Observing and Improving Hand Hygiene Compliance: Implementation and Refinement of an Electronic-Assisted Direct-Observer Hand Hygiene Audit Program

We implemented a direct-observer hand hygiene audit program that used trained observers, wireless data entry devices, and an intranet portal. We improved the reliability and utility of the data by standardizing audit processes, regularly retraining auditors, developing an audit guidance tool, and reporting weighted composite hand hygiene compliance scores.