Evaluation Background: Hand Hygiene Observation Apps

November 30, 2022 | Evaluations & Guidance


Here's background for our Evaluations of hand hygiene observation apps, outlining the key considerations for choosing a suitable tool to use in your facility. Review our latest product ratings and learn how the technology is used, which specs are important, and what factors we test for.

The primary purpose of hand hygiene observation applications (apps) is to facilitate direct observation of point-of-care staff hand hygiene compliance. In direct observation, observers, also known as "secret shoppers," are assigned to discreetly monitor and record hand hygiene compliance of staff and visitors. Hand hygiene compliance is defined as the number of hand hygiene events (i.e., washing hands with soap and water or rubbing hands with alcohol sanitizer) divided by the number of hand hygiene opportunities (i.e., times when an individual should perform hand hygiene). Typically, direct observation has been performed with paper and pen, which requires manual data entry and analysis. Hand hygiene observation apps accessed via a mobile device or computer are an electronic means of recording observation data. However, data analysis is performed either automatically or manually, depending on vendor offerings. Note that hand hygiene observation apps are different from what we refer to as hand hygiene compliance monitoring systems, which automatically monitor compliance using sensors and staff badges; for more information on that technology, see Evaluation Background: Hand Hygiene Compliance Monitoring Systems.

All of the hand hygiene observation apps we tested allow users to record the observation location, the observed person's role (e.g., doctor, nurse, respiratory therapist, visitor), the hand hygiene event (e.g., soap use, alcohol sanitizer use, or missed/no/none), and one or more hand hygiene indications (i.e., reasons for performing hand hygiene). Commonly used hand hygiene indications are the World Health Organization's (WHO) My 5 Moments for Hand Hygiene, Public Health Ontario's Your 4 Moments for Hand Hygiene, or patient/resident room entry and exit. Per WHO's "Hand Hygiene Technical Reference Manual," each indication, or multiple concurrent indications, constitutes one hand hygiene opportunity (WHO 2009).

Hand hygiene observation data is transmitted via a facility network or mobile data connection to a vendor web portal or, if an app vendor does not offer a web portal, to an email address. Apps with web portals aggregate data and allow certain users to view hand hygiene compliance rates by observed role during a specified time period per unit, per department, or across entire facilities. Apps without web portals, on the other hand, export observation data via email for manual data analysis.

Defining characteristics of hand hygiene observation apps include:

  1. Access from a mobile device (e.g., phone, tablet) or computer by users (e.g., trained hand hygiene observers, untrained users, caregivers, patients/residents) to monitor hand hygiene compliance of point-of-care clinical staff, vendors, and caregivers

  2. A means of specifying observation locations

  3. A means...

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