Patient-driven hand hygiene audit process at a regional cancer center

•Audit of hand hygiene within the privacy of the examination room is difficult.•Engagement of patient-auditors for before and after contact was piloted.•A total of 1,640 paired opportunities were observed for 4 health care provider groups.•Compliance differences before and after contact and by provider were detected.•Patient-driven audit appears to be an effective supplement to observer-driven audits. A patient-driven hand hygiene compliance audit strategy was piloted in a Canadian provincial cancer agency during routine provision of cancer outpatient care by health care providers (physicians, nurses, and health care aides) under conditions where the deployment of an independent external auditor was not feasible. The results of the audit suggest the feasibility of this approach as a routine institutional performance metric.