How surveillance affects hand hygiene compliance

A study published in the American Journal of Infection Control found covert observation of hand hygiene compliance helps detect change over time, but may not improve compliance as much as thought.

Researchers monitored healthcare workers' hand hygiene compliance in five monitoring sessions including both covert observation of handwashing practices, as well as overt observation, where healthcare workers knew handwashing was being monitored.

Key findings:

1. For overt observation, hand hygiene compliance was 91 percent; for covert observation, hand hygiene compliance was 49.3 percent.

2. After interviews were conducted about the barriers or challenges to hand hygiene compliance healthcare workers faced, covert observation of hand hygiene compliance increased to 66.9 percent.

3. Compliance based on covert observation fell to 57.5 percent in the third session. Compliance centered on overt observation increased between two sessions, from 90.8 percent to 94.5 percent.

Researchers concluded, "[Covert observation] reflects [hand hygiene compliance] change more reliably than does [overt observation]. However, it is uncertain whether [covert observation] will improve [hand hygiene compliance]."

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