Korean J Nosocomial Infect Control.  2014 Jun;19(1):20-28. 10.14192/kjnic.2014.19.1.20.

The Hawthorne Effect between Covert and Overt Observations in the Monitoring of Hand Hygiene Adherence among Healthcare Personnel at Coronary Care Unit and Cardiac Surgery Intensive Care Unit

• Kim JH
• Jeong JS
• Kim MN
• Park JY
• Choi HR

• KMID: 1802350
• DOI: http://doi.org/10.14192/kjnic.2014.19.1.20

Abstract

BACKGROUND
Direct observation of healthcare workers is commonly used in hospitals to investigate hand hygiene compliance. However, the hand hygiene compliance rate may increase due to the Hawthorne effect, which is the modification of behavior simply because subjects become aware that they are being observed. The objective of this study was to investigate the occurrence of the Hawthorne effect when directly observing hand hygiene compliance in intensive care unit (ICU) healthcare personnel.
METHODS
A total of 87 staff members from the coronary care unit and cardiac surgery ICU of a general hospital in Seoul were included in this study: 24 residents and interns, 55 nurses, and 8 nursing assistants. Both covert and overt observations, where subjects were either unaware or aware of any direct observation, were performed on separate occasions.
RESULTS
A total of 1,052 covert and 1,336 overt observations were documented over 30 and 34 occasions, respectively. Overall hand hygiene compliance was significantly higher with overt observation than with covert observation (1,041/1,336, 77.9% vs. 659/1,052, 62.6%, P<0.001). The Hawthorne effect was present in all professions and behaviors, with the exception of nursing assistants, and prior to touching a patient.
CONCLUSION
Direct observation of hand hygiene compliance was associated with the Hawthorne effect when observations were made overtly and this was likely to contribute to an overestimation of compliance rate.

Keyword

Adherence; Hand hygiene; Hawthorne effect; Health personnel; Intensive care unit

MeSH Terms

Compliance
Coronary Care Units*
Delivery of Health Care*
Effect Modifier, Epidemiologic*
Hand Hygiene*
Health Personnel
Hospitals, General
Humans
Intensive Care Units*
Nursing
Seoul
Thoracic Surgery*

Reference

References

1. Chen YY, Chou YC, Chou P. Impact of nosocomial infection on cost of illness and length of stay in intensive care units. Infect Control Hosp Epidemiol. 2005; 26:281–7.

2. Allegranzi B, Pittet D. Role of hand hygiene in healthcare-associated infection prevention. J Hosp Infect. 2009; 73:305–15.

3. Pittet D, Hugonnet S, Harbarth S, Mourouga P, Sauvan V, Touveneau S, et al. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Infection Control Programme. Lancet. 2000; 356:1307–12.

4. Jeong JS, Choe MA. The effect of hand washing improving programs on the adherence of hand washing and nosocomial infections in a surgical intensive care unit. Korean J Nosocomial Infect Control. 2004; 9:117–29.

5. Levchenko AI, Boscart VM, Fernie GR. The feasibility of an automated monitoring system to improve nurses’ hand hygiene. Int J Med Inform. 2011; 80:596–603.

6. Marra AR, Moura DF Jr, Paes AT, dos Santos OF, Edmond MB. Measuring rates of hand hygiene adherence in the intensive care setting: a comparative study of direct observation, product usage, and electronic counting devices. Infect Control Hosp Epidemiol. 2010; 31:796–801.

7. Holden JD. Hawthorne effects and research into professional practice. J Eval Clin Pract. 2001; 7:65–70.

8. Kohli E, Ptak J, Smith R, Taylor E, Talbot EA, Kirkland KB. Variability in the Hawthorne effect with regard to hand hygiene performance in high- and low-performing inpatient care units. Infect Control Hosp Epidemiol. 2009; 30:222–5.

9. Eckmanns T, Bessert J, Behnke M, Gastmeier P, Ruden H. Compliance with antiseptic hand rub use in intensive care units: the Hawthorne effect. Infect Control Hosp Epidemiol. 2006; 27:931–4.

10. WHO.WHO Guidelines Approved by the Guidelines Review Committee: Geneva: World Health Organization. 2009; http://whqlibdoc.who.int/publications/2009/9789241597906_eng.pdf. (Updated on May 23, 2011).

11. McLaws ML, Pantle AC, Fitzpatrick KR, Hughes CF. Improvements in hand hygiene across New South Wales public hospitals: clean hands save lives, part III. Med J Aust. 2009; 191(8 Suppl):S18–24.

12. Bischoff WE, Reynolds TM, Sessler CN, Edmond MB, Wenzel RP. Handwashing compliance by health care workers: The impact of introducing an accessible, alcohol-based hand antiseptic. Arch Intern Med. 2000; 160:1017–21.

13. Hugonnet S, Perneger TV, Pittet D. Alcohol-based handrub improves compliance with hand hygiene in intensive care units. Arch Intern Med. 2002; 162:1037–43.

14. Longtin Y, Sax H, Allegranzi B, Hugonnet S, Pittet D. Patients’ beliefs and perceptions of their participation to increase healthcare worker compliance with hand hygiene. Infect Control Hosp Epidemiol. 2009; 30:830–9.

15. Ciofi degli Atti ML, Tozzi AE, Ciliento G, Pomponi M, Rinaldi S, Raponi M. Healthcare workers’ and parents’ perceptions of measures for improving adherence to hand-hygiene. BMC Public Health. 2011; 11:466.

16. Cantrell D, Shamriz O, Cohen MJ, Stern Z, Block C, Brezis M. Hand hygiene compliance by physicians: marked heterogeneity due to local culture? Am J Infect Control. 2009; 37:301–5.