There is a report of a new APIC abstract in ABC-News that further quantifies that impact of the Hawthorne Effect and highlights the lack of investment in hand hygiene programs. Investigators from Santa Clara, California compared compliance measured by well-recognized Infection Prevention nurses, to observations collected by unknown high-school and college-aged volunteers who were trained to use the same surveillance methods. Here are their findings:
The investigators found that hand hygiene compliance rate observed by IP nurses was about 57%, while hospital volunteers, who tended to blend in and not be recognized as hygiene auditors, recorded rates of about 22%. While this phenomenon has been noted before, the team at SCVMC was surprised by the stark gap, and they have launched a series of interventions to try and drive their compliance rates higher and higher.
So, what do I make of these findings? First, even 57% is too low. Second, hospitals and health care systems continue to throw hand hygiene programs under the rug. We are much happier to report compliance rates of 100% collected by nurse managers on the floor (or compliance of 57% by recognized IPs) and ignore the problem than spend time and money detecting compliance rates of 22%, which would then require additional investments in proven hand hygiene interventions.
Any administrator who thinks compliance in their hospital is higher than 70% or 90% won't invest in hand hygiene programs. Since hospitals are happier to report compliance of 90% to the Joint Commission, we also won't invest in technological and socio-adaptive interventions that will finally improve the safety of our hospitals. We must work to create a safety culture where it is better to report hand hygiene compliance of 20% than falsely high compliance rates of 90%.
