Web site spotlight: Shop secretly to improve hand hygiene compliance

Staff Development Weekly: Insight on Evidence-Based Practice in Education, March 6, 2009

If you want to see someone’s true behavior, watch what they do when they think no one is looking, says Brian Hudson, MT (ASCP), CIC, an infection preventionist (IP) at Cleveland Regional Medical Center in Shelby, NC.

This is the idea behind secret shopper programs at various hospitals, which try to get a better picture of staff members’ hand hygiene compliance by observing them when they don’t think they’re being watched.

“It’s impossible for the infection control professional to do [accurate hand hygiene observation] when they’re rounding. People tend to run screaming to the closest sink when they see us,” says Gayle Lovato, MS, RN, an IP at Inova Loudoun Hospital in Leesburg, VA.

Inova’s secret shopper program has been in place for several years, using infection control trainers to perform the surveillance. One trainer on each unit monitors staff compliance with hand hygiene regulations and documents the findings on a standardized report form. Each trainer performs an average of 10 observations per month, says Lovato.

Every month, Inova issues a report card listing the compliance rates for each unit. The hospital uses these hand hygiene figures to spot trends and identify problem areas. And to encourage compliance at Inova, the names of noncompliant staff members are reported to their managers. This is primarily designed to target chronic offenders. Information about individuals with multiple offenses goes into their files, Lovato says.

There are several barriers hospitals must overcome to start a secret shopper program. Hudson says his biggest challenge has been recruiting people to take the job. “Nobody wants to be thought of as a rat,” he says. “It’s viewed as tattling.”

However, there is no reason for staff members to view the job as a negative, Lovato says. Shoppers should know that they are performing an important service by protecting patient safety. Offering an incentive, such as the step increase, is one way of overcoming an individual’s unwillingness to take the position, she says.

For more information on hand hygiene, read “Talking trash may help improve hand hygiene”

Editor’s note: This excerpt was adapted from “Secret shoppers help improve hand hygiene compliance” found in the Reading Room at Get a free trial membership that will give you 30 days to test drive all the exciting features on the Web site.

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