Compliance with antiseptic hand rub use in intensive care units: the Hawthorne effect

To determine the influence the Hawthorne effect has on compliance with antiseptic hand rub (AHR) use among healthcare personnel.

Observational study.

Five intensive care units of a university hospital in Berlin, Germany.

Medical personnel were monitored in 2 periods regarding compliance with AHR use when there were indications for AHR use. In the first period, the personnel had no knowledge of being observed. The second observation period was announced to the staff of the intensive care units in advance and information about what the observer would be monitoring was provided. Potential confounders of compliance with AHR use included occupational groups (nurses, physicians, and other healthcare workers), intensive care units, and indications for AHR use before or after any procedure.

Data were collected from 2,808 indications for AHR use. The overall rate of compliance was 29% (95% confidence interval, 26%-32%) in the first period and 45% (95% confidence interval, 43%-47%) in the second period. A logistic regression analysis with potential confounders revealed a significant odds ratio for the comparison between period 2 and period 1. The differences in compliance with AHR use were statistically significant (P<.001) between the occupational groups (nurses had the highest compliance and physicians had middle compliance) and between indication for AHR use before procedures and indication for AHR use after procedures.

The Hawthorne effect has a marked influence on compliance with AHR use, with a 55% increase of compliance with overt observation. This result is consistent throughout subgroups. The rate of compliance with AHR use may in fact be lower than we thought because of results from studies that did not take the Hawthorne effect into account. The results of this study underline the necessity for infection control teams to be on wards as often as possible.