GMS hygiene and infection control · 2025
Comparison of overtly and covertly observed hand antisepsis adherence in the intensive care units of a referral hospital in Iran.
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Zand Farid, Sanaei Anahita, Asmarian Naeimehossadat, Zarei Fatemeh, Tabatabai Azita, Zandi Rahele, Salami Solmaz, Shoja Kowsar
Аннотация
BACKGROUND AND OBJECTIVE: Hand antisepsis one of the most important strategies for preventing transmission of drug-resistant microorganisms and healthcare-associated infections. Overt observation of hand antisepsis in healthcare settings is currently considered the gold standard for monitoring its adherence rate. However, a major limitation of this method is the "Hawthorne effect", wherein health staff who know they are being assessed may alter their behavior. In this survey, we aimed to compare the overt and covert methods of observation of hand hygiene.
METHOD: This cross-sectional descriptive-analytic study was conducted over six months in the intensive care units (ICUs) of Namazi Teaching Hospital in Shiraz. The study population comprised ICU staff, including nurses, physicians (specialists and residents), and other healthcare workers (HCWs) in direct contact with patients. Convenience sampling was used. Hand antisepsis adherence was assessed through both overt (open) and covert (hidden) observations across different work shifts. Data was collected using the "WHO Hand Hygiene Observation Checklist" and analyzed in SPSS 18 using descriptive statistics and the chi-squared test.
RESULTS: The findings revealed that in a total of 9 ICUs (including 4 surgical, 2 medical, and 3 general ICUs) with over 90 active beds, 776 opportunities were observed through overt observation and 1,780 opportunities through covert observation. Overall, hand antisepsis adherence was 58.4% in overt observation and 60.3% in covert observation (p=0.352, RR=0.96). A significant difference was found in adherence rates among certain professional groups and specific hand antisepsis opportunities.
DISCUSSION AND CONCLUSION: No significant difference was found in hand antisepsis adherence between overt and covert observation methods, suggesting that both approaches are suitable to assess the in health care centers. It is essential to institutionalize hand antisepsis as an occupational culture in healthcare settings. Raising awareness among healthcare teams about the severe consequences of hospital-acquired infections can provide the necessary motivation for consistent and proper hand antisepsis practices.
METHOD: This cross-sectional descriptive-analytic study was conducted over six months in the intensive care units (ICUs) of Namazi Teaching Hospital in Shiraz. The study population comprised ICU staff, including nurses, physicians (specialists and residents), and other healthcare workers (HCWs) in direct contact with patients. Convenience sampling was used. Hand antisepsis adherence was assessed through both overt (open) and covert (hidden) observations across different work shifts. Data was collected using the "WHO Hand Hygiene Observation Checklist" and analyzed in SPSS 18 using descriptive statistics and the chi-squared test.
RESULTS: The findings revealed that in a total of 9 ICUs (including 4 surgical, 2 medical, and 3 general ICUs) with over 90 active beds, 776 opportunities were observed through overt observation and 1,780 opportunities through covert observation. Overall, hand antisepsis adherence was 58.4% in overt observation and 60.3% in covert observation (p=0.352, RR=0.96). A significant difference was found in adherence rates among certain professional groups and specific hand antisepsis opportunities.
DISCUSSION AND CONCLUSION: No significant difference was found in hand antisepsis adherence between overt and covert observation methods, suggesting that both approaches are suitable to assess the in health care centers. It is essential to institutionalize hand antisepsis as an occupational culture in healthcare settings. Raising awareness among healthcare teams about the severe consequences of hospital-acquired infections can provide the necessary motivation for consistent and proper hand antisepsis practices.