Testing a novel audit and feedback method for hand hygiene compliance: A multicenter quality improvement study

Area of Science:

• Healthcare Quality Improvement
• Infection Prevention and Control
• Patient Safety

Background:

• Hospital hand hygiene compliance (HHC) reporting often overestimates actual rates due to observation bias (Hawthorne effect).
• Accurate HHC measurement is crucial for preventing healthcare-associated infections.

Purpose of the Study:

• To compare HHC rates using a standard overt observation method versus a novel rapid, covert "secret shopper" audit method.
• To pilot test a new feedback tool for communicating HHC data.

Main Methods:

• A quasi-experimental stepped-wedge design was used across 5 Midwestern acute-care hospitals.
• A "secret shopper" observed hand hygiene during entry/exit, distinct from standard observers.
• A monthly feedback tool was provided to sites after an initial observation period.

Main Results:

• The secret shopper method yielded HHC estimates approximately 30% lower than the standard method.
• The standard audit method significantly overestimated HHC compared to the secret shopper method (OR, 9.83).
• No significant HHC changes were observed between baseline and feedback phases.

Conclusions:

• The rapid, covert "secret shopper" audit method appears less susceptible to bias than standard overt observation.
• The novel feedback tool did not demonstrate a significant impact on improving hand hygiene behaviors.