aviour change. However, there were some limitations.
Staff were observed for 90 min sessions during the working day. The optimal period for monitoring hand-hygiene compli- ance is 60 min but it has been recommended that observations are timed to capture a complete picture of 24 h activity.27,28 The number of staff and level of activity within the gastrointestinal isolation rooms was generally low, so that fewer observations could be collected and the likelihood of staff altering their behaviour as a direct result of being observed was increased.10 Manual data capture was inadequate to record rapid multiple simultaneous activities and observation was often obscured by curtains or other objects. Continuous automatic contact moni- toring is required and a system that can detect direct contact between healthcare worker and environmental surface and any subsequent hand hygiene has been evaluated.29