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Hawthorne effect limits accurate hand hygiene compliance rates
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Health care workers were approximately 35% less compliant to hand hygiene practices when they were audited by hospital volunteers they did not recognize compared with infection prevention nurses known to the staff. The findings demonstrate that the Hawthorne effect hinders accurate hand hygiene observations.
“The level of hand hygiene compliance when staff did not know they were being watched was surprising,” Maricris Niles, MA, infection prevention analyst at Santa Clara Valley Medical Center, California, said in a press release. “This study demonstrated to us that hand hygiene observations are influenced by the Hawthorne effect and that unknown observers should be used to get the most accurate hand hygiene data.”
Maricris Niles
The infection prevention (IP) department at Santa Clara Valley Medical Center measured differences in hand hygiene compliance rates when hospital staff were observed by 15 unknown hospital volunteers vs. five infection prevention nurses known to the staff. Members of the IP department trained the volunteers to review health care workers’ (HCW) compliance to hand hygiene practices based on WHO’s principles. The IP nurses and volunteers used a technology-assisted hand hygiene compliance monitoring and reporting tool to code specific variables of all hand hygiene practices that HCWs performed before entering and after exiting a room.
The IP nurses and volunteers conducted 4,640 observations from July to December 2015. There was a significant difference between compliance rates reported by the auditors (P < .01), with the volunteers finding 35% less hand hygiene compliance than the IP nurses. An assessment of the volunteers’ first set of audits verified that their reporting processes were similar to those carried out by IP nurses.
Nancy Johnson
“We have rolled out many changes as a result, including an organizationwide, hand hygiene improvement plan that is actively supported by our leadership team,” Nancy Johnson, MSN, CIC, infection prevention manager at Santa Clara Valley Medical Center, said in the release. “Moving forward, the medical center’s monitoring will be conducted by unknown observers.” – by Stephanie Viguers
Reference:
Niles M, et al. Abstract 1204-26. Presented at: Annual Conference of the Association for Professionals in Infection Control and Epidemiology; June 11-13, 2016; Charlotte, N.C.
Disclosure: The IP team reports working with Ecolab to create an app to help facilitate hand hygiene monitoring.