Overt hand hygiene compliance audits have shown a large gap in compliance between nurses and physicians, with nurses washing their hands more often than physicians. But a new study in the Journal of Hospital Medicine shows that gap narrows when hand hygiene rates are measured by covert observers.
Researchers introduced trained covert observers to a hospital during clinical rotations and compared hand hygiene compliance rates they observed to those gathered by overt auditors.
They found that covert observation produced lower compliance rates than overt observation during the same time period, 50 percent versus 83.67 percent.
Additionally, researchers found that physicians' compliance difference between overt and covert observers was 19 percent (73.2 percent versus 54.2 percent), while for nurses it was much higher, at 40.7 percent (85.8 percent versus 45.1 percent).
"Our study suggest that traditional HH audits not only overstate HH performance overall, but can lead to inaccurate inferences about performance by professional groupings due to relative differences in the Hawthorne effect," the authors concluded.