Fidelity in Hand Hygiene- Need for Greater Rigor

Five Moments of Hand Hygiene. Source: WHO

We often make interventions in hospital epidemiology without having a robust measure of compliance with practice. An example is chlorhexidine patient bathing, a seemingly simple procedure which is difficult to measure both qualitatively and quantitatively.  

The degree to which an intervention is appropriately and thoroughly completed is fidelity.

Take the example of hand hygiene interventions, considered sacrosanct in infection prevention. How are these measures truly implemented? Here is a telling publication that assessed fidelity with respect to hand hygiene studies. In a systematic review of 100 studies, only 8 reported full measures of fidelity to the protocol.

If research protocols are unable to report compliance (fidelity) with implementation of interventions, then adoption to scale by other institutions is very challenging.

This is troublesome.