Can hand hygiene observation and reporting be improved through a risk-based targeted approach?

It is well accepted that good hand hygiene practice is important in reducing health care–associated infection and therefore saving lives.1 Despite the intense research effort that has been undertaken over decades, a level of hand hygiene compliance that results in reduction in health care–associated infection has never been established. The World Health Organization program, My 5 Moments for Hand Hygiene, has resulted in an internationally accepted manner of observation and reporting of hand hygiene compliance.2 In Australia, Hand Hygiene Australia (HHA) requires quarterly reports that detail both the degree of compliance for each of the 5 moments and the number of observations, all stratified by health care worker type.3 Enormous hospital resources are spent on complying with this single activity, with the reported observation time taken to record eachmoment as 2.2 minutes.4 In a large tertiary hospital, HHA has a requirement of at least 10,000 observed moments each year, which equates to nearly 10 weeks of a full-time nurse, an annual cost of A$17,000-$21,000.