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Quantifying the Hawthorne effect using overt and covert observation of hand hygiene at a tertiary care hospital in Saudi Arabia - 01/08/18

Doi : 10.1016/j.ajic.2018.02.025 
Aiman El-Saed, MD, PhD a, b, c, Seema Noushad, MD a, Elias Tannous, CIC d, Fatima Abdirizak, MPH e, Yaseen Arabi, MD b, f, j, Salih Al Azzam, MD b, g, Esam Albanyan, MD b, h, Hamdan Al Jahdalil, MD b, h, Reem Al Sudairy, MD i, Hanan H. Balkhy, MD a, b, j, *
a Infection Prevention and Control Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia 
b King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia 
c Community Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt 
d Quality and Patient Safety Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates 
e School of Public Health, Georgia State University, Atlanta, GA 
f Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia 
g Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia 
h Department of Medicine, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia 
i Department of Oncology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia 
j King Abdullah International Medical Research Center, Riyadh, Saudi Arabia 

*Address correspondence to Hanan H. Balkhy, MD, Pediatric Infectious Disease, King Saud bin Abdulaziz University for Health Sciences, Infectious Diseases, King Abdullah International Medical Research Center, and Infection Prevention and Control, King Abdulaziz Medical City, PO Box 22490, Riyadh 11426, Saudi Arabia. (H.H. Balkhy).Pediatric Infectious DiseaseKing Saud bin Abdulaziz University for Health SciencesInfectious DiseasesKing Abdullah International Medical Research CenterInfection Prevention and ControlKing Abdulaziz Medical CityPO Box 22490Riyadh11426Saudi Arabia

Highlights

The accuracy of direct hand hygiene observation is challenged by Hawthorne effect.
Hawthorne effect was quantified at a tertiary care setting in the current study.
Overall hand hygiene compliance was 87.1% using overt observation.
Overall hand hygiene compliance was 44.9% using covert observation.
The overestimation was seen in all professions, hospital settings, and indications.

El texto completo de este artículo está disponible en PDF.

Abstract

Introduction

Although direct human observation of hand hygiene (HH) is considered the gold standard for measuring HH compliance, its accuracy is challenged by the Hawthorne effect.

Objectives

To compare HH compliance using both overt and covert methods of direct observation in different professional categories, hospital settings, and HH indications.

Methods

A cross-sectional study was conducted in 28 units at King Abdulaziz Medical City, Riyadh, Saudi Arabia, between October 2012 and July 2013. Compliance was defined as performing handrubbing or handwashing during 1 of the World Health Organization 5 Moments for HH indications (ie, opportunities). Overt observation was done by infection preventionists (IPs) who were doing their routine HH observation. Covert observation was done by unrecognized temporarily hired professionally trained observers.

Results

A total of 15,883 opportunities were observed using overt observation and 7,040 opportunities were observed using covert observation. Overall HH compliance was 87.1% versus 44.9% using overt/covert observations, respectively (risk ratio, 1.94; P < .001). The significant overestimation was seen across all professional categories, hospital settings, and HH indications.

Conclusion

There is a considerable difference in HH compliance being observed overtly and covertly in all categories. More work is required to improve the methodology of direct observation to minimize the influence of the Hawthorne effect.

El texto completo de este artículo está disponible en PDF.

Key Words : Hospital, Health care workers, Hand hygiene compliance


Esquema


 Conflicts of interest: None to report.


© 2018  Association for Professionals in Infection Control and Epidemiology, Inc.. Publicado por Elsevier Masson SAS. Todos los derechos reservados.
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Vol 46 - N° 8

P. 930-935 - août 2018 Regresar al número
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  • Journal Club: Quantifying the Hawthorne effect using overt and covert observation of hand hygiene at a tertiary care hospital in Saudi Arabia
  • Shanina C. Knighton, James Davis
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  • Understanding the patient experience of health care–associated infection: A qualitative systematic review
  • Kay Currie, Lynn Melone, Sally Stewart, Caroline King, Arja Holopainen, Alex M. Clark, Jacqui Reilly

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