Major ArticleIntroducing automated hand hygiene surveillance to an Australian hospital: Mirroring the HOW2 Benchmark Study

- Human audit should not be privileged as the gold standard over automation.
- Automation collects 4 times the data than quarterly ward samples for accreditation.
- The medical ward has on average 63 hand hygiene opportunities (HHOs) per patient day and the surgical ward has 40 HHOs per patient day.
- The average daily soap and water plus alcohol-based handrub opportunities were similar to the United States.
- In 12 months, automation collected 889,968 events and provided daily rates.

BackgroundHuman auditing and collating hand hygiene compliance data take hundreds of hours. We report on 24/7 overt observations to establish adjusted average daily hand hygiene opportunities (HHOs) used as the denominator in an automated surveillance that reports daily compliance rates.MethodsOvert 24/7 automated surveillance collected HHOs in medical and surgical wards. Accredited auditors observed health care workers' interaction between patient and patient zones to collect the total number of HHOs, indications, and compliance and noncompliance. Automated surveillance captured compliance (ie, events) via low power radio connected to alcohol-based handrub (ABHR) dispensers. Events were divided by HHOs, adjusted for daily patient-to-nurse ratio, to establish daily rates.ResultsHuman auditors collected 21,450 HHOs during 24/7 with 1,532 average unadjusted HHOs per day. This was 4.4 times larger than the minimum ward sample required for accreditation. The average adjusted HHOs for ABHR alone on the medical ward was 63 HHOs per patient day and 40 HHOs per patient day on the surgical ward. From July 1, 2014-July 31, 2015 the automated surveillance system collected 889,968 events.ConclusionsAutomated surveillance collects 4 times the amount of data on each ward per day than a human auditor usually collects for a quarterly compliance report.