The World Health Organization’s (WHO’s) My 5 Moments for Hand Hygiene is more comprehensive than the In/Out method, which requires healthcare workers to wash or sanitize their hands only when entering and leaving a patient’s room. The WHO method includes 1) before touching a patient, 2) before clean/aseptic procedures, 3) after body fluid exposure/risk, 4) after touching a patient, and 5) after touching patient surroundings. Greenville Health System in South Carolina implemented an electronic monitoring system and then measured hand hygiene compliance three ways: 1) direct observation (DO), 2) DO with discrete 24/7 video (and no feedback) of entire patient stays, and 3) electronic monitoring. During the 15-month study, DO reported 92%–99% compliance, and video monitoring reported 66%–75% compliance, which correlated closely with the electronic system’s report of 65%–71%. This validated the accuracy and reliability of electronic monitoring and proved the existence of the Hawthorne effect, which inflated compliance by more than 50% at various points in the study.
Diller, T., Kelly, J. W., Steed, C., Blackhurst, D., Boeker, S., & Alper, P. (2014, month). Electronic hand hygiene monitoring for the WHO 5 moments method. Poster session presented at the meeting of APIC Anaheim, CA.
In response to a systematic review of automated and electronically assisted hand hygiene monitoring systems published in the American Journal of Infection Control, Alper offers additional published research that validates the use of electronic systems for measuring hand hygiene. The studies reviewed include research that shows electronic systems are more accurate and reliable than direct observation, describes effective implementation of electronic systems, and offers a framework for measuring the World Health Organization’s My 5 Moments for Hand Hygiene. Alper argues that electronic monitoring is the “next major disruptive technology in hand hygiene”; when supported with behavior change models, electronic monitoring can result in sustainable improvement.
Alper, P. (2015). Letter in response to “Automated and electronically assisted hand hygiene monitoring systems: A systematic review.” [Letter to the editor]. American Journal of Infection Control, 43, 195–196. doi:10.1016/j.ajic.2014.08.022
The Hawthorne effect describes a well-known feature of human behavior: People act differently when they know they are being watched. Many have suspected that the Hawthorne effect results in inflated compliance rates when direct observation (DO)—the use of human monitors to record the number of times healthcare workers wash or sanitize their hands—is used to measure hand hygiene compliance. A hospital in Canada used a real-time location system (RTLS) to measure the Hawthorne effect when hand hygiene was measured by DO. The RTLS recorded all hand hygiene events and the presence of human observers, which allowed the researchers to see if the presence of an observer influenced activity at specific sanitizer dispensers. The results showed that usage rates increased threefold (a Hawthorne Effect of 300%) at dispensers where observers were visible.
Srigley, J. A., Furness, C. D., Baker, G. R., & Gardam, M. (2014). Quantification of the Hawthorne effect in hand hygiene compliance monitoring using an electronic monitoring system: A retrospective cohort study. BMJ Quality & Safety, 23(12), 974–980. doi:10.1136/bmjqs-2014-003080