Clinical audit is commonly used in health- care; a quality improvement process which is completed to improve patient care through review of the care against specific criteria and the implementation of appropriate change. In contrast, Slyne et al (2012) suggest that audit can have little effect on the improvement of IPC practice and argue that direct observation audit, perceived to be the best method of audit, can be influenced by bias and the Hawthorne effect; people altering their practice when they are aware that they are in a study and therefore an unrealis- tic representation is produced . Audit is considered by some HCWs to be threatening and regarded as unimportant potentially resulting in inadequate care.