Hostname: page-component-f554764f5-8cg97 Total loading time: 0 Render date: 2025-04-12T06:27:56.181Z Has data issue: false hasContentIssue false
  • English
  • Français

Compliance With Antiseptic Hand Rub Use in Intensive Care Units The Hawthorne Effect

Published online by Cambridge University Press:  21 June 2016

Tim Eckmanns ,
Jan Bessert ,
Michael Behnke ,
Petra Gastmeier  and
Henning Rüden
Tim Eckmanns*
Affiliation:
Institute of Hygiene and Environmental Medicine, Charité—University Medicine Berlin, Berlin, Germany
Jan Bessert
Affiliation:
Institute of Hygiene and Environmental Medicine, Charité—University Medicine Berlin, Berlin, Germany
Michael Behnke
Affiliation:
Institute of Hygiene and Environmental Medicine, Charité—University Medicine Berlin, Berlin, Germany
Petra Gastmeier
Affiliation:
Institute of Microbiology and Hospital Hygiene, Medical University Hannover, Hannover, Germany
Henning Rüden
Affiliation:
Institute of Hygiene and Environmental Medicine, Charité—University Medicine Berlin, Berlin, Germany
*
Institute of Hygiene and Environmental Medicine, Charité—University Medicine Berlin, Heubnerweg 6, 14059 Berlin, Germany, ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

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

Design.

Observational study.

Setting.

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

Participants.

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.

Results.

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.

Conclusions.

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.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 9 , September 2006 , pp. 931 - 934
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

1.Mangram, AJ, Horan, TC, Pearson, ML, Silver, LC, Jarvis, WR; Hospital Infection Control Practices Advisory Committee. Guideline for prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol 1999; 20:250–278.Google Scholar
2.Boyce, JM, Pittet, D; Healthcare Infection Control Practices Advisory Committee; HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Guideline for Hand Hygiene in Health-Care Settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. MMWR Recomm Rep 2002; 51(RR-16):1–45.Google Scholar
3.O'Grady, NP, Alexander, M, Dellinger, EP, et al. Guidelines for the prevention of intravascular catheter-related infections. MMWR Recomm Rep 2002;51(RR-10):1–29.Google ScholarPubMed
4.Tablan, OC, Anderson, LJ, Besser, R, Bridges, C, Hajjeh, R; CDC; Healthcare Infection Control Practices Advisory Committee. Guidelines for preventing health-care—associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep 2004; 53(RR-3):1–36.Google Scholar
5.Girou, E, Stephan, F, Novara, A, Safar, M, Fagon, JY. Risk factors and outcome of nosocomial infections: results of a matched case-control study of ICU patients. Am J Respir Crit Care Med 1998; 157:1151–1158.Google Scholar
6.Rello, J, Ollendorf, DA, Oster, G, et al. Epidemiology and outcomes of ventilator-associated pneumonia in a large US database. Chest 2002; 122:2115–2121.Google Scholar
7.Bates, DW, Yu, DT, Black, E, et al. Resource utilization among patients with sepsis syndrome. Infect Control Hosp Epidemiol 2003; 24:62–70.Google Scholar
8.Buchanan, D, Huczynski, A. Organizational Behavior. 3rd ed. Vol. 7. London: Prentice Hall; 1997.Google Scholar
9.Pittet, D, Simon, A, Hugonnet, S, Pessoa-Silva, CL, Sauvan, V, Perneger, TV. Hand hygiene among physicians: performance, beliefs, and perceptions. Ann Intern Med 2004; 141:1–8.Google Scholar
10.Wendt, C, Knautz, D, von Baum, H. Differences in hand hygiene behavior related to the contamination risk of healthcare activities in different groups of healthcare workers. Infect Control Hosp Epidemiol 2004; 25:203–206.Google Scholar
11.Bittner, MJ, Rich, EC, Turner, PD, Arnold, WH Jr. Limited impact of sustained simple feedback based on soap and paper towel consumption on the frequency of hand washing in an adult intensive care unit. Infect Control Hosp Epidemiol 2002; 23:120–126.Google Scholar
12.Harbarth, S, Pittet, D, Grady, L, et al. Interventional study to evaluate the impact of an alcohol-based hand gel in improving hand hygiene compliance. Pediatr Infect Dis J 2002; 21:489–495.Google Scholar
13.Pittet, D, Hugonnet, S, Harbarth, S, et al. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Lancet 2000; 356:1307–1312.CrossRefGoogle ScholarPubMed
14.Eckmanns, T, Rath, A, Rüden, H, Gastmeier, P, Daschner, F. Outbreak of Enterobacter cloacae related to understaffing, overcrowding, and poor hygiene practices. Infect Control Hosp Epidemiol 2000; 21:305–307.Google Scholar
15.Harbarth, S, Pittet, D, Grady, L, Goldmann, DA. Compliance with hand hygiene practice in pediatric intensive care. Pediatr Crit Care Med 2001; 2:311–314.Google Scholar
16.Grundmann, H, Hori, S, Winter, B, Tami, A, Austin, DJ. Risk factors for the transmission of methicillin-resistant Staphylococcus aureus in an adult intensive care unit: fitting a model to the data. J Infect Dis 2002; 185:481–488.Google Scholar