Healthcare providers are half as likely to wash their hands well when you are not watching

The infection prevention department at Santa Clara Valley Medical Center in San Jose, California measured the differences in hand hygiene compliance rates when healthcare workers recognized the observers and when they did not. The study found a difference of more than 30 percent in hand hygiene compliance depending on whether or not they recognized the auditors. "This was not a result that we expected to see," said Nancy Johnson, MSN, CIC, infection prevention manager, Santa Clara Valley Medical Center. Infection preventionists validated the audits conducted by hospital volunteers, which showed no difference in the group's observations.

"The level of hand hygiene compliance when staff did not know they were being watched was surprising," said Maricris Niles, MA, infection prevention analyst, Santa Clara Valley Medical Center, California. "This study demonstrated to us that hand hygiene observations are influenced by the Hawthorne Effect and that unknown observers should be used to get the most accurate hand hygiene data."

Five infection prevention nurses (known to staff) and 15 hospital volunteers (unknown to staff) collected 4,640 observations between July 2015 and December 2015. The volunteers were trained in a two-hour course on the importance, identification and reporting of hand hygiene compliance.

Nancy Johnson stated that this data was recognized by our leadership. "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, our monitoring will be conducted by unknown observers."