Epidemiology, Healthcare Associated Infections and Infectious Diseases Control, School of Public Health and Community Medicine, UNSW Sydney, Sydney, NSW, Australia.
School of Public Health and Community Medicine, UNSW Australia, Sydney, NSW, Australia.
Am J Infect Control. 2018 Aug;46(8):876-880. doi: 10.1016/j.ajic.2018.03.030. Epub 2018 May 31.
The mandatory national hand hygiene program requires Australian public hospitals to use direct human auditing to establish compliance rates. To establish the magnitude of the Hawthorne effect, we compared direct human audit rates with concurrent automated surveillance rates.
A large tertiary Australian teaching hospital previously trialed automated surveillance while simultaneously performing mandatory human audits for 20 minutes daily on a medical and a surgical ward. Subtracting automated surveillance rates from human audit rates provided differences in percentage points (PPs) for each of the 3 quarterly reporting periods for 2014 and 2015.
Direct human audit rates for the medical ward were inflated by an average of 55 PPs in 2014 and 64 PPs in 2015, 2.8-3.1 times higher than automated surveillance rates. The rates for the surgical ward were inflated by an average of 32 PPs in 2014 and 31 PPs in 2015, 1.6 times higher than automated surveillance rates. Over the 6 mandatory reporting quarters, human audits collected an average of 255 opportunities, whereas automation collected 578 times more data, averaging 147,308 opportunities per quarter. The magnitude of the Hawthorne effect on direct human auditing was not trivial and produced highly inflated compliance rates.
Mandatory compliance necessitates accuracy that only automated surveillance can achieve, whereas daily hand hygiene ambassadors or reminder technology could harness clinicians' ability to hyperrespond to produce habitual compliance.
强制性国家手部卫生计划要求澳大利亚公立医院使用直接人工审核来确定合规率。为了确定霍桑效应的大小，我们将直接人工审核率与同期的自动监测率进行了比较。
一家大型澳大利亚教学医院之前在对一个内科和外科病房进行强制性人工审核的同时，试用了自动监测，每天进行 20 分钟。从人工审核率中减去自动监测率，为 2014 年和 2015 年的每一个季度报告期提供了差异百分比（PP）。
内科病房的直接人工审核率在 2014 年平均高出 55 个百分点，在 2015 年高出 64 个百分点，比自动监测率高出 2.8-3.1 倍。外科病房的审核率在 2014 年平均高出 32 个百分点，在 2015 年高出 31 个百分点，比自动监测率高出 1.6 倍。在 6 个强制性报告季度中，人工审核共收集了 255 个机会，而自动化则收集了 578 倍的数据，平均每个季度收集 147308 个机会。直接人工审核的霍桑效应幅度不小，产生了极高的合规率。
强制性合规需要自动化监测才能实现的准确性，而日常的手部卫生大使或提醒技术可以利用临床医生的能力来过度反应，从而产生习惯性的合规。
