The Unseen Struggles: Hand Hygiene Audits in Long-Term Care Homes
When performing hand hygiene audits on the units in long-term care homes, our mission is clear: ensure the safety and well-being of residents and staff. Yet, this mission comes with a host of unique and often overlooked challenges that staff performing these audits face personally. I have firsthand knowledge of this, as I have been performing these audits regularly since the start of the COVID era.
At the heart of these struggles are biases, which can affect the quality of our audit data. One of the most significant biases we encounter is observer bias. The battle against observer bias is relentless, requiring meticulous training and self-awareness. Observer bias is also known as the “Hawthorne Effect”. It’s the knowledge that staff might alter their behavior because they are aware of being observed. This awareness sometimes leads to short-lived improvements in hand hygiene practices during audits. To navigate this challenge, you can recruit someone to be your “secret shopper” auditor, this will negate the observer bias!
Confirmation bias is another hurdle we grapple with during audits. It’s the inclination for the auditor to favor information that aligns with their preconceived notions. If auditors perform an audit with certain expectations about a home’s or unit’s hygiene practices, they risk unconsciously focusing on evidence that confirms those expectations while disregarding opposing data. If the auditor wants to show their boss that things are going well, or a fellow colleague neglects to record a missed moment because they are friends, the audit data will be corrupted. Staying impartial and objective becomes paramount in combating this bias.
Survivorship bias is a tricky adversary. When auditing, we might find ourselves observing only those who are readily available or willing to participate. This can lead to skewed data if certain staff consistently evade observation. Our duty is to strive for comprehensive and representative sampling, despite the challenges this may pose.
Amidst these challenges, there’s also an emotional toll. Witnessing non-compliance or substandard practices, especially in long-term care settings where residents are vulnerable, can be emotionally taxing. As an auditor, we need not only the right training but also emotional support and coping strategies to navigate these demanding aspects of the job. Ensuring the integrity of audit data is non-negotiable. Through adequate training and a steadfast dedication to data accuracy, auditors must strive to overcome these obstacles, knowing that their role as an auditor directly impacts the quality of care and safety for residents. In these often unseen struggles, we find purpose and fulfillment in making a meaningful difference every day.
If you’re looking for support, direction or education – reach out to info@ipacconsulting.com
Calvin Walker RPN, a-IPC
