School of Health Sciences, City, University of London, London, UK.
School of Health Sciences, City, University of London, London, UK.
J Hosp Infect. 2020 Oct;106(2):311-317. doi: 10.1016/j.jhin.2020.07.028. Epub 2020 Aug 5.
Numerous studies demonstrate that the Hawthorne effect (behaviour change caused by awareness of being observed) increases health workers' hand hygiene adherence but it is not clear whether they are methodologically robust, what the magnitude of the effect is, how long it persists or whether it is the same across clinical settings. The objective of this review was to determine the rigour of the methods used to assess the Hawthorne effect on hand hygiene, effect size estimation, variations between clinical settings and persistence. To this end, a systematic literature review with meta-analysis was conducted. Nine studies met the criteria for the review. Methodological quality was variable. The Hawthorne effect ranged from -6.9% to 65.3%. It was 4.2% in one study conducted in intensive care and 16.4% in transplant units. It was most marked when data were collected across an entire hospital and in a group of general hospitals. Differences between wards in the same hospital were apparent. In the two studies where duration was estimated, the Hawthorne effect appeared transient. Despite methodological shortcomings, the review indicates clear evidence of a Hawthorne effect on general wards. There is evidence that it may vary between clinical speciality and across departments. The review identifies a need for standardized methodologies to measure the Hawthorne effect to overcome the dilemma of reporting the potentially inflated rates of adherence obtained through overt audit. Occasional covert audit could give a better estimation of true hand hygiene adherence but its acceptability and feasibility to health workers need to be explored.
许多研究表明，霍桑效应（由于意识到被观察而导致的行为改变）会增加卫生工作者的手卫生依从性，但目前尚不清楚这些研究在方法学上是否严谨，其影响的大小、持续时间以及在不同临床环境下是否相同。本综述的目的是确定评估手卫生中霍桑效应的方法的严谨性、效应大小估计、临床环境之间的差异和持续性。为此，进行了系统的文献综述和荟萃分析。符合综述标准的有 9 项研究。方法学质量参差不齐。霍桑效应的范围从-6.9%到 65.3%。在一项重症监护病房进行的研究中为 4.2%，在移植病房中为 16.4%。当数据在整个医院和一组综合医院中收集时，效果最为明显。同一医院不同病房之间存在差异。在对持续时间进行估计的两项研究中，霍桑效应似乎是短暂的。尽管存在方法学上的缺陷，但该综述清楚地表明了一般病房中确实存在霍桑效应。有证据表明，它可能因临床专业和科室而异。该综述确定需要标准化的方法来测量霍桑效应，以克服通过公开审核报告潜在虚高的依从率的困境。偶尔进行秘密审核可能会对手卫生的真实依从率进行更好的估计，但需要探讨卫生工作者对其的可接受性和可行性。
