Why Manual Hand Hygiene Audits Keep Hospitals Stuck in the Past


Direct observation, secret shoppers, and unreliable data – on paper?!?


If you asked any Infection Preventionist in a hospital using manual hand hygiene audits about the accuracy of their compliance data, the response would be startling. And probably very different from how others inside the same hospital or network perceive that same data.

What is a hand hygiene audit? This is an initiative of hospitals and healthcare organizations to monitor the number of opportunities clinical and operational staff have to wash their hands when interacting with patients in an effort to reduce the spread of infection.

Since the 2018 Joint Commission mandates have pressured hospitals to start reporting individual compliance, many clinicians are wondering how to best achieve a methodical and accurate way of collecting, analyzing and processing the data to identify areas for improvement.

Up until the emergence of electronic hand hygiene, direct observation (DO) has been the primary method to gather hand washing or sanitizing opportunities. But there are several problems with hand hygiene data collected through direct observation:

1.     The data is limited in scope.

Nurses, volunteers and other staff who are tasked with direct observation may have the best of intentions, but they are only able to monitor events they see, which are usually ‘wash in, wash out’ opportunities. In reality, though, this number is extremely low when compared with real opportunities for hand washing or sanitizing.

For example, we’ve seen a 200-bed hospital with a strong direct observation program capture up to 6,000 hand hygiene opportunities over the course of a year. However, the same sized hospital with our system in place will capture more than 4,000,000 hand hygiene opportunities over the same time period.

This goes to show, even with the best intentions in place, manual hand hygiene audits only account for events that have been witnessed by people. But there are many, many more going unseen, unrecorded and unaddressed!

2.     The data is inaccurate.

If you’re not familiar with the Hawthorne effect, here’s a quick example. Imagine a highway you drive on all the time and know like the back of your hand. You know the speed limit, but you also know nobody abides by it. Now, imagine there’s a highway patrol officer sitting in his car at one specific spot every day. You know where this spot is and you (like everyone else) slows down right before this spot to the actual speed limit. But as soon as you’re out of sight, you increase your speed.

When it comes to hospitals, the Hawthorne effect is a well-documented reason as to why hand hygiene data collected via direct observation is so inaccurately high. The method essentially leads to a false positive some hospitals unashamedly accept in order to avoid penalties or Joint Commission citations. And, consider how interpersonal relationships among the auditors and monitored individuals may lead to biased results: do friends get a pass even if they didn’t wash their hands?

3.     The data analysis and reporting are manual.

In a previous post, we broke down the hidden costs of HAIs and HACs, and it’s worth repeating – the time it takes your staff to collect and gather data equates to time not spent with patients. Additionally, consider the abundance of time it takes staff to tabulate, review, and transfer the data from manual hand hygiene audits into a digital format, in addition to analyzing and synthesizing the data so it can be consumed in an easy-to-understand way that is actionable. In many cases, IPs pull the data and run their reports with little fanfare and not much changes until the next dreaded audit data comes in again.

So what’s the alternative to using direct observation for hand hygiene compliance? Automation. In the last few years, more hospitals have turned to electronic hand hygiene systems to address the issue above.


Real-Time, Always On Data Collection

The SwipeSense real-time sensor network automates data collection across the entire hospital. The intuitive dashboard allows hospital staff to view compliance rates and hand hygiene opportunities by location, unit, role, individual, and shift. These insights provide leaders with instant access to performance data so they can be more predictive in their patient care.

Innovative technology helps us deliver accurate and trustworthy data where it’s impossible to do so with people alone. Systems like SwipeSense remove the burden on staff that takes their attention away from patient care.

Numbers don’t lie. But if you get the sense that yours may not be telling the truth about your manual hand hygiene program, let’s talk!