Baycrest developing hand-hygiene compliance metric
Thursday November 22, 2007 -- Jason Thompson
By using counters inside wall-mounted hand sanitizer dispensers and a student volunteer to monitor healthcare worker traffic, Chingiz Amirov says Baycrest is developing a metric to accurately measure hand-hygiene compliance because it is free of the Hawthorne effect.

Well known within the realm of infection control, the Hawthorne effect describes a change in behaviour or performance in response to a change in the environment. The change is typically an improvement.

If healthcare workers know they’re being monitored for hand-hygiene compliance, they’re more likely to keep their hands clean. If they don’t know they’re being monitored, chances are they’ll follow their normal routine.

If Baycrest is to accurately measure the level of hand-hygiene compliance amongst its healthcare workers, Amirov, the director of infection prevention and control, says they need to be sure the data hasn’t been compromised by the Hawthorne effect.

“Here at Baycrest, we’re really pushing for awareness and recognition of hand-hygiene as an important practice in healthcare,” he says. Baycrest is a Healthcare Insurance Reciprocal of Canada subscriber.

Dressed in standard Baycrest volunteer garb, which includes a plain yellow shirt and a name tag, the student hung around designated units, collecting data about healthcare worker traffic and hand-hygiene compliance. At the end of the day he would report back what he observed.

Amirov says the student is free from the Hawthorne effect because he is not identifiable as a member of the infection control team and he’s not doing direct observations.

“If (healthcare workers) see us coming to the unit, they know infection control is here,” Amirov says. “His task is to collect data on healthcare worker traffic and if anybody asks, that is what he tells them, which is true. He does not follow nurses or physicians into the room, he just observes the designated rooms from the outside.”

Because the counters installed in the sanitizer dispensers are not seen by the user, they’re also free of the Hawthorne effect. Amirov says they’re also time efficient and unobtrusive to healthcare providers trying to do their jobs.

The reason Amirov is trying to develop a metric is because the data from the counters and the student volunteer aren’t able to measure compliance on their own.

If the counter at a hand-washing station reads 300 that number is not sufficient in calculating whether or not healthcare workers are sanitizing their hands enough.

The goal is to marry the data from the counters onto the data collected by the student volunteer about healthcare worker traffic.

Amirov says the metric could be useful for other organizations as long as the technology can be accommodated at the facility.

For example, many hospitals use pump-top bottles to dispense sanitizer. The sanitizer bottles at Baycrest are loaded into a dispenser which is wall-mounted, which also serves as concealment for the counter. The counters are priced at about $42 a piece.

Amirov says the companies that provide the sanitizer usually offer the dispensers free of charge.