Methodological and technical considerations for video-based auditing of hand hygiene compliance in clinical practice: an exploratory study

  • Katherine J. McKay
    Address correspondence to: Katherine McKay, MAdClinPrac(PP) (Hons), 39 Velma Grove, Ringwood East, Victoria 3135, Australia
    Infection Prevention and Control, Eastern Health, Box Hill, Victoria, Australia

    Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, University of Sydney, Camperdown, NSW, Australia
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  • Patricia E. Ferguson
    Marie Bashir Institute for Infectious Diseases and Biosecurity, Faculty of Medicine and Health, University of Sydney, NSW, Australia

    Center for Infectious Diseases and Microbiology, Westmead Hospital, Western Sydney Local Health District, Westmead, NSW, Australia
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  • Ramon Z. Shaban
    Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, University of Sydney, Camperdown, NSW, Australia

    Marie Bashir Institute for Infectious Diseases and Biosecurity, Faculty of Medicine and Health, University of Sydney, NSW, Australia

    Department of Infection Prevention and Control, Division of Infectious Diseases and Sexual Health, Westmead Hospital and Western Sydney Local Health District, Westmead, NSW, Australia

    New South Wales Biocontainment Centre, Western Sydney Local Health District and New South Wales Health, NSW, Australia
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Published:April 30, 2021DOI:


      • Direct observation is increasingly considered a flawed data collection method for hand hygiene auditing
      • Electronic alternatives, while recommended, are largely incompatible with the WHO “5 Moments”
      • Video-based monitoring systems (VMS) offer a possible solution but present methodological and technical challenges
      • Success of future VMS technology for hand hygiene auditing will particularly need to consider patient and health professional acceptability.


      Direct observation is the gold standard method for measuring hand hygiene compliance but its utility is increasingly being questioned. Various alternative electronic methods have been proposed, yet there is a paucity of research examining the use of these according to the World Health Organization's (WHO) ‘5 Moments for Hand Hygiene’. As a part of the process of developing a video-based monitoring system (VMS) capable of measuring hand hygiene compliance against the 5 moments criteria this paper reports methodological and technical issues that might arise from the use of a VMS for auditing in clinical practice.


      In-depth semi-structured interviews were conducted with 27 Australian content experts in hand hygiene auditing and infection prevention to explore their responses to proposed VMS auditing approaches. Transcripts were analyzed using thematic and content analysis.


      Technical and methodological considerations for the use of VMS were interrelated and included concerns surrounding privacy, footage security, fears of surveillance and the potential for medico-legal consequences. Additionally, possible detrimental impacts on healthcare worker (HCW) -patient relationships, issues of cost versus benefits, HCW and patient safety and changes to feedback were also identified.


      The primary methodological and technical issues to overcome in order to implement VMS for hand hygiene auditing in clinical practice, centered upon issues of acceptability to patients and health professionals, privacy, consent and liability.



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