The Hawthorne Effect, or the alteration of human behavior because individuals modify their actions when they know they are being observed, likely plays a role in how and when health care providers comply with hand hygiene recommendations, according to a study presented at the 43rd Annual Conference of the Association for Professionals in Infection Control and Epidemiology (APIC).

The infection prevention department at Santa Clara Valley Medical Center in San Jose, California measured the differences in hand hygiene compliance rates when healthcare workers recognized the observers and when they did not. 

The study researchers  noted a difference of more than 30% in hand hygiene compliance depending on whether or not they recognized the auditors. 

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Five infection prevention nurses (known to staff) and 15 hospital volunteers (unknown to staff) collected 4,640 observations between July 2015 and December 2015. The volunteers were trained in a two-hour course on the importance, identification and reporting of hand hygiene compliance.

“This was not a result that we expected to see,” said Nancy Johnson, MSN, CIC, infection prevention manager, Santa Clara Valley Medical Center. Infection preventionists validated the audits conducted by hospital volunteers, which showed no difference in the group’s observations.

“We have rolled out many changes as a result, including an organization-wide, hand hygiene improvement plan that is actively supported by our leadership team,” Ms Johnson said. “Moving forward, the medical center’s monitoring will be conducted by unknown observers.”


1. Johnson N. Presented at: Annual Conference of the Association for Professionals in Infection Control and Epidemiology; June 11-13, 2016; Charlotte, N.C.