Beyond the Hawthorne Effect: Reduction of <i>Clostridium difficile</i> Environmental Contamination through Active Intervention to Improve Cleaning Practices

Guerrero, Dubert M.; Carling, Philip; Jury, Lucy A.; Ponnada, Suresh; Nerandzic, Michelle M.; Donskey, Curtis J.

doi:10.1086/670213

Cited by 37 publications

(23 citation statements)

References 9 publications

(5 reference statements)

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“…For instance, patients who were aware of being in a study had less post-operative knee pain than subjects who were unaware [25]. Being aware of ongoing monitoring was associated with improvement in decontamination hospital practices [26].…”

Section: Discussionmentioning

confidence: 97%

Hawthorne Effect with Transient Behavioral and Biochemical Changes in a Randomized Controlled Sleep Extension Trial of Chronically Short-Sleeping Obese Adults: Implications for the Design and Interpretation of Clinical Studies

et al. 2014

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ObjectiveTo evaluate the effects of study participation per se at the beginning of a sleep extension trial between screening, randomization, and the run-in visit.DesignSubjects were screened, returned for randomization (Comparison vs. Intervention) after 81 days (median), and attended run-in visit 121 days later.SettingOutpatient.PatientsObese (N = 125; M/F, 30/95; Blacks/Whites/Other, N = 73/44/8), mean weight 107.6±19.7 kg, <6.5 h sleep/night.InterventionNon-pharmacological sleep extension.MeasurementsSleep duration (diaries and actigraphy watch), sleep quality (Pittsburgh Sleep Quality Index), daily sleepiness (Epworth Sleepiness Scale), fasting glucose, insulin and lipids.ResultsPrior to any intervention, marked improvements occurred between screening and randomization. Sleep duration increased (diaries: 357.4 ±51.2 vs. 388.1±48.6 min/night; mean±SD; P<0.001 screening vs. randomization; actigraphy: 344.3 ±41.9 vs. 358.6±48.2 min/night; P<0.001) sleep quality improved (9.1±3.2 vs. 8.2±3.0 PSQI score; P<0.001), sleepiness tended to improve (8.9±4.6 vs. 8.3±4.5 ESS score; P = 0.06), insulin resistance decreased (0.327±0.038 vs. 0.351±0.045; Quicki index; P<0.001), and lipids improved, except for HDL-C. Abnormal fasting glucose (25% vs. 11%; P = 0.007), and metabolic syndrome (42% vs. 29%; P = 0.007) both decreased. In absence of intervention, the earlier metabolic improvements disappeared at the run-in visit.LimitationsRelatively small sample size.ConclusionsImprovements in biochemical and behavioral parameters between screening and randomization changed the “true” study baseline, thereby potentially affecting outcome. While regression to the mean and placebo effect were considered, these findings are most consistent with the “Hawthorne effect”, according to which behavior measured in the setting of an experimental study changes in response to the attention received from study investigators. This is the first time that biochemical changes were documented with respect to the Hawthorne effect. The findings have implications for the design and conduct of clinical research.Trial RegistrationClinicalTrials.gov NCT00261898.

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Section: Discussionmentioning

confidence: 97%

Hawthorne Effect with Transient Behavioral and Biochemical Changes in a Randomized Controlled Sleep Extension Trial of Chronically Short-Sleeping Obese Adults: Implications for the Design and Interpretation of Clinical Studies

et al. 2014

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“…Several other studies have demonstrated different results after instituting direct observation, supervision, and education of staff as they clean, again often showing reductions of important hospital pathogens (257,(261)(262)(263)(264). There is a concern that these interventions might lose impact over time, since cleaning is physically demanding, poorly paid, and subject to inadequate staffing (17,265).…”

Section: Observation Supervision and Education Of Housekeeping Staffmentioning

confidence: 99%

Controlling Hospital-Acquired Infection: Focus on the Role of the Environment and New Technologies for Decontamination

2014

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SUMMARY There is increasing interest in the role of cleaning for managing hospital-acquired infections (HAI). Pathogens such as vancomycin-resistant enterococci (VRE), methicillin-resistant Staphylococcus aureus (MRSA), multiresistant Gram-negative bacilli, norovirus, and Clostridium difficile persist in the health care environment for days. Both detergent- and disinfectant-based cleaning can help control these pathogens, although difficulties with measuring cleanliness have compromised the quality of published evidence. Traditional cleaning methods are notoriously inefficient for decontamination, and new approaches have been proposed, including disinfectants, steam, automated dispersal systems, and antimicrobial surfaces. These methods are difficult to evaluate for cost-effectiveness because environmental data are not usually modeled against patient outcome. Recent studies have reported the value of physically removing soil using detergent, compared with more expensive (and toxic) disinfectants. Simple cleaning methods should be evaluated against nonmanual disinfection using standardized sampling and surveillance. Given worldwide concern over escalating antimicrobial resistance, it is clear that more studies on health care decontamination are required. Cleaning schedules should be adapted to reflect clinical risk, location, type of site, and hand touch frequency and should be evaluated for cost versus benefit for both routine and outbreak situations. Forthcoming evidence on the role of antimicrobial surfaces could supplement infection prevention strategies for health care environments, including those targeting multidrug-resistant pathogens.

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“…Checklists to instruct housekeepers on the cleaning sequence should be promoted 13. Moreover, education, implementation of standardized processes, and direct interaction with or to domestic staff are all interventions that have been reported to improve the efficiency of disinfection of contaminated surfaces.32,56 New automated technologies, such as hydrogen peroxide, have been reported to be effective against C. difficile spores. 33,[57][58][59] This approach can only be used in vacant rooms, needs special equipment and personnel, has a relatively high cost, and is associated withsignificant turnaround time.…”

mentioning

confidence: 99%

Hospital management of Clostridium difficile infection: a review of the literature

Khanafer¹,

Voirin²,

Barbut³

et al. 2015

Journal of Hospital Infection

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Beyond the Hawthorne Effect: Reduction of Clostridium difficile Environmental Contamination through Active Intervention to Improve Cleaning Practices

Cited by 37 publications

References 9 publications

Hawthorne Effect with Transient Behavioral and Biochemical Changes in a Randomized Controlled Sleep Extension Trial of Chronically Short-Sleeping Obese Adults: Implications for the Design and Interpretation of Clinical Studies

Hawthorne Effect with Transient Behavioral and Biochemical Changes in a Randomized Controlled Sleep Extension Trial of Chronically Short-Sleeping Obese Adults: Implications for the Design and Interpretation of Clinical Studies

Controlling Hospital-Acquired Infection: Focus on the Role of the Environment and New Technologies for Decontamination

Hospital management of Clostridium difficile infection: a review of the literature

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