Validity of hand hygiene compliance measurement by observation: A systematic review

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

Using Graphical Representations to Support the Calculation of Infusion Parameters

Abstract. A variety of medical procedures require arithmetic calculations to be performed. These calculations can be complex and induce errors that can have serious consequences on the ward. In this paper, we consider whether a graphical representation might make these calculations easier. The results of a laboratory experiment are reported in which participants were asked to solve a number of infusion parameter problems that were represented either graphically or textually. Results show that participants were faster but no more accurate in solving graphical problems than they were textual problems. We discuss the need for situated work to be conducted that builds on these initial findings to determine whether the advantages of graphical representations transfer to actual workplace settings