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• W2897529890 endingPage "322" @default.
• W2897529890 startingPage "313" @default.
• W2897529890 abstract "•Results of monitoring hand hygiene compliance by direct observation may be biased. •Seventy-one publications were assessed for the presence and type of methodological bias. •Sampling bias was present in all studies, including no night-time measurement in 46 (65%) studies. •Observers were trained in 56 (79%) studies, and 28 (39%) undertook validation of scoring. •Inter-rater reliability was measured in 26 (37%) studies. Background Hand hygiene is monitored by direct observation to improve practice, but this approach can potentially cause information, selection, and confounding bias, threatening the validity of findings. The aim of this study was to identify and describe the potential biases in hand hygiene compliance monitoring by direct observation; develop a typology of biases and propose improvements to reduce bias; and increase the validity of compliance measurements. Methods This systematic review of hospital-based intervention studies used direct observation to monitor health care workers’ hand hygiene compliance. Results Seventy-one publications were eligible for review. None was free of bias. Selection bias was present in all studies through lack of data collection on the weekends (n = 61, 86%) and at night (n = 46, 65%) and observations undertaken in single-specialty settings (n = 35, 49%). We observed inconsistency of terminology, definitions of hand hygiene opportunity, criteria, tools, and descriptions of the data collection. Frequency of observation, duration, or both were not described or were unclear in 58 (82%) publications. Observers were trained in 56 (79%) studies. Inter-rater reliability was measured in 26 (37%) studies. Conclusions Published research of hand hygiene compliance measured by direct observation lacks validity. Hand hygiene should be measured using methods that produce a valid indication of performance and quality. Standardization of methodology would expedite comparison of hand hygiene compliance between clinical settings and organizations. Hand hygiene is monitored by direct observation to improve practice, but this approach can potentially cause information, selection, and confounding bias, threatening the validity of findings. The aim of this study was to identify and describe the potential biases in hand hygiene compliance monitoring by direct observation; develop a typology of biases and propose improvements to reduce bias; and increase the validity of compliance measurements. This systematic review of hospital-based intervention studies used direct observation to monitor health care workers’ hand hygiene compliance. Seventy-one publications were eligible for review. None was free of bias. Selection bias was present in all studies through lack of data collection on the weekends (n = 61, 86%) and at night (n = 46, 65%) and observations undertaken in single-specialty settings (n = 35, 49%). We observed inconsistency of terminology, definitions of hand hygiene opportunity, criteria, tools, and descriptions of the data collection. Frequency of observation, duration, or both were not described or were unclear in 58 (82%) publications. Observers were trained in 56 (79%) studies. Inter-rater reliability was measured in 26 (37%) studies. Published research of hand hygiene compliance measured by direct observation lacks validity. Hand hygiene should be measured using methods that produce a valid indication of performance and quality. Standardization of methodology would expedite comparison of hand hygiene compliance between clinical settings and organizations." @default.
• W2897529890 created "2018-10-26" @default.
• W2897529890 creator A5043074423 @default.
• W2897529890 creator A5054060131 @default.
• W2897529890 creator A5067964207 @default.
• W2897529890 creator A5083861879 @default.
• W2897529890 date "2019-03-01" @default.
• W2897529890 modified "2023-09-27" @default.
• W2897529890 title "Validity of hand hygiene compliance measurement by observation: A systematic review" @default.
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