The power of feedback: Implementing a comprehensive hand hygiene observer program

•Overt observations and timely feedback provide reliable and efficient Hand hygiene (HH) monitoring.•Observer visibility allows for dialogue around the observation process and HH moments.•Transparency around observer presence encourages dialogue around improvement.•Leadership engagement strengthened relationship between HH observers and clinicians. Hand hygiene (HH) is a fundamental component of infection prevention within all healthcare settings. We implemented a hospital-wide program built on overt HH observation, real-time feedback, and thematic analysis of HH misses. A robust observer training program was established to include foundational training in the WHO's My Five Moments of HH. Observational data from 2011 to 2019 were analyzed by unit, provider type, and thematic analyses of misses. During the study period, we conducted 160,917 hospital-wide observations on 29 units (monthly average of 1,490 observations). Institutional compliance remained above 95% from 2013 to 2019. Thematic analysis revealed “touching self” and “touching phone” as common, institution-wide reasons for HH misses. Overt observations facilitated communication between HH program and healthcare staff to better understand workflow and educate staff on HH opportunities. This program is an integral part of the Infection Prevention team and has been deployed to collect supplemental data during clusters and outbreaks investigations. In addition to having rich HH data, successes of this program, include increased awareness of IPC practices, enhanced communication about patient safety, enriched dialog and feedback around HH misses, and relationship building among program observers, unit staff and leaders.