The Hawthorne effect has a marked influence on compliance with AHR use, with a 55% increase of compliance with overt observation. This result is consistent throughout subgroups. The rate of compliance with AHR use may in fact be lower than we thought because of results from studies that did not take the Hawthorne effect into account. The results of this study underline the necessity for infection control teams to be on wards as often as possible.

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The Hawthorne Effect refers to the tendency of people being observed as part of a research effort, to behave differently than they would otherwise. However during the collection of data about the compliance with hand disinfection (HD) it should be avoided that the observed personnel behaves differently as if it is not observed. It was examined which influence the Hawthorne Effect has on the compliance with HD in health care personnel. Medical personnel on 5 intensive care units (ICU) was monitored in two periods concerning compliance with HD in potential opportunities for HD. In the 1st period the personnel did not have knowledge of the observation, since the observing person was regularly present on the ICUs because of other studies. The 2nd period of observation was announced on the ICUs with detailed information about what the observer will monitor. Observations were done 10 times 2 hours during the morning shifts in both periods at all ICUs. Potential confounders of HD compliance included: Occupational group (nurses, doctors, other health care workers), ICU, nurse-to-patient ratio at time of observation. Differences in proportions were compared by chi-square tests. Data were collected from 2,808 opportunities for HD, of which 937 were in period 1 and 1,871 in period 2. Among staff categories, nurses contributed 57% of all opportunities doctors 18% and other health care workers 25%. All together in the 1st period the compliance was 29% and in the 2nd period 45%. Nurses had a compliance of 30% and 58% and doctors had a compliance of 25% and 47%. The differences between 1st and 2nd period were significant p<0.001. Other health care workers had a compliance of 29% and 21% this difference was not significant. In the 1st period substantially fewer opportunities for HD were observed as the observer worked "undercover". Nurses and doctors had a significant higher compliance in the 2nd period. The exception in the group of other health care workers is explainable, since these are not regular workers of the ICU and they were not informed about the observation. The Hawthorne Effect has a large influence on the compliance with HD.