A low-cost but effective hand hygiene observation program

The December issue of Academic Medicine has a paper that describes UCLA Medical Center's hand hygiene program, which uses pre-health career college students as volunteer observers. The students are trained to use standardized tools and the program yields about 9,000 observations per year. The authors of the paper note that the advantages of the program are that it gives the students experience in the healthcare setting and its low cost ($5,000/year). Disadvantages are the lack of nighttime observations and gaps in observations when the university is not in session. Hand hygiene across the institution has increased from 50% to over 90%. Click here to view the program's website.

At VCU Medical Center we are currently in the third year of our observer program, which also relies on students (undergraduate and graduate). Our observers are paid an hourly wage, which allows us to obtain nighttime observations as well as year-round coverage. Although our program is four times more costly (still a bargain), it yields four times as many observations, and the results in improvement in hand hygiene compliance are very similar to those at UCLA.


  1. Hiring people with little expertise to do hand hygiene observations has been effective in our experience and if anything more accurate--who pays attention to students?
    Anything seems better than the standard unit nurse observations of their own unit that are so common.


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