title: Compliance with antiseptic hand rub use in intensive care units: the Hawthorne effect.
abstract: OBJECTIVE
  To determine the influence the Hawthorne effect has on compliance with antiseptic hand rub (AHR) use among healthcare personnel.
  
  
  METHODS
  Observational study.
  
  
  METHODS
  Five intensive care units of a university hospital in Berlin, Germany.
  
  
  METHODS
  Medical personnel were monitored in 2 periods regarding compliance with 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.
  
  
  RESULTS
  Data were collected from 2,808 indications for AHR use. The overall rate of compliance was 29% (95% confidence interval, 26%-32%) in the first period and 45% (95% confidence interval, 43%-47%) in the second period. A logistic regression analysis with potential confounders revealed a significant odds ratio for the comparison between period 2 and period 1. 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.
  
  
  CONCLUSIONS
  The Hawthorne effect has a marked influence on compliance with AHR use, with a 55% 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 thought 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.
authors.affiliation: Institute of Hygiene and Environmental Medicine, Charité University Medicine Berlin, Berlin, Germany. tim.eckmanns@charite.de
authors.forename: Tim
authors.initials: T
authors.lastname: Eckmanns
authors.forename: Jan
authors.initials: J
authors.lastname: Bessert
authors.forename: Michael
authors.initials: M
authors.lastname: Behnke
authors.forename: Petra
authors.initials: P
authors.lastname: Gastmeier
authors.forename: Henning
authors.initials: H
authors.lastname: Ruden
mesh_terms: D000891:Anti-Infective Agents, Local; D005858:Germany; D019983:Guideline Adherence; D006235:Hand Disinfection / Q000379:methods*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D016015:Logistic Models; D010564:Personnel, Hospital
chemical_list: D000891:Anti-Infective Agents, Local