Improving hand hygiene compliance: harnessing the effect of advertised auditing

BackgroundGood hand hygiene can prevent healthcare-associated infections. The observer effect is the tendency of research participants to behave differently from the way they otherwise would when aware of being studied. This effect may be associated with improved hand hygiene compliance when utilised in the prior advertisement of auditing.MethodsAn observational study was carried out between 1 June 2012 and 31 August 2012 at the Liverpool Hospital, an 877-bed tertiary teaching hospital in south-western Sydney, Australia, to determine the association between prior notification of hand hygiene auditing by recognisable observers and compliance rates and to evaluate the acceptability of such a practice. Surveys regarding the general acceptability of hand hygiene auditing were conducted, followed by advertised and unadvertised audits over the study period. Participants were made aware of being audited by prior notice and conspicuous identification signs.ResultsThe auditors recorded 2080 moments over 3 months, of which 462 (22.2%) were done with prior notification. A significant improvement in overall hand hygiene compliance from 82.3% to 87.9% (P = 0.004) was found. Subgroup analysis revealed improved compliance for the moments ‘before patient contact’ (71.8% to 81.3%; P = 0.018) and ‘after patient contact’ (85.8% to 93.8%; P = 0.019). Over60%of healthcare workers rated hand hygiene as a high priority in daily work and 55% or more regarded weekly auditing as being acceptable.ConclusionAdvertised auditing is associated with an increase in the overall hand hygiene adherence rate as well as in the subgroups ‘before’ and ‘after patient contact’ and appears to be acceptable to healthcare workers. This association requires validation with multicentre randomised controlled trials.