Quantification of the Hawthorne effect in hand hygiene compliance monitoring using an electronic monitoring system: a retrospective cohort study

Srigley, Jocelyn A.; Furness, Colin D.; Baker, G. Ross; Gardam, Michael

doi:10.1136/bmjqs-2014-003080

Cited by 174 publications

(143 citation statements)

References 17 publications

Supporting

Mentioning

131

Contrasting

Unclassified

Order By: Relevance

“…Hawthorn effect, i.e., the possibility that HCWs change their behavior when they know they are being observed, has also been demonstrated to have an effect on compliance rates (Srigley et al 2014). It is therefore possible that this effect have led to an overestimation of compliance rates at point of stability and follow-up, in papers II and III, respectively.…”

Section: Transmission Routes and Sources (Papers III And Iv)mentioning

confidence: 99%

“…It is therefore possible that this effect have led to an overestimation of compliance rates at point of stability and follow-up, in papers II and III, respectively. However, it is assumed that the Hawthorn effect only has a transient effect on the human mind (Srigley et al 2014). The compliance rates slowly improved after the hygiene intervention and stabilized at a satisfactory level more than six months later.…”

Section: Transmission Routes and Sources (Papers III And Iv)mentioning

confidence: 99%

See 1 more Smart Citation

Infection control of Staphylococcus aureus : spa typing to elucidate transmission

Mernelius¹

2015

View full text Add to dashboard Cite

Staphylococcus aureus is a commensal of the human flora, primarily colonizing the anterior nares and throat, but it may also cause infections ranging from mild skin and soft tissue infections to severe diseases such as endocarditis and septicemia. S. aureus is also a major nosocomial problem increasing with the worldwide dissemination of methicillin-resistant S. aureus (MRSA).The main vector for bacterial cross-transmission in healthcare settings is the hands of healthcare workers (HCWs). No S. aureus was detected in the air in this thesis demonstrating that transmission through air is not important. Despite the fact that good compliance with hand hygiene is essential to prevent cross-transmission the compliance is generally less than 50 %.Gold standard to track bacterial transmission in healthcare settings has for long been pulsedfield gel electrophoresis (PFGE), a method that is labor-intensive, lacks consensus protocol and relies on semi-subjective analysis. Molecular typing by sequencing of the hypervariable part of the S. aureus protein A gene (spa typing) has overcome these problems and has shown promising results in epidemiological investigations.The aims of this thesis were to study bacterial transmission with S. aureus colonization of newborn infants as a model and to evaluate spa typing as a molecular tool. Additionally, the influence of compliance with hygiene guidelines on S. aureus transmission was assessed.Analysis of 280 MRSA isolates by spa typing revealed excellent typeability and epidemiological concordance and satisfactory discriminatory power. Additionally, spa typing was considered superior to PFGE thanks to its accessibility, ease of use and rapidity. Also, spa typing results are registered in a global database, facilitating inter-laboratory comparison.The prevalence of S. aureus ranged from 41 % to 66 % in the populations studied and males had the highest colonization rate. Throat was the premier colonization site for adults and transmission from individuals colonized in the throat only was documented, suggesting that throat cultures should be included in S. aureus screening programs. The umbilicus was the premier colonization site for newborn infants. Incubating the swabs in enrichment broth prior to plating increased the prevalence of S. aureus positive samples by 46 %, resulting in prevalence viii ranging from 51 % to 70 % in the populations studied. Thus enrichment prior to plating is necessary to determine more truthful S. aureus colonization rates. There were no indications of an institutional flora, as the colonization rates, spa type distribution and antibiotic resistance prevalence were similar among parents and HCWs.Direct observations and self-reporting by HCWs were both validated as tools for monitoring compliance with hygiene guidelines. The compliance with hygiene guidelines was significantly higher following a 10-point hygiene intervention as compared to baseline. The compliance was also higher three years after the intervention in three of four participating departm...

show abstract

Section: Transmission Routes and Sources (Papers III And Iv)mentioning

confidence: 99%

Section: Transmission Routes and Sources (Papers III And Iv)mentioning

confidence: 99%

Infection control of Staphylococcus aureus : spa typing to elucidate transmission

Mernelius¹

2015

View full text Add to dashboard Cite

show abstract

“…It has been argued that staff become habituated to presence of the device when they are used continuously, 58 and there is evidence that they can overcome the Hawthorne effect. Srigley et al 59 …”

Section: Electronic and Computerised Devicesmentioning

confidence: 99%

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

Gould

Creedon

Jeanes

et al. 2017

Journal of Hospital Infection

View full text Add to dashboard Cite

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

show abstract

“…Still, we have to work on increasing acceptance and further enhancing knowledge of the five moments for HH. Using direct observation to assess HH compliance is considered to be the norm when measuring compliance and is the gold standard [5,6,22]; however, it remains unclear how valid the method is as an indicator of adherence to HH guidelines [5]. Apart from direct observation, ABHR-consumption is a further indicator of HH compliance [5].…”

Section: Discussionmentioning

confidence: 99%

“…For Europe it is estimated that HAIs are responsible for approximately 37,000 deaths annually [1]; in the US, HAIs cause 99,000 deaths per year [2]. This major issue with respect to patient safety has led to numerous hand hygiene (HH) campaigns all over the world, as HH compliance is still estimated to be below 50 % [3][4][5][6]. Most healthcare workers are aware of the rationale behind HH-procedures and despite the relative simplicity of HH-procedures, adherence is still unacceptable low [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Hand hygiene behavior in a tertiary university hospital: differences between surgical and nonsurgical departments

et al. 2015

View full text Add to dashboard Cite

Background: Health care-associated infections are a major patient safety issue worldwide. Hand hygiene (HH) campaigns have started all over the world to increase awareness and decrease HH barriers. The aim of this study was to assess healthcare professionals' HH-knowledge, HH-barriers as well HH-environmental factors in general and especially in surgical and nonsurgical departments within a tertiary university hospital. Methods: In order to achieve our primary goal, five phases were implemented: i) environmental audit, ii) baseline survey, iii) HH-campaign, iv) follow-up survey and v) alcohol-based hand rub consumption. Results: The environmental audits showed that 443 HH-dispensers were missing. A total of 1,340 questionnaires were returned (baseline: 855; follow-up: 485). Eight HH-barriers were addressed in the baseline survey, 2 of which became significantly reduced during the HH-campaign. HH-environment improved and was followed by a significant increase in compliance with respect to the five moments for HH. Progress in the surgical departments was more evident than in nonsurgical departments. The average procurement of alcohol-based hand rub rose from 105 to 108 mL per patient day in intensive care units and from 26 to 31 mL per patient day in wards. Conclusion: HH-motivation can be addressed with comprehensive HH-campaigns; however, positive role models are needed to attract all healthcare professionals to take part. The necessity of physicians taking part in HH-campaign is the key to the future success of HH-campaigns.

show abstract

Quantification of the Hawthorne effect in hand hygiene compliance monitoring using an electronic monitoring system: a retrospective cohort study

Cited by 174 publications

References 17 publications

Infection control of Staphylococcus aureus : spa typing to elucidate transmission

Infection control of Staphylococcus aureus : spa typing to elucidate transmission

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

Hand hygiene behavior in a tertiary university hospital: differences between surgical and nonsurgical departments

Contact Info

Product

Resources

About