ECJ EUROPEAN Cleaning Journal

Hand hygiene rates were found to be three times higher when auditors were visible to healthcare workers than when there were no auditors present, according to a study in a major Canadian acute care hospital.

The study was titled 'Quantification of the Hawthorne effect in hand hygiene compliance monitoring using an electronic monitoring system: a retrospective cohort study', and published in the BMJ Quality & Safety Journal, by Dr Jocelyn Srigley.

The study examined the Hawthorne effect, also known as observation bias - the tendency of people to change their behaviour when they are aware of an observer - using an electronic monitoring hand hygiene system in real-time, eliminating many of the biases inherent to human observation.

Ultrasound 'tags' on soap dispensers transmitted a signal to a nearby receiver each time the levers were pushed, and a time-stamped hand hygiene wash was recorded in a central data base.

Two inpatient units in University Health Network were electronically monitored, with 60 healthcare workers volunteering to be part of a study of the electronic monitoring system. Staff were aware that data would be used in a variety of studies, but were 'blind' to the questions asked in the studies.

Auditors did not announce their presence during audits but wore white lab coats. Auditors were also blinded to the questions asked in the research. Hand hygiene dispenses were electronically measured while the auditors were visible, and were compared to the same locations prior to the arrival of the auditors at one, two and three weeks before the audit, as well as to a different area of the unit not visible to the auditor.

Auditors typically did not go into patient rooms, so separate hand washing rates were determined for dispensers inside patient rooms and those in hallways.

The study found that there was an approximately three-fold increase in the rate of hallway hand washes per hour amongst healthcare staff when an auditor was visible (3.75 per hour), compared to a location where the auditor was not visible (1.48 per hour) and to the previous weeks (1.07 per hour).

Hand washing rates with the auditor present were compared to separate groups at different time periods and locations to ensure that the differences found were not due to hand hygiene patterns that could be attributable to time of day or location.

In each instance, the hand washing rates were significantly higher when the auditors were present, with the increase occurring after the auditors' arrival, suggesting that the arrival of the auditor triggered the increase in hand hygiene.