Compliance With Antiseptic Hand Rub Use in Intensive Care Units The Hawthorne Effect

Eckmanns, Tim; Bessert, Jan; Behnke, Michael; Gastmeier, Petra; Rüden, H.

doi:10.1086/507294

Cited by 237 publications

(148 citation statements)

References 12 publications

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“…Although our observers remained unobtrusive, we could not eliminate a Hawthorne effect, which has been shown to influence hand hygiene compliance. 37 We recognize that our hand hygiene compliance data may be inflated; we used a best-case scenario. Nevertheless, this method was applied consistently across the hospital by trained external observers and was useful to monitor trends over the course of the program.…”

Section: Discussionmentioning

confidence: 99%

Dissemination and Sustainability of a Hospital-Wide Hand Hygiene Program Emphasizing Positive Reinforcement

Mayer

Mooney

Gundlapalli

et al. 2011

Infect. Control Hosp. Epidemiol.

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Objective.To increase and sustain hospital-wide compliance with hand hygiene through a long-term ongoing multidimensional improvement program emphasizing behavioral factors.Design.Quasi-experimental short study (August 2000-November 2001) and descriptive time series (April 2003-December 2006).Setting.A 450-bed teaching tertiary-care hospital.Interventions.An initial intervention bundle was introduced in pilot locations that addressed cognitive behavioral factors, which included access to alcohol sanitizer, education, and ongoing audit and feedback. The bundle was subsequently disseminated hospital-wide, along with a novel approach focused on behavior modification through positive reinforcement and annually changing incentives.Results.A total of 36,123 hand hygiene opportunities involving all categories of healthcare workers from 12 inpatient units were observed from October 2000 to October 2006. The rate of compliance with hand hygiene significantly improved after the intervention in 2 cohorts over the first year (from 40% to 64% of opportunities and from 34% to 49% of opportunities;P< .001, compared with the control group). Mean compliance rates ranged from 19% to 41% of 4174 opportunities (at baseline), increased to the highest levels of 73%–84% of 6,420 opportunities 2 years after hospital-wide dissemination, and remained improved at 59%–81% of 4,990 opportunities during year 6 of the program.Conclusion.This interventional cohort study used a behavioral change approach and is one of the earliest and largest institution-wide programs promoting alcohol sanitizer from the United States that has shown significant and sustained improvements in hand hygiene compliance. This creative campaign used ongoing frequent audit and feedback with novel use of immediate positive reinforcement at an acceptable cost to the institution.

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Section: Discussionmentioning

confidence: 99%

Dissemination and Sustainability of a Hospital-Wide Hand Hygiene Program Emphasizing Positive Reinforcement

Mayer

Mooney

Gundlapalli

et al. 2011

Infect. Control Hosp. Epidemiol.

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“…This focus on hand hygiene has in turn contributed to increased awareness of the Hawthorne effect. One study reported a 55% increase in use of alcohol handrub when health workers were aware that they were being watched compared to when they were unaware 26 . Compliance declined from 61% when doctors knew they were being observed to 44% when they were unaware 27 while in another study 28 hand hygiene compliance was reported to increase in the presence of data collectors known to staff compared to data collection by someone they did not recognise.…”

Section: Behaviour Change During Hand Hygiene Observation: Historicalmentioning

confidence: 99%

Impact of observing hand hygiene in practice and research: a methodological reconsideration

Gould

Creedon

Jeanes

et al. 2017

Journal of Hospital Infection

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This is the accepted version of the paper.This version of the publication may differ from the final published version. Direct observation is the recommended audit method but is associated with a number of disadvantages, including potential for being observed to alter usual behaviour. The Hawthorne effect in relation to hand hygiene is equated with productivity by increasing the frequency that hand hygiene is undertaken. Permanent repository linkUnobtrusive and/or frequent observation to accustom staff to the presence of observers are considered acceptable ways of reducing the Hawthorne effect but little has been written about how to implement these techniques or assess their effectiveness. There is evidence that awareness of being watched can disrupt the usual behaviour of individuals in complex and unpredictable ways other than simple productivity effect. Health workers might defer or avoid activities that require hand hygiene in the presence of auditors but these issues are not

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“…The role of hand hygiene is crucial and has been recognized as the single most important preventive measure [161]. Nevertheless, compliance with hand hygiene procedures is often poor, at only 30%-40% [162][163][164][165]. Compliance seems to vary depending on several issues: women tend to comply more often than men, and nurses more often than physicians or nursing assistants [162,166].…”

Section: Hand Hygiene and Cross-transmissionmentioning

confidence: 99%

“…Hand hygiene compliance rates can be improved by educational campaigns [163,184,185]. The Hawthorne effect, first described in electric factory workers as early as in the 1930s [186], refers to the tendency of people under observation in a study context to behave differently from the way they otherwise do and may explain why the effect of educational campaigns could likely be short-lived [184].…”

Section: Hand Hygiene and Cross-transmissionmentioning

confidence: 99%

“…The Hawthorne effect, first described in electric factory workers as early as in the 1930s [186], refers to the tendency of people under observation in a study context to behave differently from the way they otherwise do and may explain why the effect of educational campaigns could likely be short-lived [184]. Regular interaction between infection control and nursing staff on wards is important and may promote stricter adherence to hand hygiene than occasional campaigns [163,183,187,188].…”

Section: Hand Hygiene and Cross-transmissionmentioning

confidence: 99%

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314 Healthcare-Associated Infections in Pediatrics

SpringerReference

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Helsinki 2008 P u b l i c a t i o n s o f t h e N a t i o n a l P u b l i c H e a l t h I n s t i t u t e K T L A 1 1 / 2 0 0 8 Dr. Alexander Langmuir, 1963 Emmi Sarvikivi, Healthcare-associated infections in pediatrics Publications of the National Public Health Institute, A11/2008, 93 Pages ISBN 978-951-740-803-5; 978-951-740-804-2 (pdf-version) ISSN 0359-3584; 1458-6290 (pdf-version) http://www.ktl.fi/portal/4043 ABSTRACT Background and aims. Healthcare-associated infections (HAIs) are known to increase the risk for patient morbidity and mortality in different healthcare settings and thereby to cause additional costs. HAIs typically affect patients with severe underlying conditions, such as patients treated in intensive care units, or patients who have undergone medical procedures, e.g., surgery. HAIs are prevalent also among pediatric patients, but the distribution of the types of infection and the causative agents differ from those detected in adults. The aim of this study was to obtain information on pediatric HAIs in Finland through an assessment of the surveillance of bloodstream infections (BSIs), through two outbreak investigations in a neonatal intensive care unit (NICU), and through a study of postoperative HAIs after open-heart surgery.Methods. The Hospital for Children and Adolescents of the Helsinki University Central Hospital has participated in the BSI surveillance of the Finnish Hospital Infection Program since 1999. These data were utilized in all studies. The epidemiological features of pediatric BSIs were assessed. For the outbreak investigations, case definitions were set and data collected from microbiological and clinical records. The antimicrobial susceptibilities of the Serratia marcescens and the Candida parapsilosis isolates were determined. The S. marcescens isolates were genotyped with pulsed-field gel electrophoresis and the C. parapsilosis blood culture isolates (obtained between the years 1990 and 2002) with Southern blot hybridization by use of a DNA fingerprinting probe. Patient charts were reviewed for the case-control and cohort studies during the outbreak investigations, as well as for those patients who acquired surgical site infections (SSIs) after having undergone open-heart surgery. Also a prospective postdischarge study was conducted to detect postoperative HAIs after open-heart surgery.Results. During 1999During -2006, the overall annual BSI rate was 1.6/1,000 patient-days (range by year, 1.2-2.1). High rates (average, 4.9 and 3.2 BSIs/1,000 patient-days) were detected in hematology and neonatology units. Coagulase-negative staphylococci were the most common pathogens both hospital-wide and in each patient group. The overall mortality was 5%. The genotyping of the 15 S. marcescens isolates revealed three independent clusters. All of the 26 C. parapsilosis isolates studied proved to be indistinguishable. No common source was identified for either of the outbreaks, but the NICU was overcrowded during the S. marcescens clusters. In both investigations, low birth we...

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Compliance With Antiseptic Hand Rub Use in Intensive Care Units The Hawthorne Effect

Cited by 237 publications

References 12 publications

Dissemination and Sustainability of a Hospital-Wide Hand Hygiene Program Emphasizing Positive Reinforcement

Dissemination and Sustainability of a Hospital-Wide Hand Hygiene Program Emphasizing Positive Reinforcement

Impact of observing hand hygiene in practice and research: a methodological reconsideration

314 Healthcare-Associated Infections in Pediatrics

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