Yet Another Nail in Direct Observation’s Coffin

By Chris Hermann

More and more evidence keeps building, showing that direct observation doesn’t work in terms of measuring hand hygiene performance. A new study was recently published by the American Journal of Infection Control from a hospital in Saudi Arabia. Direct observation was performed by both presumably recognized Infection Preventionists as well as new, presumably unrecognized “secret shoppers.”

Almost 23,000 hand hygiene opportunities were observed in more than 400 hours of observation. The difference between overt and covert observation was clear.

Hand hygiene was performed correctly 87% of the time when the overt observer was present. But it was only performed 44.9% of the time when the covert observer was present. When they knew they were being watched, healthcare workers were almost 94% more likely to clean their hands.

Overt observers can’t be present all the time, so the figure of 44.9% performance is likely much closer to the true number. If your hospital is relying on the same direct observers month after month – “not-so-secret shoppers” – the hand hygiene numbers you’re reporting are false and misleading. If you’re wondering why your hospital has so many HAIs despite a “high” rate of observed hand hygiene, this is why.

(You may also be interested in reading “Direct Observation: the ‘Fool’s Gold’ Standard” and/or “The Impossible Duality of Direct Observation.”)

If you’d like to explore how our system typically doubles hand hygiene performance rates…and has reduced HAIs by between 45% and 81% in 100% of customers following our process for 6 months…here’s a brief video about how it works. Or here’s a white paper about The 4 Data Points You Need To Reduce HAIs.

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