Yesterday I spent the morning listening to presentations by vendors of new hand hygiene compliance monitoring technologies. In my subsequent meanderings on PubMed I came across this article in PLOS ONE documenting differences in hand hygiene compliance between overt and covert hand hygiene observers.
Of the 23,333 hand hygiene observations 76.0% were by medical students (trained, covert hand hygiene observers), 5.3% by infection control nurses and 18.7% by unit staff. The annual compliance rates were medical students (covert) 44.1%, infection control nurses (overt) 74.4% and unit staff (overt) 94.1%; P<0.001. The medical students found significantly lower annual compliance rates for 4/5 hand hygiene indications compared to infection control nurses and unit staff; P<0.05.
The results are not surprising. The Hawthorne effect, no doubt.