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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

The ethics of health care worker surveillance

“Big Brother is Watching You,” wrote George Orwell in his classic cautionary novel 1984.

The increasingly high-tech solutions to the historic problem of hand hygiene (HH) compliance raise this familiar specter, as health care workers are being tagged, badged, beeped, viewed and videotaped in the name of patient safety. Some of this is working, and with a surprising lack of pushback from the staff.

For example, in a recently published study the use of video cameras and real-time electronic feedback dramatically improved and sustained HH compliance rates on a 17-bed unit at North Shore University Hospital in Manhasset, NY.(1) The hospital did several things right when it comes to answering ethical questions before they are raised, we are told.

“I am impressed by the transparency and candor with which they designed this intervention,” says Lauris C. Kaldjian, MD, PhD, Director of Bioethics in the Department of Internal Medicine University of Iowa Carver College of Medicine. Asked to review the study for Hospital Infection Control & Prevention, Kaldjian says North Shore set up the program with a wise commitment to full transparency from the onset.

“Healthcare workers were aware that HH was a condition of employment, signed an annual HH contract, and were informed that cameras were being installed to monitor HH to generate aggregate data only," he says. "One of the key elements in these sort of interventions has to be a straight forwardness so that care workers know what’s going on and they know why it’s going on.”

Using electronic displays to give direct aggregate feedback to staff is both equitable and fair as long as all parties agree on the definitions of the observed behavior, he adds. “If there is no dispute there, this kind of approach seems to be a very impressive attempt to try and reflect what is actually happening and show that to the people who are the actors on the stage,” he says. [They are using] this as not only an incentive to try harder but also congratulate them for doing well.” Of course, extending such surveillance into other areas potentially involving patients would open up a new set of ethical and disclosure questions. However, in the current study one could certainly argue that it is better to know cameras are monitoring you than a lurking “secret shopper” of the human variety.


1. Armellino D, Hussain E, Schilling ME, et al. Using high-technology to enforce low-technology safety measures: The use of third-party remote video auditing and real-time feedback in healthcare. Clin Infect Dis Published online on November 21, 2011.