I had the privilege of participating in the IPS Autumn Webinar series yesterday, in a debate with Dr Evonne Curran on whether we should routinely audit hand hygiene in hospitals. It was good fun – and highlighted some important points about the strengths and limitations of hand hygiene audits – and audits generally for that matter!
Here’s my case for routine hand hygiene auditing in hospitals (you can register (free!) and view the webinars here):
My key arguments were that:
- Hand hygiene is really important, and one of a range of interventions that we should be routinely auditing to launch focussed improvement work.
- There are key sources of bias in hand hygiene auditing (see below). However, these can be reduced with optimised methodology.
- Observation bias (aka Hawthorne effect) – where behaviour is modified by awareness of being observed. For example, if I stand over you with a clipboard and a pen, you’re more likely to do hand hygiene.
- Observer bias – difference between the true value and the observed value related to observer variation. For example, poor trained auditors will result in variations in reported practice due to observer bias.
- Selection bias – when the selected group / data does not represent the population. For example, only doing hand hygiene audits during day shifts won’t tell you the whole picture.
- Hand hygiene audits are a legal and regulatory requirement (in England at least).
- My own experience is that optimised hand hygiene auditing methodology can deliver a performance indicator that can identify areas of poor performance and drive focussed improvement initiatives.
At the end of the debate, two thirds of the live audience voted against doing routine hand hygiene audits in hospitals. Put another way – I lost! I am taking the view that the audience voted against the concept of inaccurate auditing returning unrealistically high level of compliance, rather than against properly monitored and measured auditing, which can help to fuel improvement.
If nothing else, I hope the debate made the point that poorly planned and executed hand hygiene auditing is doing nobody any good – and may be doing harm. If we are going to do hand hygiene auditing, it should be using optimised methodology to deliver actionable information that is put to work to improve hand hygiene practice.