310. The Hawthorne Effect in Hand Hygiene Compliance Monitoring
Session: Poster Abstract Session: Hand Hygiene in Healthcare Settings
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
  • IDWeek Hawthorne Poster.pdf (473.0 kB)
  • Background: Direct observation of healthcare worker hand hygiene compliance is subject to bias, such as the Hawthorne effect. The Hawthorne effect is the tendency for people to change their behaviour when aware of being observed. The Hawthorne effect is believed to inflate hand hygiene compliance rates when measured by direct observation, but there are limited data to measure the magnitude of the effect.

    Methods: A real-time location system (RTLS) was used to track the movement of a hand hygiene auditor during routine observation of two hospital wards. The RTLS also recorded the time and location of all uses of alcohol-based hand rub (ABHR) and soap dispensers. Rates of hand hygiene events per dispenser per hour were calculated for dispensers within sight of the auditor and were compared other dispensers out of sight of the auditor during the time of the auditor visit, as well as to the same times on other days when no auditor was present.

    Results: When an auditor was present, the mean hand hygiene event rate per hallway dispenser visible to the auditor was 4.47/hour, compared to 1.94/hour in hallways not visible to the auditor during the same time period. A Wilcoxon signed-rank test showed that the areas in sight of the auditor had significantly higher rates (p=0.002). The same dispensers in the week prior to the auditor visit had a rate of 1.33/hour, which was significantly lower than when an auditor was present (p<0.001). These findings were consistent when compared to two and three weeks prior to auditor visits. The mean event rate per dispenser inside patient rooms within sight of auditor was not significantly different from rooms that were not within sight of the auditor (0.31/hour vs. 0.37/hour, p=0.94), and was not significantly different from the rate inside the same rooms one week prior (p=0.68).

    Conclusion: Hand hygiene event rates are more than three times higher in hallways when an auditor is visible compared to when no auditor is visible, but there is no significant change inside patient rooms when an auditor is present. This is consistent with a Hawthorne effect that is localized to lines of sight around the auditor.

    Jocelyn A Srigley, MD, FRCPC1,2, Colin D. Furness, MISt, PhD3,4 and Michael Gardam, MSc, MD, FRCPC1,2, (1)Infection Prevention and Control, University Health Network, Toronto, ON, Canada, (2)Faculty of Medicine, University of Toronto, Toronto, ON, Canada, (3)Infonaut Inc., Toronto, ON, Canada, (4)Dalla Lana School of Public Healthg, University of Toronto, Toronto, ON, Canada


    J. A. Srigley, None

    C. D. Furness, Infonaut Inc.: Employee, Salary

    M. Gardam, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.