"Hand Washing" by Anthony Albright is licensed under CC BY-SA 2.0

Mandated Audit-and-Feedback Did Not Improve Hospital Hand Hygiene

MedicalResearch.com Interview with:
"Hand Washing" by Anthony Albright is licensed under CC BY-SA 2.0Dr. Daniel J. Livorsi, MD
Assistant Professor
University of Iowa

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: One of the Joint Commission’s standards is that hospitals audit and provide feedback on hand hygiene compliance among healthcare workers. Audit-and-feedback is therefore commonly practiced in US hospitals, but the effective design and delivery of this intervention is poorly defined, particularly in relation to hand hygiene improvement.

We studied how 8 hospitals had implemented audit-and-feedback for hand hygiene improvement. We found that hospitals were encountering several barriers in their implementation of audit-and-feedback. Audit data on hand hygiene compliance was challenging to collect and was frequently questioned. The feedback of audit results did not motivate positive change. 

MedicalResearch.com: What should readers take away from your report?

Response: Our report shows that improving hand hygiene compliance through audit-and-feedback is challenging.

There is a larger literature on audit-and-feedback that could inform how hospitals’ develop their own audit-and-feedback programs specifically for hand hygiene. In the Discussion section of our article, we refer the reader to some of this literature. However, it remains unclear how some of these approaches to audit-and-feedback can be practically incorporated into real-life hand hygiene improvement programs.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Future research should develop strategies for making hand hygiene audit data more credible. This may involve modifying the process of collecting direct observations or developing altogether new audit strategies for hand hygiene compliance (e.g. electronic surveillance). In addition, there is a need to understand how audit data can be fed back in a more effective manner to encourage positive change.


Livorsi DJ, Goedken CC, Sauder M, Vander Weg MW, Perencevich EN, Reisinger HS. Evaluation of Barriers to Audit-and-Feedback Programs That Used Direct Observation of Hand Hygiene ComplianceA Qualitative Study. JAMA Network Open. 2018;1(6):e183344. doi:10.1001/jamanetworkopen.2018.3344

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Last Updated on October 13, 2018 by Marie Benz MD FAAD