Estimation of hand hygiene opportunities on an adult medical ward using 24-hour camera surveillance: validation of the HOW2 Benchmark Study

Am J Infect Control. 2014 Jun;42(6):602-7. doi: 10.1016/j.ajic.2014.02.020.


Background: We previously published a formula to estimate the number of hand hygiene opportunities (HHOs) per patient-day using the World Health Organization's "Five Moments for Hand Hygiene" methodology (HOW2 Benchmark Study). HHOs can be used as a denominator for calculating hand hygiene compliance rates when product utilization data are available. This study validates the previously derived HHO estimate using 24-hour video surveillance of health care worker hand hygiene activity.

Methods: The validation study utilized 24-hour video surveillance recordings of 26 patients' hospital stays to measure the actual number of HHOs per patient-day on a medicine ward in a large teaching hospital. Statistical methods were used to compare these results to those obtained by episodic observation of patient activity in the original derivation study.

Results: Total hours of data collection were 81.3 and 1,510.8, resulting in 1,740 and 4,522 HHOs in the derivation and validation studies, respectively. Comparisons of the mean and median HHOs per 24-hour period did not differ significantly. HHOs were 71.6 (95% confidence interval: 64.9-78.3) and 73.9 (95% confidence interval: 69.1-84.1), respectively.

Conclusion: This study validates the HOW2 Benchmark Study and confirms that expected numbers of HHOs can be estimated from the unit's patient census and patient-to-nurse ratio. These data can be used as denominators in calculations of hand hygiene compliance rates from electronic monitoring using the "Five Moments for Hand Hygiene" methodology.

Keywords: Compliance; Handwashing; Monitoring; WHO Five Moments.

Publication types

  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Age Factors
  • Aged
  • Bed Occupancy / statistics & numerical data
  • Benchmarking*
  • Female
  • Guideline Adherence
  • Hand Hygiene / standards*
  • Hand Hygiene / statistics & numerical data*
  • Hospitals, Teaching
  • Humans
  • Male
  • Middle Aged
  • Nursing / organization & administration
  • Nursing / statistics & numerical data
  • Patients' Rooms
  • Practice Guidelines as Topic
  • Time Factors
  • Video Recording