Handwashing has been shown to be the most effective means of reducing cross infection in the healthcare environment. However, staff compliance remains low in the real setting.

A prospective study was carried out over one month period in one cubicle of neurosurgery intensive care unit (ICU). A surveillance camera which was previously installed and functioning was focused on a cubicle of three patients, and recordings of the previous 24 hours were reviewed every day for 15 days. The number of incidents in which handwashing was required but not performed was recorded. An incident was defined as any one of the following: (1) handwashing not performed by healthcare workers; (2) touching different patients without handwashing; (3) using the same gloves for different patients and for different procedures; (4) not performing handwashing after finishing the procedures. Following this 15-day period, all staff were verbally instructed during every shift that they were under surveillance for the next 15 days. Camera recordings of the previous 24 hours were similarly reviewed every day for these 15 days and incidents recorded.

In the first 15-days period, there was a total of 480 incidents when handwashing was not performed. Of the incidents, 83%(n = 401) occurred during the night shift, especially during the early morning hours. In the subsequent 15 days when the staff were informed that they were under camera surveillance, the total number of events when handwashing was not done was 140. The difference between the two periods was statistically significant(p < 0.01 > .

Handwashing is practiced poorly in this ICU. As the maximum number of incidents occurred during the night shift, poor motivation may be one of the factors for this behavior. This study shows that camera surveillance plays a major role in changing the staff behavior and may improve compliance for handwashing.