For hospital and health care workers, hand hygiene has probably become second nature. But what if they actually need to be supervised in order to constantly keep their hands clean?

Doctors and nurses are not spared from the so-called “Hawthorne Effect,” where people’s behavior changes when they know they are not being watched, according to new research from the Santa Clara Valley Medical Center (SCVMC) in California.

The study found a grave difference in hand hygiene compliance at the hospital when health professionals were undergoing evaluation (and they knew it) and when they were not.

“[We saw] a very consistent trend that our Infection Prevention nurses were seeing something different (from) what volunteers were seeing,” SCVMC infection prevention (IP) analyst Maricris Niles told ABC News, pertaining to the nurses noting much higher compliance rates.

Could it be that compliance struck different observers in varying ways? Not really, as it actually boiled down to the Hawthorne Effect.

Compliance rate observed by IP nurses was at 57 percent, while hospital observers – high school and college-age volunteers trained to conduct those assessments and who likely blended in the crowd – recorded only around 22 percent.

IP nurse Lisa Hanford noticed this herself: nurses glancing up and seeing her would start using rubbing alcohol, versus when she would observe them secretly and they were not really lathering up.

These findings, presented at the Association for Professionals Infection Control and Epidemiology meeting in North Carolina, emerge as a crucial issue in hospitals and health care centers nationwide, as pathogenic bacteria and organisms are often transmitted from patient to patient and end up on the hands of hospital personnel.

A separate study in March found that 1 in 4 elderly patients carried superbugs or drug-resistant bacteria on their hands. Seniors who visited nursing homes and other post-acute care facilities, too, were expected to keep acquiring new superbugs during their stay.

The San Jose hospital is currently working on a number of interventions to drive compliance rates higher. One technique is to publicize such adherence data, something that can make competitive hospital departments respond positively.

In early May, the Centers for Disease Control and Prevention began to further promote hand hygiene compliance among hospitals through the Clean Hands Count Campaign.

“No measure of hand hygiene is perfect,” reminded epidemiologist Dr. Sharon Wright of the Beth Israel Deaconness Medical Center, pinpointing, for instance, that directly observing hand hygiene practices is laborious and could overestimate overall compliance numbers.

The guidelines actually vary, too, but doctors and nurses working in ICUs may need to clean or wash their hands more than a hundred times during their 8-hour shift.

To Wright, the hope is for clinicians to “feel funny” whenever they pass alcohol dispensers and don’t use them – just like wearing one’s seat belt in the car.

Photo: SRG Picker | Flickr

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