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Werzen A, Thom KA, Robinson GL, Li S, Rock C, Herwaldt LA, Diekema DJ, Reisinger HS, Perencevich EN. Comparing brief, covert, directly observed hand hygiene compliance monitoring to standard methods: A multicenter cohort study. American journal of infection control. 2019 Mar 1; 47(3):346-348.
Hand hygiene compliance is subject to the Hawthorne effect, which may be attenuated by covert observers and brief observation periods. This study demonstrated that hand hygiene compliance rates were between 8% and 29% greater when reported by infection prevention programs than when reported by covert observers over brief observation periods.