Hand hygiene audits utilising medical student observers and measuring product consumption

Abstract

Hand hygiene is critical in controlling hospital-acquired infection. Traditional methods of surveillance are resource-intensive. They are often influenced by the awareness of being observed (the Hawthorne effect) and so observers must be unobtrusive. In Singapore, medical students are not part of the ward team and are potentially excellent auditors. Utilising students may have additional benefits such as infection control training and could therefore improve hand hygiene among future doctors. It is essential that the infection control community continues to consider novel strategies in the quest for simple, reliable hand hygiene audits. A prospective observational study was conducted to: (i) determine whether medical students were effective observers; and (ii) determine whether consumption of hand hygiene products can be used to monitor adherence. Hand hygiene observation was undertaken at the National University Hospital of Singapore using trained medical students. Hand hygiene products consumed were correlated with hand hygiene. Overall hand hygiene adherence was 16%. It was significantly worse among doctors (odds ratio 2.14, 95% confidence interval 1.44–3.18) and allied health professionals (odds ratio 2.31, 95% confidence interval 1.24–4.28), as well as in shared rooms. The results were markedly lower than previous audits at the hospital using infection control nurse observers. A moderate positive correlation was found between hand hygiene observed and consumption of both alcohol hand rub (r_s = 0.7) and chlorhexidine-based solution (r_s = 0.7). Medical student observers of hand hygiene reduce the Hawthorne effect. In this study, these observations correlated with product consumption. More work is required to validate easily implementable hand hygiene compliance tools.