Highlights
- •The Australian mandatory national hand hygiene program requires rates for 3 quarterly periods annually.
- •Human audits for 2 years and automated surveillance were compared for 2 teaching wards, and the magnitude of the Hawthorne effect was not trivial.
- •The magnitude of the Hawthorne effect was highest on the less compliant ward (53-66 percentage points), whereas the Hawthorne effect on the more compliant ward was high but half as great (25-37 percentage points).
Background
The mandatory national hand hygiene program requires Australian public hospitals to
use direct human auditing to establish compliance rates. To establish the magnitude
of the Hawthorne effect, we compared direct human audit rates with concurrent automated
surveillance rates.
Methods
A large tertiary Australian teaching hospital previously trialed automated surveillance
while simultaneously performing mandatory human audits for 20 minutes daily on a medical
and a surgical ward. Subtracting automated surveillance rates from human audit rates
provided differences in percentage points (PPs) for each of the 3 quarterly reporting
periods for 2014 and 2015.
Results
Direct human audit rates for the medical ward were inflated by an average of 55 PPs
in 2014 and 64 PPs in 2015, 2.8-3.1 times higher than automated surveillance rates.
The rates for the surgical ward were inflated by an average of 32 PPs in 2014 and
31 PPs in 2015, 1.6 times higher than automated surveillance rates. Over the 6 mandatory
reporting quarters, human audits collected an average of 255 opportunities, whereas
automation collected 578 times more data, averaging 147,308 opportunities per quarter.
The magnitude of the Hawthorne effect on direct human auditing was not trivial and
produced highly inflated compliance rates.
Conclusions
Mandatory compliance necessitates accuracy that only automated surveillance can achieve,
whereas daily hand hygiene ambassadors or reminder technology could harness clinicians'
ability to hyperrespond to produce habitual compliance.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of Infection ControlAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- WHO guidelines on hand hygiene in health care: first global patient safety challenge: clean care is safer care.(Available from)http://apps.who.int/iris/bitstream/10665/44102/1/9789241597906_eng.pdfDate: 2011Date accessed: January 6, 2018
- The World Health Organization hand hygiene observation method.Am J Infect Control. 2009; 37: 827-834
- Management and the worker: an account of a research program conducted by the Western Electric Company, Hawthorne Works.Harvard University Press Chicago, Cambridge (MA)1967
- (Available from)http://www.hha.org.auDate accessed: January 6, 2018
- (Available from)http://www.myhospitals.gov.auDate accessed: January 6, 2018
- Doctor do you have a moment? National Hand Hygiene Initiative compliance in Australian hospitals.Med J Aust. 2014; 200: 534-537
- Compliance of healthcare workers with hand hygiene practices: independent advantages of overt and covert observers.PLoS ONE. 2013; 8 (1-7)
- Observer bias in hand hygiene compliance reporting.Infect Control Hosp Epidemiol. 2010; 31: 869-870
- Replicating changes in hand hygiene in a surgical intensive care unit with remote video auditing and feedback.Am J Infect Control. 2013; 41: 925-927
- Enhancement of hand hygiene compliance among health care workers from a hemodialysis unit using video-monitoring feedback.Am J Infect Control. 2016; 44: 868-872
- Introduction of an electronic monitoring compliance with moments 1 and 4 of the WHO “My 5 moments for hand hygiene” methodology.BMC Infect Dis. 2011; 11: 151-164
- Quantification of the Hawthorne effect in hand hygiene compliance monitoring using an electronic monitoring system: a retrospective cohort study.BMJ Qual Saf. 2014; 23: 974-980
- Quantifying the Hawthorne effect in hand hygiene compliance through comparing direct observation with automated hand hygiene monitoring.Infect Control Hosp Epidemiol. 2015; 36: 957-962
- Introducing automated hand hygiene surveillance to an Australian hospital: mirroring the HOW2 benchmark study.Am J Infect Control. 2016; 44: 772-776
- Automated hand hygiene auditing with and without an intervention.Am J Infect Control. 2016; 44: 1475-1480
- Hospital hand hygiene opportunities: where and when (HOW2)? The HOW2 benchmark study.Am J Infect Control. 2011; 39: 19-26
- Estimation of hand hygiene opportunities on an adult medical ward using 24-hour camera surveillance: validation of the HOW2 Benchmark Study.Am J Infect Control. 2014; 42: 602-607
- New technologies to monitor healthcare worker hand hygiene.Clin Microbiol Infect. 2014; 20: 29-33
- Social cohesion: the missing factor required for a successful hand hygiene program.Am J Infect Control. 2017; 45: 222-227
- Measuring hand hygiene when it matters.Lancet Infect Dis. 2016; 16: 1306-1307
- Hand hygiene compliance in Penang, Malaysia: human audits versus product usage.Am J Infect Control. 2016; 44: e95-e97
- Establishing evidence-based criteria for directly observed hand hygiene compliance monitoring programs: a prospective, multicenter cohort study.Infect Control Hosp Epidemiol. 2014; 35: 1163-1168
- Systematic review of the effectiveness of strategies to encourage patients to remind healthcare professionals about their hand hygiene.J Hosp Infect. 2015; 89: 141-162
- Hand hygiene compliance: are we kidding ourselves?.J Hosp Infect. 2016; 92: 307-308
- Observing and improving hand hygiene compliance: implementation and refinement of an electronic-assisted direct-observer hand hygiene audit program.Infect Control Hosp Epidemiol. 2013; 34: 207-210
- Successful use of alcohol sensor technology to monitor and report hand hygiene compliance.J Hosp Infect. 2010; 76: 364-365
- Real-time feedback for improving compliance to hand sanitization among healthcare workers in an open layout ICU using radiofrequency identification.J Med Syst. 2015; 39: 68
- Effectiveness of an electronic hand hygiene monitoring system on healthcare workers' compliance to guidelines.J Infect Public Health. 2015; 8: 117-126
- Implementation and impact of an automated group monitoring and feedback system to promote hand hygiene among health care personnel.Jt Comm J Qual Patient Saf. 2014; 40: 408-417
- Electronic monitoring of individual healthcare workers' hand hygiene event rates.Infect Control Hosp Epidemiol. 2014; 35: 1189-1192
- Hand hygiene-related clinical trials reported since 2010: a systemic review.J Hosp Infect. 2016; 92: 309-320
- The Hawthorne effect in measurements of hand hygiene compliance: a definite problem, but also an opportunity.BMJ Qual Saf. 2014; 23: 965-967
- Measuring healthcare worker hand hygiene activity: current practices and emerging technologies.Infect Control Hosp Epidemiol. 2011; 32: 1016-1028
- Electronic monitoring in combination with direct observation as a means to significantly improve hand hygiene.Am J Infect Control. 2017; 45: 528-535
- Hand hygiene electronic monitoring: are we there yet?.Am J Infect Control. 2017; 45: 464-465
- Thirty years if safety climate research: reflections and future directions.Accid Anal Prev. 2010; 42: 1517-1522
Article info
Publication history
Published online: May 17, 2018
Footnotes
Conflicts of interest: None to report.
Identification
Copyright
Crown Copyright © 2018 Published by Elsevier Inc. on behalf of Association for Professionals in Infection Control and Epidemiology, Inc. All rights reserved.
