A case study of healthcare professional views on the meaning of data produced by hand hygiene auditing

Abstract

Background: Measurement of hand hygiene (HH), crucial for patient safety, has acknowledged flaws stemming from methods available. Even direct observation, the World Health Organization gold standard, may lead to behaviour changes which can affect outcome validity. However, it remains important to understand current levels of HH to allow targeted interventions to be developed. This has resulted in wider adoption of auditing processes.

Aim: This study addressed how healthcare professionals perceive data generated by HH auditing processes.

Methods: Qualitative study involving participatory observation and semi-structured interviews with 30 healthcare professionals recruited from a large National Health Service (NHS) two-hospital site in England.

Findings: Healthcare professionals perceived two main problems with HH measurement, both associated with feedback: (1) lack of clarity with regard to feedback; and (2) lack of association between training and measurement. In addition, concerns about data accuracy led the majority of participants (22/30) to conclude audit feedback is often 'meaningless'.

Conclusion: Healthcare professionals require meaningful data on compliance with HH to engender change, as part of a multimodal strategy. Currently healthcare professionals perceive that data lack meaning, and are not seen as drivers to improve HH performance. Potential opportunities to change practice and improve HH are being missed.

Keywords: WHO 5 Moments; audit; hand hygiene (HH); healthcare professional involvement; infection control; patient safety; qualitative research.

Figure 1.

New Current State Map: produced using data from interviews and participatory observation. Provides visual representation of perceived causes of problems relating to the current auditing process. Showing Feedback Loops 1 and 2, described as representing HH measurement data flowing ‘up’ and ‘down’, respectively. Incomplete feedback loops are shown as using dashed lines, with question marks included to indicate the lack of clarity expressed by participants regarding how feedback was used.