Testing of the WHO hand hygiene self-assessment framework

Methods Development consisted of three phases: initial drafting, usability testing and reliability testing. The HHSF draft was developed by a team of experts, based on the key elements of the WHO multimodal HH improvement strategy. For usability testing, 42 HC facilities were invited to score their facility and complete a feedback survey. For inter-rater reliability testing, two users in each facility independently completed the HHSF. The reliability of each indicator, component sub-total and the overall score was estimated by using the variance components model. After each phase, the tool was examined with regard to the need for modification.