Korean researchers show that at least 92 hand disinfections need to be observed to collect meaningful data on hand hygiene compliance in hospitals.
Direct observation of hand hygiene is considered an important tool in hospitals for drawing conclusions about the hygiene behavior its staff. However, the method has a well-known weakness: the results are influenced by the observer in the ward, as staff usually notice that they are being watched more closely. The result is called the Hawthorne effect, which has been shown to distort observed compliance by a factor of three.  Additionally, the method is considered extremely time-consuming for hygienists.
In a recently published paper, a team of researchers from South Korea investigated how many observations in individual hospital wards are actually needed to accurately calculate hand hygiene compliance. In different scenarios, Park et al. arrive at a minimum number of between 61 and 92 direct observations. Translating this into a time value, we arrive at 45 minutes of pure observation, as hygienic hand disinfection ideally takes 30 seconds.
Easing time pressure in hospitals with digital solutions
If we add to this the intervals between the individual observations in each ward, hygenists will be spending considerable time on direct observation as a whole. This is not even taking into consideration the amount of time that it takes to share the compliance findings with staff.
Luckily, an alternative that saves time and increases precision already exists. Electronic monitoring systems for hand hygiene consist of connected sanitizer dispensers that register each activation and provide detailed analysis 24/7 through a computer, tablet, or smartphone.
Against the background of time-consuming recording via direct observation, the Korean scientists strongly advocate alternative methods, which include electronic recording.
The OPHARDT Hygiene Monitoring System® (OHMS) is considered the leading solution in this field and has already digitally measured over 50 million hand disinfections in clinics, hospitals, and other healthcare facilities since its launch in 2011.
With the help of systems like Kanary, the time required to observe hand disinfection can be drastically reduced. At the same time, hygiene managers have precise, unbiased, and detailed data on disinfection behavior at their fingertips.
Study for the article “This is the minimum number of hand disinfections needed to track compliance”: Park, Se Yoon, et al. “Appropriate number of observations for determining hand hygiene compliance among healthcare workers.” Antimicrobial Resistance & Infection Control 10.1 (2021): 1-5.
 Hagel, Stefan, et al. „Quantifying the Hawthorne effect in hand hygiene compliance through comparing direct observation with automated hand hygiene monitoring.“ infection control & hospital epidemiology 36.8 (2015): 957-962.