Research or audit? The benefits and limitations of structured observation of the hand hygiene practice of named staff

A pilot research study was undertaken on two tertiary care wards to examine factors influencing hand hygiene compliance. This comprised environmental audit and observation of individual staff for two hour periods. Although it was labour intensive, observation proved a valuable tool in highlighting problems in risk assessment. The results show that hand hygiene was performed following a high proportion (59%) of hand hygiene opportunities, but not in accordance with local guidelines, due predominately to choice of inappropriate hand decontamination agent and/or unnecessary use of gloves. These errors in individual decision-making processes about the choice of hand hygiene measures may be the reason why motivational interventions can be ineffective, and they need to be addressed before audit of compliance can be meaningful.