Friday, June 10, 2016

APIC: The Impact Of The Hawthorne Effect On Hand Hygiene Audits

Credit WHO


One hundred and sixty-eight years ago, a Hungarian physician named Ignaz Semmelweis published a controversial medical book called Etiology, Concept and Prophylaxis of Childbed Fever

Semmelweis demonstrated that infections could be greatly reduced by simply having doctors wash their hands before performing gynecological exams.

What makes sense today, was at the time, considered an outrageous insult to doctors. Semmelweis was ridiculed, ostracized and eventually forced to leave his hospital post.

He died at the age of 47 in an asylum, a broken man.

Remarkably, 16 decades later, infection control professionals must still continually remind HCWs (Health Care Workers) of the importance of good hand hygiene, and have employed various methods of auditing their compliance.

But human nature being what it is, HCWs who know they are being watched are more to be compliant, than those who do not.
This is called the `Hawthorne Effect', and is something we looked at two years ago in BMJ: The `Hawthorne Effect’ On Hospital Hand Hygiene Compliance, where researchers found hand hygiene rates at a Canadian hospital were three times higher when HCWs could see the auditors.

Today APIC (Association for Professionals in Infection Control) has a press release on a presentation to be given at their 43rd Annual Conference that sadly indicates the Hawthorne Effect is alive and well in California (and almost certainly, everywhere else).

Association for Professionals in Infection Control

Charlotte, N.C., June 10, 2016 - When healthcare providers know they are being watched, they are twice as likely to comply with hand hygiene guidelines. This is in comparison to when healthcare providers do not know someone is watching, according to a new study being presented at the 43rd Annual Conference of the Association for Professionals in Infection Control and Epidemiology (APIC).
This phenomenon--called The Hawthorne Effect--impacts the ability to capture accurate human behavior because individuals modify their actions when they know they are being observed. 

The infection prevention department at Santa Clara Valley Medical Center in San Jose, California measured the differences in hand hygiene compliance rates when healthcare workers recognized the observers and when they did not. The study found a difference of more than 30 percent 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, MSN, CIC, infection prevention manager, Santa Clara Valley Medical Center. Infection preventionists validated the audits conducted by hospital volunteers, which showed no difference in the group's observations.

"The level of hand hygiene compliance when staff did not know they were being watched was surprising," said Maricris Niles, MA, infection prevention analyst, Santa Clara Valley Medical Center, California. "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." 

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. 

Nancy Johnson stated that this data was recognized by our leadership. "We have rolled out many changes as a result, including an organization-wide, hand hygiene improvement plan that is actively supported by our leadership team. Moving forward, our monitoring will be conducted by unknown observers."

(Continue . . . )

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