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

In the September 2006 issue of Infection Control and Hospital Epidemiology (27:931-934), medical personnel in five German hospitals were monitored in two periods regarding compliance with antiseptic hand rub (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 2808 indications for AHR use. The overall rate of compliance was 29 per cent (95 per cent confidence interval 26 to 32 per cent) in the first period and 45 per cent (95 per cent confidence interval, 43 to 47 per cent) in the second period. A logistic regression analysis with potential confounders revealed a significant odds ratio for the comparison between period two and period one. 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 (test subjects’ compliance with measured behaviour increases with awareness of being observed) has a marked influence on compliance with AHR use, with a 55 per cent 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 through 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.