Hawthorne effect influences hand hygiene among healthcare workers, new study shows

When healthcare professionals are aware they're being observed, they're significantly more likely to comply with hand hygiene guidelines, according to a study being presented at the 43rd Annual Conference of the Association for Professionals in Infection Control and Epidemiology held in Charlotte, N.C.

For the study, the infection prevention department at Santa Clara Valley Medical Center in San Jose, Calif., collected 4,640 observations between July 2015 and December 2015. The observations were made by five infection prevention nurses whose presence was known to staff and 15 hospital volunteers whom the staff was unaware of.

Researchers found that when providers were aware of being observed, they were 30 percent more likely to comply with hand hygiene recommendations.

The reactive social mechanism at play in the study is known as the Hawthorne effect — a social occurrence in which individuals alter or improve their behavior in response to their awareness of being observed. The study's results suggest this effect can hinder accurate hand hygiene observation in healthcare settings.

"This was not a result that we expected to see," said Nancy Johnson, infection prevention manager at Santa Clara Valley Medical Center. "We have rolled out many changes as a result, including an organization wide hand hygiene improvement plan that is actively supported by our leadership team. Moving forward, the medical center's monitoring will be conducted by unknown observers."

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