Cardiff University, Cardiff, UK.
University of Cork, Cork, Ireland.
J Hosp Infect. 2017 Feb;95(2):169-174. doi: 10.1016/j.jhin.2016.08.008. Epub 2016 Aug 18.
The purpose of hand hygiene is to break the chain of healthcare-associated infection. In many countries hand hygiene is regularly audited as part of quality assurance based on recommendations from the World Health Organization. Direct observation is the recommended audit method but is associated with disadvantages, including potential for being observed to alter usual behaviour. The Hawthorne effect in relation to hand hygiene is analogous with productivity improvement by increasing the frequency with which hand hygiene is undertaken. Unobtrusive and/or frequent observation to accustom staff to the presence of observers is considered an acceptable way of reducing the Hawthorne effect, but few publications have discussed how to implement these techniques or examine their effectiveness. There is evidence that awareness of being watched can disrupt the usual behaviour of individuals in complex and unpredictable ways other than simple productivity effect. In the presence of auditors, health workers might defer or avoid activities that require hand hygiene, but these issues are not addressed in guidelines for practice or research studies. This oversight has implications for the validity of hand hygiene audit findings. Measuring hand hygiene product use overcomes avoidance tactics. It is cheaper and generates data continuously to assess the compliance of all clinicians without disrupting patient care. Disadvantages are the risk of overestimating uptake through spillage, wastage, or use by visitors and non-clinical staff entering patient care areas. Electronic devices may overcome the Hawthorne and avoidance effects but are costly and are not widely used outside research studies.
手卫生的目的是打破医疗保健相关感染的传播链。在许多国家，手卫生作为质量保证的一部分，根据世界卫生组织的建议定期进行审核。直接观察是推荐的审核方法，但存在一些缺点，包括可能因被观察而改变通常的行为。与通过增加手卫生的频率来提高生产力的“霍桑效应”类似，手卫生的霍桑效应也会发生。非干扰性和/或频繁的观察，以使员工习惯观察者的存在，被认为是减少霍桑效应的一种可接受方法，但很少有出版物讨论如何实施这些技术或检查其效果。有证据表明，被观察到会以比简单的生产力效应更复杂和不可预测的方式破坏个人的正常行为。在审核员在场的情况下，卫生工作者可能会推迟或避免需要进行手卫生的活动，但这些问题在实践指南或研究中并未得到解决。这种忽视对手卫生审核结果的有效性产生了影响。测量手卫生产品的使用可以克服回避策略。它的成本更低，并且可以连续生成数据，以评估所有临床医生的依从性，而不会干扰患者护理。缺点是通过溢出、浪费或访客和进入患者护理区域的非临床工作人员使用而高估使用率的风险。电子设备可能会克服霍桑效应和回避效应，但成本较高，并且在研究之外并未广泛使用。
