The Particulars: The standard method for monitoring hand hygiene compliance before and after patient contact does not assess the appropriateness or risk stratification of compliance as described in the World Health Organization’s 5 Moments (5M) hand hygiene audit tool. The accuracy of monitoring compliance in prolonged episodes of patient care that involves long “strings” of hand hygiene activity is uncertain.

Data Breakdown: A study compared use of the before-and-after contact method with 5M tools during prospective audits of hand hygiene compliance in two ICUs. The research team assessed overall and per-moment rates of compliance. Overall compliance was significantly over-reported with before-and-after contact method (~9%), when compared with 5M, particularly when episodes included more than three moments. When comparing individual moments, the before-and-after contact method overestimated compliance by 4% (1 moment) to 18% (4 moments).

Take Home Pearl: When compared with 5M tools, before-and-after contact method auditing for hand hygiene compliance appears to significantly overestimate compliance.