Monday September 16th 2019

Watching affects practice


When health care providers know they are being watched, they are twice as likely to comply with hand hygiene guidelines. This is in comparison to when health care providers do not know someone is watching, according to a new study that was presented at the 43rd Annual Conference of the Association for Professionals in Infection Control and Epidemiology this June.

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, CA, measured the differences in hand hygiene compliance rates when health care 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 at the medical center. “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.

Johnson stated that facility leadership recognized the data.

“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,” she said. “Moving forward, the medical center’s monitoring will be conducted by unknown observers.”

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