel workbook tool has been provided to enter and analyze
     observation results

   – 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
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands
            Observation Analysis Tool
              Data Entry Page
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands
                                 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.
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands


         Calculating Reliable 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
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands

              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 AFT-PAT/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.
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands

                                                 Report 1 a - sample
                          Hand Hygiene Compliance Before I nitial Patient/Patient Environment Contact
                                           by Category of Health Care Provider
                   100%
                   80%
                                                                           60%
    % Compliance




                   60%      41%                                                         48%
                                                                                                     40%
                   40%                          29%                                                                                28%          29%
                                                                                                                      22%
                                                                15%
                   20%
                    0%
                                               Environmental




                                                                                                                                   Physicians


                                                                                                                                                Other
                                                                            Nurses
                                                               Students




                                                                                       Students




                                                                                                                    Transporters
                            Allied HCPs*




                                                                                                      PSA,PSW,PCA
                                                                                        Nursing
                                                                Medical




                                                                                                                       Patient
                                                 Services




                                           *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
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands

                                           Report 1 b – sample
                                           Hand Hygiene Compliance Before Aseptic Procedure
                                                  by Category of Health Care Provider
                     100%
                      80%
      % Compliance




                                                                        60%
                      60%                                                         48%
                            41%                                                               40%
                      40%                     29%                                                             22%          28%          29%
                                                              15%
                      20%
                       0%
                                             Environmental




                                                                                                                           Physicians


                                                                                                                                        Other
                                                                        Nurses
                                                             Students




                                                                                 Students




                                                                                                            Transporters
                            Allied HCPs*




                                                                                              PSA,PSW,PCA
                                                                                  Nursing
                                                              Medical




                                                                                                               Patient
                                               Services




                              *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
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands

                                           Report 1 c - sample
                                        Hand Hygiene Compliance After Body Fluid Exposure Risk
                                                  by Category of Health Care Provider
                  100%
                  80%
                                                                    60%
   % Compliance




                  60%    41%                                                  48%
                                                                                           40%
                  40%                     29%                                                                           28%          29%
                                                                                                           22%
                                                          15%
                  20%
                   0%
                                         Environmental




                                                                                                                        Physicians


                                                                                                                                     Other
                                                                    Nurses
                                                         Students




                                                                             Students




                                                                                                         Transporters
                         Allied HCPs*




                                                                                           PSA,PSW,PCA
                                                                              Nursing
                                                          Medical




                                                                                                            Patient
                                           Services




                           *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
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands

                                              Report 1 d - sample
                               Hand Hygiene Compliance After Patient/Patient Environment Contact
                                             by Category of Health Care Provider
                   100%
                   80%
                                                                    60%
    % Compliance




                   60%    41%                                                  48%
                                                                                            40%
                   40%                    29%                                                                            28%          29%
                                                                                                            22%
                                                          15%
                   20%
                    0%
                                         Environmental




                                                                                                                         Physicians


                                                                                                                                      Other
                                                                    Nurses
                                                         Students




                                                                             Students




                                                                                                          Transporters
                          Allied HCPs*




                                                                                            PSA,PSW,PCA
                                                                              Nursing
                                                          Medical




                                                                                                             Patient
                                           Services




                            *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
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands

                                      Report 2 - sample
                                         Hand Hygiene by Type of Indication

                      100%
                                                          74%
                      80%
       % Compliance




                                                                                57%                    54%
                      60%
                                    31%
                      40%
                      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
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands

                                                 Report 3 - sample
                           Hand Hygiene Compliance by Category of Health Care Provider

                    100%
                     80%                                                   60%
     % Compliance




                     60%   41%                                                          48%
                                                                                                      40%
                     40%                        29%                                                                    22%          28%            29%
                                                                15%
                     20%
                      0%
                                               Environmental




                                                                                                                                    Physicians


                                                                                                                                                   Other
                                                                            Nurses



                                                                                       Students




                                                                                                                     Transporters
                            Allied HCPs*




                                                                                                      PSA,PSW,PCA
                                                               Students




                                                                                        Nursing
                                                                Medical




                                                                                                                        Patient
                                                 Services




                                           *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                                                                                 x 100 = %
 compliance
 Total # observed hand hygiene opportunities for a specific HCP category
Canada’s Hand Hygiene Challenge:
STOP! Clean Your Hands

                         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

				
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