The presence of the auditor is increasing hand hygiene rates among health workers

The presence of the auditor is increasing hand hygiene rates among health workers -

The hand hygiene rates were found to be three times high when auditors were visible to healthcare workers when there was no audience present, according to a study in a major Canadian short-term care hospital

the study, entitled "Quantification Hawthorne effect in compliance with hand hygiene monitoring with an electronic monitoring system: a retrospective cohort study, "published today in the online ON- BMJ Quality &. Safety Journal , first author Dr. Jocelyn Srigley, who did the study as part of his Masters in clinical Fellow thesis in prevention and infection control at University health Network and University of Toronto and lead author Dr. Michael Gardam, Director, prevention and infection control, University Health Network and women College Hospital.

The study examined the Hawthorne effect, also known as observer bias - the tendency for people to change their behavior when they are aware of an observer - using a hygiene system electronic monitoring hands in real time, eliminating many of the biases inherent to human observation. Ultrasound "tags" on the soap dispensers transmitted a signal to a nearby receiver whenever the levers were pushed, and washing hands with timestamped hygiene was recorded in a central database.

Two inpatient units at University Health Network were controlled electronically, with 60 volunteer health workers to be part of a study of the electronic monitoring system. The staff was aware that the data would be used in a variety of studies, but were "blind" to the questions in the studies. Accounts announce their presence during the investigations, but wore white blouses. Statements were also blinded to the questions in the research. exemption for hand hygiene were measured electronically while listeners were visible, and were compared to the same places before the arrival of auditors at one, two and three weeks before the audit, and in another area of ​​the not visible unity to the listener. Accounts generally do not go into patient rooms, so that the separate hand-washing rates were determined for distributors within the patient room and those in the corridors. Twelve audits were enrolled between November 2012 and March 2013.

The study found that there was an increase of about three times the rate corridor washes hands per hour in the staff health care when an auditor was visible (3.75 per hour), compared to a place where the listener is not visible (1.48 per hour) and previous week (1.07 per hour). Hand washing rate with the present auditor were compared with separate groups at different times and different places times to ensure that the differences are not due to reasons of hygiene of hands that could be attributable to time of day or location. In each case, hand washing rates were significantly higher when the auditors were present, with the increase occurring after the arrival of auditors, suggesting that the arrival of the listener triggered the increase hand hygiene.

"The difference in the rate of hand hygiene, when a listener is present compared to those times when we are not, is huge in this study, and we have shown that this effect is very consistent "says Dr. Gardam, who is also an associate professor of medicine at the University of Toronto.

"the magnitude of what we found calls into question the accuracy of hand hygiene rates directly observed and the usefulness of the measurement and communication between them," says Dr. Gardam . "However, human auditing hand hygiene was useful to draw attention to this important prevention measure we just can not stop focusing on it because our posted rates are not nearly as high as we think they are. "

Dr. Srigley said that although researchers were "surprised by the triple effect" of having an auditor present, there can still be of value to audit as it could be educational opportunities in-the-moment with the health care staff. Dr. Srigley is assistant medical director of prevention and infection control at Hamilton Health Sciences, composed of seven hospitals in the Hamilton area.

Dr. Gardam approach suggests that "first line of personal property" that engages rather than "nags" staff is a good option. This approach was brought to the University Health Network about six years by Dr. Gardam, in which frontline staff have developed their own reminders to influence the staff to wash their hands, including: pancake breakfasts, reports from the public unit, pledges, posters, and holding each other accountable.
"We need to change the way we look at these complex problems," says Dr. Gardam, "We need to help people change by engaging them and bring them with local solutions."