A nationwide covert observation study using a novel method for hand hygiene compliance in health care

•A novel covert observation method and reporting system was developed.•The novel covert observation method is feasible for large-scale observation.•Overall hand hygiene compliance by covert observation is low in Taiwan.•Hand hygiene compliance increases significantly with an increase in the number of indications within 1 hand hygiene opportunity.

BackgroundEvaluation and feedback is a core hand hygiene (HH) improvement strategy. The covert observation method avoids observation bias inherent to the overt method. The aim of the study was to observe HH compliance by a novel covert method in a real-world setting.MethodsWe conducted a 2-year, nationwide, prospective, observational study in teaching hospitals across Taiwan. Medical students and students who may have contact with patients in their careers were recruited as participants. A novel, shorthand notation method for covert observation was used. Observation results were reported through a study website.ResultsThere were a total of 25,379 HH opportunities covertly observed by 93 observers. Overall HH compliance was 32.0%. Health care workers had the highest HH compliance for indication 4 (42.6%), and the lowest for indication 5 (21.7%). Overall handrubbing percentage was high, reaching 83.6%. The HH compliance increased significantly with an increase in the number of indications within 1 HH opportunity (P < .001).ConclusionsThe overall HH compliance by the covert observation method was low. An innovative shorthand notation method facilitated covert observation, and website reporting was demonstrated to be feasible for large-scale observation.