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HCW hand hygiene three times more frequent in presence of auditors
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A new study shows that health care workers may be three times more likely to wash their hands or use hand sanitizer in the presence of an auditor, suggesting the perceived success rates of compliance measures that rely on the use of auditors may be misleading.
In their study, researchers from Canada expressed concern over the lack of solid data related to hand hygiene in health care settings, and particularly about the Hawthorne effect, or observational bias. They designed a study that would eliminate many of the biases by using electronic monitoring, and not revealing any study hypotheses to the participants in two acute care units within the University Health Network. They used real-time location systems to monitor the frequency of hand washing and sanitization.Electronic monitors were placed on soap and sanitizer dispensers, and a geographic location system tracked the devices and the location of compliance auditors.
Twelve audits were conducted between Nov. 29, 2012 and March 11, 2013. Audits were conducted no more than twice per month, or at the same frequency prior to the study, in an effort to blind HCWs to the study so as not to alter their normal behavior.
Researchers compared hand hygiene events that occurred while exposed to an audit with those that went unexposed. Unexposed events were categorized as those not visible to auditors, those that occurred on days when auditors were previously visible, and those that occurred 1 to 5 minutes before an auditor arrived.
Among those visible to auditors, the median rate of hand hygiene events was 3.75 per dispenser per hour compared with 1.48 among those not visible to auditors and 1.07 per dispenser per hour among those that occurred during the previous week not visible to auditors (P<.001). Only 1.5 per dispenser per hour took place among those that occurred 1 to 5 minutes prior to the auditor’s arrival, compared with when auditors were present (P=.009).
“The difference in hand hygiene rates, when an auditor is present compared to those times when one is not, is huge in this study, and we showed this effect to be very consistent,” Michael Gardam, MSc, MD, FRCPC, associate professor of medicine at the University of Toronto, said in a press release.
One limitation of the study is that the identities of the participants are unknown, so frequent hand washers cannot be distinguished from those who performed acts of hand hygiene less frequently.
“We need to change how we look at these complex problems,” Gardam said in the release. “We need to help people change by engaging them and having them come up with local solutions.”
Disclosure: See the full article for a complete list of relevant financial disclosures.
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