1. Measurement of
hand washing in
wound infections
Rachel Duffy
Phomolo Madome
Eva van Swaaij

2. Measurement: Process and Outcome
Indicators
Measures
There are 3 types of measures used in quality work:
Structure: Physical equipment and facilities
Process: How the system works
Outcome: The final product, results
Structure and process are easier to measure; outcome is more important.
Difference between Process and outcome:
Process:
How Healthcare is provided
How the system works
Outcome:
Health status
Does it make a difference?

3. Building Measurement and Data
Collection into Medical Practice
Aim: What are we trying to accomplish?
Measures: How will we know that a change
is an improvement?
Changes: What changes can we make that
we think will lead to an improvement?

4. Principles
1. Seek usefulness, not perfection, in the
measurements- Helps to begin with a small, useful
data set that fits your work environment, time
limitations and costs constraints
2. Use a balanced set of process, outcome and cost
measures
3. Keep measurement simple; think big, but small-
focus on a limited, manageable, meaningful set of
starter measures
4. Use qualitative and quantitative data- quantative
measures are better at capturing the objective
world; qualitative measures are better at reflecting
subjective issues

5. 5. Write down the operational definitions of measures-
provides a clear method for scoring or measuring a
variable in a reproductive manner
6. Measure small, representative samples- emphasis on
usefulness, not perfection
7. Build measures into daily work- help the person
capture the right information at the right time
8. Develop a measurement team- success in
measurement requires time and technical expertise.
Team up to lighten the workload, add knowledge and
boost moral

6. Fishbone-diagram
People Prevention
Nurses Knowledge
Patients nurses
Assistants
Lifestyle
Wound
infections
Appointments
Time Education
material
Dressing
procedure
Hand washing Dressings
Procedures Materials

7. What?
Compliance with hand washing procedures in a
community health care center

8. Why hand hygiene
• One of the most important factor in cross infections
• Adherence to hand hygiene recommendations remains
poor, and improvement efforts frequently lack
sustainability.
• To assess the performance of individual staff members
and educate them by intervening in real time
• To assess the impact of a quality improvement
intervention to increase adherence to hand hygiene
guidelines

9. How?
Ask patients to register whether their nurse is washing her hands
Positive Negative
Patients are likely to register correctly A lot of work to inform the patients
about their task
Cheap Possible bias: Nurse can wash her
hands when the patients is out of
sight
Raise patients awareness about Does not register the quality of
infection control washing
Does not compromise patient privacy

10. How?
Observer looking if the nurse washes her hands
Record hand hygiene compliance
Positive Negative
Very little to no bias Expensive
Count both opportunities for hand Not very appropriate in an understaffed
hygiene and the action of hand setting
hygiene.
Can verify when hand hygiene was Compromising patient privacy
practiced
Hand hygiene quality can be assessed Staff members can change their
behaviours

11. How?
Ask staff to register when they forgot to wash their hands
Positive Negative
Easy Bias e.g. due to time constraints ,
expectancy
Cheap Time consuming for a busy nurse
Does not compromise patient privacy

12. Consequences
• Better adherence to hand washing
• Raise awareness
• Better knowledge of infection control in community centres
• Specific actions for infection control in a community centre
• Less potential for infection transmission

13. Desirable Characteristics
• Relevance
• Evidence-based
• Reliability
• Reproducibility
• Validity
• Feasibility

14. Reasons against implementation
• Financial
• Observer costs money
• Bias
• Positive or negative
• Time
• Nurse already has time constraints with patients

15. References
• Meister, S (2011). QI tools, root cause analysis. Iowa
department of Public Health. Retrieved from:
http://www.idph.state.ia.us/mphi/common/pdf/root_cause_a
nalysis.pdf
• Varkley, P (2010). Medical Quality and Management. Theory
and practice. American College of Medical Quality. Jones and
Bartlett Publishers. Sudbury, Massachusetts. Pg. 37.
• Nelson, E., Splaine, M., Batalden, P., & Plume, S. (1998).
Building measurement & Data Collection into Medical
Practice. Annals of Internal Medicine, 128(6). 460-466.
Retrieved from
http://edocs.library.curtin.edu.au/eres_display.cgi?url=DC602
62746.pdf&copyright=1