The Hawthorne effect on adherence to hand hygiene in patient care

Purssell, Edward; Drey, Nicholas; Chudleigh, Jane; Creedon, Sile A.; Gould, Dinah

doi:10.1016/j.jhin.2020.07.028

Cited by 59 publications

(50 citation statements)

References 45 publications

(60 reference statements)

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“…All healthcare workers had the opportunity to watch an educational video of how and when to conduct proper hand hygiene, and they knew that they were being observed. Other studies have shown increased hand hygiene adherence when participants know they are being watched, as described by the Hawthorne effect [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…The students conducted the observations during their third of a 4-week practice session in the nursing homes. To reduce the Hawthorne effect, where the observers themselves influence the behavior of those they are observing [ 24 ], the students conducted the observations after they were already known to the healthcare workers. Observations were conducted mainly from Monday to Friday.…”

Section: Methodsmentioning

confidence: 99%

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Students’ observations of hand hygiene adherence in 20 nursing home wards, during the COVID-19 pandemic

et al. 2022

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Background Healthcare-associated infections are a major threat to patient safety, particularly vulnerable elderly living in nursing homes, who have an increased risk of infections and mortality. Although good hand hygiene is the most effective preventive measure against infections, few studies of hand hygiene adherence have been conducted in nursing homes. The aim of this study is to investigate hand hygiene adherence in nursing homes with students as observers using a validated observation tool. In addition, to examine when healthcare workers perform hand hygiene and when they do not. Methods This observational study used the World Health Organization’s observation tool for studying hand hygiene indication and adherence: “My five moments for hand hygiene.” For 1 week each in February and March 2021, 105 first-year nursing students conducted 7316 hand hygiene observations at 20 nursing home wards in one large municipality in Norway. Results The overall adherence rate found in this study was 58.3%. Hand hygiene adherence decreased from 65.8% in February to 51.4% in March. The adherence varied largely between the different wards, from 26.4 to 83.1%, and by occupation status, indications of hand hygiene, and use of gloves. Nursing students were found to have the greatest adherence, followed by nurses. The use of gloves reduced adherence. Healthcare workers to a larger degree conduct hand hygiene after contact with patients than before approaching them. Conclusions Hand hygiene adherence is too low to protect all residents against healthcare-associated infections, and the findings from this study indicate that there are many factors that influence hand hygiene adherence, eg., education, occupation status and glove use Increasing healthcare workers’ knowledge and skills of hand hygiene is needed to reduce healthcare-associated infections and reminders of the importance of hand hygiene adherence must be an ongoing activity. Interventions to improve hand hygiene adherence in healthcare workers is needed to reduce infections and antibiotic use in nursing homes.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Students’ observations of hand hygiene adherence in 20 nursing home wards, during the COVID-19 pandemic

et al. 2022

View full text Add to dashboard Cite

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“…The initial 10 min was not measured, but allowed the observer to adjust to the pace being set by the staff member being observed. These procedures allowed for some dissipation of the Hawthorne effect, a known confounder in observational studies of healthcare practices such as hand washing [ 47 ]. The micro-costing data collected in this study were captured with an observational prospective study design, the optimal technique for obtaining accurate cost estimates to inform resource allocation decisions [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

A pre-pandemic COVID-19 assessment of the costs of prevention and control interventions for healthcare associated infections in medical and surgical wards in Québec

Tchouaket

Robins

Boivin

et al. 2021

Antimicrob Resist Infect Control

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Background Healthcare-associated infections (HCAIs) present a major public health problem that significantly affects patients, health care providers and the entire healthcare system. Infection prevention and control programs limit HCAIs and are an indispensable component of patient and healthcare worker safety. The clinical best practices (CBPs) of handwashing, screening, hygiene and sanitation of surfaces and equipment, and basic and additional precautions (e.g., isolation, and donning and removing personal protective equipment) are keystones of infection prevention and control (IPC). There is a lack of rigorous IPC economic evaluations demonstrating the cost–benefit of IPC programs in general, and a lack of assessment of the value of investing in CBPs more specifically. Objective This study aims to assess overall costs associated with each of the four CBPs. Methods Across two Quebec hospitals, 48 healthcare workers were observed for two hours each shift, for two consecutive weeks. A modified time-driven activity-based costing framework method was used to capture all human resources (time) and materials (e.g. masks, cloths, disinfectants) required for each clinical best practice. Using a hospital perspective with a time horizon of one year, median costs per CBP per hour, as well as the cost per action, were calculated and reported in 2018 Canadian dollars ($). Sensitivity analyses were performed. Results A total of 1831 actions were recorded. The median cost of hand hygiene (N = 867) was 20 cents per action. For cleaning and disinfection of surfaces (N = 102), the cost was 21 cents per action, while cleaning of small equipment (N = 85) was 25 cents per action. Additional precautions median cost was $4.1 per action. The donning or removing or personal protective equipment (N = 720) cost was 76 cents per action. Finally, the total median costs for the five categories of clinical best practiced assessed were 27 cents per action. Conclusions The costs of clinical best practices were low, from 20 cents to $4.1 per action. This study provides evidence based arguments with which to support the allocation of resources to infection prevention and control practices that directly affect the safety of patients, healthcare workers and the public. Further research of costing clinical best care practices is warranted.

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“…The initial 10 minutes was not measured, but allowed the observer to adjust to the tasks and pace being set by the staff member being observed. These procedures allowed for some dissipation of the Hawthorne effect, a known confounder in observational studies of healthcare practices such as hand washing (45). The micro-costing data collected in this study were captured with an observational prospective study design, the optimal technique for obtaining accurate cost estimates to inform resource allocation decisions (24).…”

Section: Cbp Costsmentioning

confidence: 99%

A pre-pandemic COVID-19 assessment of the costs of prevention and control interventions for healthcare associated infections in medical and surgical units in Québec

Tchouaket

Robins

Boivin

et al. 2021

Preprint

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Background Healthcare-associated infections (HCAIs) present a major public health problem that significantly affects patients, health care providers and the entire healthcare system. Infection prevention and control programs limit HCAIs and are an indispensable component of patient and healthcare worker safety. The clinical best practices (CBPs) of handwashing, screening, hygiene and sanitation of surfaces and equipment, and basic and additional precautions are keystones of infection prevention and control (IPC). Systematic reviews of IPC economic evaluations report the lack of rigorous empirical evidence demonstrating the cost-benefit of IPC program in general, and point to the lack of assessment of the value of investing in CBPs more specifically. Objective This study aims to assess overall costs associated with each of the four CBPs. Methods Across two Quebec hospitals, 48 healthcare workers were observed for two hours each shift, for two consecutive weeks. A modified time-driven activity-based costing framework method was used to capture all human resources (time) and materials required (e.g. masks, cloths, disinfectants) for each clinical best practice. Using a hospital perspective with a time horizon of one year, median costs per CBP per hour, as well as the cost per action, were calculated and reported in 2018 Canadian dollars. Sensitivity analyses were performed. Results A total of 1831 actions were recorded. The median cost of hand hygiene (N = 867) was 19.6 cents per action. For cleaning and disinfection of surfaces (N = 102), the cost was 21.4 cents per action, while cleaning of small equipment (N = 85) was 25.3 cents per action. Additional precautions median cost was $4.13 per action. The donning or removing or personal protective equipment (N = 720) cost was 75.9 cents per action. Finally, the total median costs for the five categories of clinical best practiced assessed were 27.2 cents per action. Conclusion The costs of clinical best practices were low, from 20 cents to $4.13 per action. This study provides evidence based arguments with which to support the allocation of resources to infection prevention and control practices that directly affect the safety of patients, healthcare workers and the public. Further research of costing clinical best care practices is warranted.

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The Hawthorne effect on adherence to hand hygiene in patient care

Cited by 59 publications

References 45 publications

Students’ observations of hand hygiene adherence in 20 nursing home wards, during the COVID-19 pandemic

Students’ observations of hand hygiene adherence in 20 nursing home wards, during the COVID-19 pandemic

A pre-pandemic COVID-19 assessment of the costs of prevention and control interventions for healthcare associated infections in medical and surgical wards in Québec

A pre-pandemic COVID-19 assessment of the costs of prevention and control interventions for healthcare associated infections in medical and surgical units in Québec

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