STUDIES No observation without influence! New findings on the Hawthorne effect in hand hygiene 24/7 data from the EMS, supplemented by direct observations During the study, data was collected from an intensive care unit, an intermediate care unit, and a standard ward. Patient rooms, waste disposal/cleaning rooms, and other areas (e.g. kitchens and corridors) were examined. While the EMS provided continuous data via sensor-equipped disinfectant dispensers, hygiene specialists carried out direct observations of HHC in accordance with the ‘5 Moments‘ approach [2]. The results were statistically modelled for evaluation [1]. The Hawthorne effect (HE) refers to the phenomenon whereby people behave differently when they know they are being observed. As the HE can distort the results of a study, every effort is made to avoid it in research. However, despite awareness of the HE, direct observation is still considered the gold standard for monitoring hand hygiene compliance (HHC). A new study at a German hospital has now quantified the HE using an electronic monitoring system (EMS), finding differences between wards and room types [1]. Positive Hawthorne effect strongest in patient rooms Overall, a positive HE (i.e. improved HHC under direct observation) was most evident in patient rooms in the normal and intensive care wards. In contrast, there was no significant difference in the intermediate care ward. Negative HE (i.e. poorer HHC despite observation) was primarily found in waste disposal rooms. However, fewer observations were made in these rooms, and the observed staff may have exhibited reactive behaviour [1]. References 1. Otchwemah R et al. (2025) Am J Infect Control: S0196-6553(25)00451-1. https://doi.org/10.1016/j.ajic.2025.06.020 2. WHO (2009). WHO Guidelines on Hand Hygiene in Health Care. https://www.who.int/publications/i/item/9789241597906 (accessed on 31.07.2025) Conclusion Although further studies are needed to corroborate the results, one thing is clear: HE is particularly relevant in direct patient contact. It can also vary significantly between different hospital wards. To monitor HHC as accurately as possible, hospitals can use a combination of electronic and staff-based methods, as was done in this case. The full article is available to download here: Observing is influencing: How hand disinfection compliance observations affect hand disinfection rates; specifics derived from an electronic monitoring system - American Journal of Infection Control Figure based on [1]. Significance levels: * ≤ 0.05, ** ≤ 0.01, *** ≤ 0.001. Other Utility/Waste Patient w/o observation observation 25 20 15 10 5 0 ** + 31.4% ** + 57.7% *** + 70.5% Rate (HD/patient day) normal ward Other Utility/Waste Patient 50 40 30 20 10 0 + 3.5% *** -99.4% + 5.3% IMC Other Utility/Waste Patient 75 60 45 30 15 0 *** + 27.4% * + 32.9% ** + 32.0% ICU 7
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