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Being watched affects hand hygiene compliance

  • 2 Comments

When healthcare providers know they are being watched, they are twice as likely to comply with hand hygiene guidelines, according to US researchers.

This is in comparison to when healthcare providers do not know someone is watching, according to a new study being presented at an infection control conference.

“Compliance when staff did not know they were being watched was surprising”

Maricris Niles

The phenomenon – called The Hawthorne Effect – affects the ability to record accurate behaviour because individuals modify their actions when they know they are being observed, noted researchers.

The infection prevention department at the Santa Clara Valley Medical Center in San Jose, California, measured the differences in hand hygiene compliance rates when healthcare workers recognised the observers and when they did not.

The study found a difference of more than 30% in hand hygiene compliance depending on whether or not they recognized the auditors.

“This was not a result that we expected to see,” said Nancy Johnson, infection prevention manager at Santa Clara Valley Medical Center.

“The level of hand hygiene compliance when staff did not know they were being watched was surprising,” said Maricris Niles, an infection prevention analyst at the centre.

Santa Clara Valley Medical Center

Being watched affects hand hygiene compliance

Maricris Niles

“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,” she said.

Five infection prevention nurses – known to staff – and 15 hospital volunteers – unknown to staff – collected 4,640 observations between July 2015 and December 2015.

The volunteers were trained in a two-hour course on the importance, identification and reporting of hand hygiene compliance.

Ms Johnson said: “Moving forward, the medical centre’s monitoring will be conducted by unknown observers.”

The study was presented at the annual conference of the Association for Professionals in Infection Control and Epidemiology in Charlotte, North Carolina.

  • 2 Comments

Readers' comments (2)

  • michael stone

    Well, although this is technically correct:

    '“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,” she said.'

    as the whole point is that better hand hygiene is a good thing, then the implication of the study seems to be that you only get the optimum result (the best level of hand hygiene) when an identified observer is present !

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  • I am amazed that the researchers were surprised that hand hygiene was better when staff knew they were being observed. I do not need to be aware of 'Hawthorne Effect' (although I am) to understand why.

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