Lights, cameras, action! Technical and methodological specifications for video surveillance methods of hand hygiene auditing according to the 5 Moments.

Ms Katherine McKay1,2, Professor Ramon Shaban2,3, Doctor Patricia  Ferguson4

1Eastern Health, Box Hill, Australia,
2The University of Sydney, Camperdown, Australia,
3Western Sydney Local Health District, North Paramatta, Australia,
4Department of Infectious Diseases, Westmead Hospital, Westmead, Australia


Hand hygiene (HH) compliance auditing is required in all public healthcare facilities in Australia under the auspices of the National Hand Hygiene Initiative (NHHI).  Data is collected using direct human observation and while this method is considered the “gold standard” it is resource intensive in terms of training, auditing and administrative requirements, there are also questions as to impacts of selection bias, observer bias and the Hawthorne Effect. While electronic monitoring systems have been proposed, there have been no studies that are sensitive to NHHI data collection requirements. We report findings of a study that determined technical and methodological specifications required for a HH video monitoring system (VMS) suitable for NHHI data collection.


Interviews with key stakeholders and content experts were informed by an extensive review of the literature.  Thematic content analysis of interview transcripts allowed for the development of technological and methodological specifications for a VMS suitable for NHHI data collection requirements.


The literature and the themes from interviews yielded four preliminary technical and methodological specifications for VMS: (i) Camera placement in patient and healthcare zones (ii) Staff education, support and buy-in; (iii) policy and procedure relating to data management, storage and use; and (iv) patient consent.


VMS recording HH compliance according to the WHO 5 Moments criteria presents challenges, however shows potential to collect data for NHHI submission which is also free from the biases associated with direct observational auditing.


Katherine McKay is a Clinical Nurse Consultant (Infection Prevention and Control) at Eastern Health and holder of the Hand Hygiene Portfolio for the network. She undertaking a PhD at the Univeristy of Sydney having completed a Master of Advanced Practice (Infection Prevention and Control) with First Class Honours at Griffith University, and has presented her findings on the topic of Bare Below the Elbows at ICPIC 2013 in Geneva. Katherine has also completed a Post Graduate Certificate in Advanced Nursing (Critical Care) at Deakin University and a Post Graduate Certificate in Clinical Nursing Education at Latrobe University.

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