"Secret Shopper" Surveys on Hand Hygiene

Thu, 01/25/2018 - 08:43 -- johnshutze


We are re-thinking how we monitor hand hygiene. Sometimes it's quite obvious when staff are being observed for hand hygiene compliance by infection control staff. We think this might skew the results.

So, an idea we came up with is to use the "secret shopper" approach with patients being the one's that are monitoring hand hygiene compliance.

Do you use or have heard of this type of approach? I can't find much information specifically related to hand hygiene monitoring.



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Grace Gorenflo's picture
Submitted by Grace Gorenflo on
Hi John, What an intriguing idea! Unfortunately, I don't know of any information about that. However, you might try posing this question on phPIN -- the members of that network cover a range of things that go beyond QI so you might find someone with additional expertise. Let me know if you'd like information on how to join phPIN. My best, Grace
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Submitted by jgoodern on

Hi John-

I wonder if the feedback from patients would really add value. They may be able to tell you if the HCP washed their hands or not but could they really tell if the HCP was using the proper technique and following protocol? In some settings they may not even observe the handwashing (sink or hand sanitizer outside the room).

Another idea might be a "secret" staff person. So rather than infection control staff doing the audit different staff members are selected to report at different times.  It may get more staff engaged and more proficient.

We have annual competency trainings with nursing staff with return demonstration but I'm not sure anyone audits this routinely at our agency. 

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Submitted by gkroberts on

Hi John,

I have heard of this approach, mainly in the healthcare setting. You're absolutely right that direct observation skews the results, but when staff don't think anyone is watching, true compliance is much lower.

However, asking patients to be the secret shopper may not be reliable because they may not be aware of what qualifies as "proper hand hygiene techniques." For example, they may think hand sanitizer is not considered washing their hands, when this would be considered as compliant.

On the other hand, you could ask staff members to volunteer to be a secret shopper, but this may be difficult since they may feel like this would make them a rat/taddle tail, and no one wants that title.

Have you considered measuring the amount of soap or hand sanitizer used as a way to monitor compliance?

I found the following resources helpful:

Please let us know what you end up doing! Good luck!

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Gurleen Roberts, MPH
Director of Quality Management
Cobb & Douglas Public Health
Marietta, GA

Submitted by klouther on

If you are a member of APIC, Association of Professionals in Infection Control and Epidemiology (www.apic.org), you can go to their online forums and ask for resources from others from around the nation.  If not, they likely still have great resources on their website.  The Hand Hygiene Guide (second link on the page) can be found here: http://apic.org/Professional-Practice/Implementation-guides.

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Submitted by tkane on

"klouther" ... good suggestion. John, your "hand hygiene and QI" question reminds me of the Dr. Mike Evans PDSA White Board video (link below). I can't get enough of the Dr. Mike Evans white board videos ...



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