872 infection control & hospital epidemiology july 2017, vol. 38, no. 7


programs seems to be associated with the establishment of a minimum standard in hand hygiene among HCWs, which is important for quality assurance. Finally, recording AHC as a surrogate marker for hand


disinfection adherence has certain limitations. Measured values may include the amount of hand disinfectant used by visitors and/or patients. Calculating AHC on the unit level can be difficult and may require modification of the dispensing system for hand rub within the hospital. The main disadvantage of indirect monitoring of AHC is its inability to determine when hand disinfection is performed by HCWs at the right time and according to the guidelines.6,7 A statement on compliance with hand disinfection indica-


efficient way to estimate the frequency of hand-disinfection activities continuously and over time. It is a useful tool for benchmarking in long-term, multifaceted intervention pro- grams; it complements direct observation of hand disinfection adherence; and it informs a comprehensive picture of this important element of infection control in hospital care.


acknowledgments


Financial support: No financial support was provided relevant to this article. Potential conflicts of interest: All authors report no conflicts of interest relevant to this article.


Affiliation: Charité - Universitätsmedizin Berlin, Institut für Hygiene und Umweltmedizin, Berlin, Germany. Address correspondence to Wibke Wetzker, Charité - Universitätsmedizin


Berlin, Institut für Hygiene und Umweltmedizin, Hindenburgdamm 27, D-12203 Berlin, Germany (wibke.wetzker@charite.de).


tions can only be made by direct observation by a trained and validated observer, which is considered the gold standard of monitoring hand disinfection adherence. In Germany, both methods (direct observation and AHC surveillance) are used to depict hand hygiene in health care. So far, most studies that have compared the results of monitoring AHC with the results of direct observation have reported no correlation between the 2 methodologies.8,9 Under the premise of long-term observa- tion, Haubitz et al10 assessed AHC as a surrogate for hand disinfection compliance, and a significant correlation was demonstrated. Certainly, however, regular observation of HCWs performing hand disinfection is not superfluous after several years of AHC surveillance. In summary, AHC monitoring is a simple and resource-


Received December 8, 2016; accepted March 13, 2017; electronically published May 31, 2017 © 2017 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2017/3807-0017. DOI: 10.1017/ice.2017.71


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