What is the difference between an opportunity and an indication?

*This article is relevant to SpeedyAudit users*

Overview

This article explains the difference between an opportunity and an indication. Each time a healthcare provider needs to perform hand hygiene this represents ONE opportunity for hand hygiene. The reason for a single opportunity is called an indication, resulting in one hand hygiene action (missed, rub, wash).

Summary of Sections

  1. Basic Definitions.
  2. More References.
  3. Examples (#1-3).
  4. The Multiple Interface.
  5. Example (#4).
  6. Summary.

Getting started

You will need access to a mobile device with a reliable internet connection and SpeedyAudit installed.

What is the difference between an indication and an opportunity? Even among trained ICPs, it’s common to have confusion. To use SpeedyAudit efficiently, it is important to understand the difference and how to record them in your observation.

Quick Summary:

Each time a healthcare provider needs to perform hand hygiene this represents ONE opportunity for hand hygiene. Each opportunity should be recorded separately, by either clicking on the white arrow at the top right hand corner of the screen (Single Interface) or by moving to the next row (Multiple Interface). 

The reasons for a single opportunity are called indications, and these are recorded using the arrows (Single Interface) or the buttons (Multiple Interface), resulting in one hand hygiene action (missed, rub, wash).

Since some facilities focus on opportunity count to obtain hand hygiene compliance, being able to select multiple indications for one opportunity allows users to more accurately capture hand hygiene opportunities.

1. Basic Definitions.

Let’s start with the Basic Definitions:

Opportunity: A point in time when it would be appropriate for the health care provider to perform hand hygiene.

Indication: The reason why the health care provider would perform hand hygiene during an opportunity. (Also called a moment).

Note: There are 4 or 5 common reasons for performing hand hygiene. They are: 1) Before Patient/Environment Contact, 2) Before Aseptic Procedure 3) After Body Fluid Exposure 4) After Patient Contact and 5) After Patient Environment Contact.

Some facilities only use 4 of the moments, and some choose to use In/Out auditing (which is moments 1 and 4). This should be a discussion made between your facility to ensure everyone in your team is consistent.

2. More References.

For more detailed references around opportunities and indications, please see:

Differences between Opportunities and Indications (WHO Technical Reference Manual, Section III.5, Page 18):
https://www.who.int/teams/integrated-health-services/infection-prevention-control/hand-hygiene/monitoring-tools

Differences between Opportunities and Indications (Public Health Ontario) Page 12
https://www.publichealthontario.ca/-/media/documents/b/2014/bp-hand-hygiene.pdf?la=en

Comprehensive hand hygiene manual: Hand Hygiene Technical Reference Manual:
http://apps.who.int/iris/bitstream/10665/44196/1/9789241598606_eng.pdf

"Hand Hygiene Observation and Analysis" slide #6 (Just Clean Your Hands Program. 2008) (Note: this link will trigger an automatic ppt file download)
https://www.publichealthontario.ca/-/media/documents/p/2008/presentation-jcyh-observation-analysis.ppt

3. Examples (#1-3).
Example 1

Scenario:

Physician shakes Mr. Brown’s hand then leaves the room.
Physician then washes her hands.
Physician walks into Ms. Johnson’s room and shakes her hand.

How you would record this using the SpeedyAudit Single Interface?

Answer:

In this situation there are two indications: After Patient Contact and Before Patient Contact. However, there was one opportunity to perform hand hygiene. In other words, the Physician only had to wash her hands one time, in-between patients, to comply with the two reasons (indications) that hand hygiene was needed.

Count:

  • One Opportunity was Complied
  • Two indications (After Patient Contact, Before Patient Contact) were Complied

 

Example 2

Scenario:

Physician is finishing off tending to Mr. Brown, touches the patient and then leaves the room.
Physician does not wash her hands.
Physician walks into Mr. Johnson’s room and touches the patient.

How you would record this using the SpeedyAudit Single Interface?

Answer:

Similarly, in this situation there are two indications: After Patient Contact and Before Patient Contact. However, there is still only one opportunity to wash the hands. In other words, the Physician would have had to wash her hands once to comply with both indications.

Count:

  • One Opportunity was Missed
  • Two Indications were Missed

 

Example 3

Scenario:

Physician enters a patient room.
She washes her hands.
She touches the patient while tending to him.
She washes her hands.
She exits patient room and touches the external environment.

How you would record this using the SpeedyAudit Single Interface?

Answer
Step 1) Record the first opportunity, then click on the arrow to save it.

“Physician enters a patient room. She washes her hands. She touches the patient while tending to him.”

Step 2) Record the second opportunity, then click the arrow to save it.

“She washes her hands. She exits patient room and touches the external environment.”

Because there were two separate opportunities for the Physician to wash her hands (i.e: she had to wash her hands on two separate occasions), we would need to record this as two completely separate opportunities and click “Save” in between the two of them. In this situation, there were 2 opportunities to wash her hands and two indications.

Count:

  • Two Opportunities, both Complied
  • Two Indications, both Complied

 

4. The Multiple Interface

In order to prevent users from having to save and set up their hand hygiene audit multiple times, once for each opportunity, we have developed the “Multiple Interface”. This allows users to capture multiple opportunities in one interface.

Let’s combine Example 1, 2 and 3 into one long series of events. Here is what it would look like on the Multiple Interface. Please study this carefully, and note the differences between having several indications on one line, versus separate lines. In the Multiple Interface, each line represents one opportunity.

5. Example (#4)
Example 4 (Single Interface)

Another way to check understanding is to do this backwards. We will use a 4 Moments hospital example. Underneath, you will find a SpeedyAudit auditing screen, with all 4 Indications selected and a wash complied selected.

One potential scenario could be:

  1. Physician touches Mr. Brown’s arm while coming into contact with the patient’s blood. The Physician then washes her hands as she leaves Mr. Brown’s room. (After Patient Contact and After Body Fluid Exposure).
  2. The Physician walks into Ms. Johnson’s room and touches the patient, while performing an Aseptic Procedure. (Before Initial Patient Contact and Before AsepticProcedure)

In this scenario, there was only ONE opportunity to wash her hands, and this opportunity complied with FOUR different indications.

This is a completely different from the following scenario, which is not represented by the above picture:

  1. Physician enters Mr. Brown’s room, washes her hands and then touches Mr. Brown.
  2. She then comes into contact with Mr. Brown’s blood, so she washes her hands once more afterwards. The Physician then continues to tend to Mr. Brown, holding his arm.
  3. When she is finished, she washes her hands again and leaves the room. The Physician then touches the phone, found in the hallway.
  4. She walks into Ms. Johnson’s room, washes her hands and performs an Aseptic Procedure.

In the above, scenario you have FOUR separate opportunities and FIVE indications. Each of these opportunities needs to be recorded separately, as separate opportunities, and Saved (click the top right hand corner arrow button) in between each of them.

Example 4 (Multiple Interface)

Alternatively, you can use the Multiple Interface to denote all FOUR opportunities in one screen, more easily.

  1. Physician enters Mr. Brown’s room, washes her hands and then touches Mr. Brown. (Before Patient/Patient Environment)
  2. She then comes into contact with Mr. Brown’s blood, so she washes her hands once more afterwards. The Physician then continues to tend to Mr. Brown, holding his arm. (After Body Fluid and Before Patient/Environment Contact)
  3. When she is finished, she washes her hands again and leaves the room. The Physician then touches the phone, found in the hallway. (After Patient/Patient Environment Contact)
  4. She walks into Ms. Johnson’s room, washes her hands and performs an Aseptic Procedure. (Before Aseptic Procedure)
6. Summary.

In summary, a good rule of thumb to use is: each time a health care provider needs to perform hand hygiene, this represents ONE opportunity for hand hygiene. Each opportunity should be recorded separately, by either clicking on the “Save” arrow at the top, right hand corner of the screen (Single Interface) or by moving to the next row (Multiple Interface). The reasons for an opportunity are the indications.