Major articleReflection on observation: A qualitative study using practice development methods to explore the experience of being a hand hygiene auditor in Australia

•Hand hygiene auditors are passionate advocates for the role of effective hand hygiene in improved patient safety.•Hand hygiene auditors face many significant challenges in undertaking the role.•Barriers include organizational, professional, and cultural issues.•Enablers include overt managerial leadership, support, and feedback.

BackgroundWithin the Australian public health care system, an observation model is used to assess hand hygiene practice in health care workers, culminating in a publicly available healthcare service performance indicator. The intent of this study was for the results to inform the development of a strategy to support individual auditors and local sustainability of the hand hygiene auditing program.MethodThis qualitative study used a values clarification tool to gain an understanding of the experiences of hand hygiene auditors. The methodology involved qualitative interpretation of focus group discussions to identify the enablers and barriers to successful performance of the auditors' role.ResultsTwenty-five participants identified congruous themes of the need for peer and managerial support, improved communication and feedback, and consideration for succession planning. There was consistency in the participants' most frequently identified significant barriers in undertaking the role.ConclusionHand hygiene auditors take pride in their role and work toward the goal of reducing health care-associated infections by having a part to play in improving hand hygiene practices of all staff members. Important themes, barriers, and enablers were identified in this study. This research will be of interest nationally and globally, considering the dearth of published information on the experience of hand hygiene auditors. This study provides evidence of the need to support individual hand hygiene auditors.