Turkey's First Hand Hygiene Assessment Tool Developed for Healthcare Sector

Infection Control Nurse Fatma Kartaloğlu Agay and her team developed Turkey's first and the world's second hand hygiene assessment tool. This scale reliably measures awareness and implementation levels of hand hygiene practices among healthcare workers at the institutional level. The scale was prepared through extensive data collection and scientific methods, and brought into compliance with national and international standards.

Thanks to its digitalizable structure and artificial intelligence-supported analysis capabilities, it will hold an important place in future healthcare management systems. Research results were published in a reputable journal in 2025, gaining recognition in the scientific community.

Fatma Kartaloğlu Agay, Infection Control Nurse at Üsküdar University NPİSTANBUL Hospital, provided information about the development process of Turkey's first and the world's second 'hand hygiene compliance scale in healthcare services'.

Insufficiency of existing measurement practices prompted new research!
Noting that prevention of hospital infections related to healthcare services is one of the most important indicators in current healthcare delivery, Fatma Kartaloğlu Agay stated, "As microorganisms causing healthcare-associated infections develop resistance with each passing day and create risk, prevention strategies are now being discussed alongside treatment policies."

Agay noted that the COVID-19 pandemic experienced globally reminded people once again of the importance of hygiene, and added, "In this context, ensuring proper hand hygiene is recognized as the easiest, most applicable, and most practical strategy to prevent the spread of microorganisms in both public health and in the process of educating healthcare professionals. However, we started our research process because existing measurement practices at both individual and institutional levels proved insufficient for measuring awareness."

"There was a need for a current method to evaluate hand hygiene policies"
Noting that all national and international health authorities aim to develop hand hygiene programs in healthcare facilities and measure and improve awareness among healthcare professionals, Fatma Kartaloğlu Agay continued her remarks as follows:
"In this context, the first measurement scale at international standards that could allow for comparison was developed by American healthcare professionals in the early 2000s, and validity and reliability studies were conducted in Turkey in 2016. However, the scope of healthcare service delivery is changing rapidly. For this reason, field workers like us believed there was a need for an analysis method that could measure current systems and guide both healthcare professionals and healthcare administrators in taking preventive measures to ensure adequate implementation of hand hygiene policies in their institutions."

Turkey's first, the world's second hand hygiene assessment tool!
Stating that they examined many national and international guidelines, quality standards, and field studies in the scale development process, Fatma Kartaloğlu Agay said, "We tried to create a draft that could encompass all this data and at the same time provide improvement suggestions when applied."

Explaining that R&D work on the scale began in 2023, Agay stated, "Along with many guidelines and scientific studies, with evaluations from health authorities that contribute to the field in infection control, it took its initial form in early 2024. Initial assessments were conducted with 458 volunteer healthcare workers including doctors, nurses, technicians, and nursing assistants working in seven regions across Turkey. After compiling it together with my colleague nurse Muhdedir Caner, who works in the Quality Management Unit at Kırıkkale High Specialization Hospital, with the contributions of Assoc. Prof. Gamze Özbek Güven from Ankara High Specialization University, the scale took its final form. Actually, as a working team, we also individually reflected the field."

Adding that the research, which was formulated as an article and prepared for publication as a measurement scale with very high validity and reliability in its results, was published in early view in the Journal of Nursing Measurement on 25 April 2025, Agay stated that it acquired the distinction of being Turkey's first and the world's second 'Hand Hygiene Compliance and Competency Measurement Assessment Tool in Healthcare Services'.

The scale can be used reliably in evaluating hand hygiene practices!
Referring to distinct differences observed among healthcare workers where the scale was applied in terms of work areas, seniority, and specialties, Fatma Kartaloğlu Agay said, "That was also our basic aim. Because infection prevention packages can only be effective through institutional comprehensive practices rather than individualized implementations."

Agay also stated, "We believe the scale can be used reliably to evaluate the current state of hand hygiene practices in healthcare institutions, identify areas open for improvement, and assess the knowledge and compliance levels of healthcare workers."

"The scale we developed received great interest at national and international levels"
Emphasizing that the scale could be an effective method in measuring institutional performance within the scope of patient safety culture rather than individual performance, Fatma Kartaloğlu Agay said, "Currently in Turkey, measuring hand hygiene awareness is a requirement within the Ministry of Health Service quality standards framework, but we did not have a national scale. From the day our developed scale was published until today, we have experienced justified pride and joy in seeing it receive great interest at national and international levels."

Providing information about digitalizing the scale or integrating it with artificial intelligence-supported platforms, Agay concluded her remarks as follows:
"We prepared this scale to develop a system to keep pace with the times. In accordance with today's digital age, institutions can already adapt it to digital format according to their own internal working systems and use it in this form now. We ourselves used this method in the data collection phase. Because our population was very broad—we aimed to collect data from every region of Turkey. Analysis with artificial intelligence is very easy because all questions and answers are evidence-based. We are at the very beginning of our work. It will definitely be facilitated to contribute to the system."