How is the effectiveness of hand hygiene policy measured?

Question

How is the effectiveness of the hand hygiene policy measured other than the use of audits?

Answer

In medical literature, there have been several attempts to measure the effectiveness of hand hygiene in healthcare settings. For example, in 2006, MacDonald et al. conducted a study of the effectiveness of handwashing techniques by secretly adding a clear fluorescent substance to the alcohol hand gels in a hospital. The person’s hands were then examined under a UV light, allowing them to see any areas that they had missed during the sanitisation, and giving them opportunities to improve their techniques.

Other studies, such as Bloomfield et al., 2007, measure the efficacy of different techniques using the Committee European Normalisation Hygienic Handwash Test EN1499. This involves measuring the number of bacteria on the hands before and after the treatment, and calculating the logarithmic reduction in numbers. Generally, the standard bacterium used in this measurement is E. coli, although it does vary (in the United States, Serratia marcescens is used).

Although not a direct measure of effectiveness, adherence to the policy on hand hygiene is often measured by weighing the content of hand and soap dispensers on wards, and calculating the expected rate at which these would be used up, given the personnel : dispenser ratios. The rate at which the weight decreases can be compared to the expected values, and this can imply whether or not the ward personnel are fully complying with policy.

These aside, it seems that the most common technique for measuring the effectiveness of different policies is to survey the proportion of patients who pick up secondary infections while in hospital. This is a less reliable measure though, as a huge variety of other factors could influence the results, in addition to the hand hygiene techniques at work.

References

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1963687/

http://www.ajicjournal.org/article/S0196-6553(07)00595-0/fulltext#sec4.1