Abstract
BackgroundThe Hawthorne Effect is the change in behaviour by subjects due to their awareness of being observed and is evident in both research and clinical settings as a result of various forms of observation. When the Hawthorne effect exists, it is short-lived, and likely leads to increased productivity, compliance, or adherence to standard protocols. This study is a qualitative component of an ongoing multicentre study, examining the role of Incisional Negative Pressure Wound Therapy after vascular surgery (INVIPS Trial). Here we examine the factors that influence hygiene and the role of the Hawthorne effect on the adherence of healthcare professionals to standard hygiene precautions.MethodsThis is a qualitative interview study, investigating how healthcare professionals perceive the observation regarding hygiene routines and their compliance with them. Seven semi-structured focus group interviews were conducted, each interview included a different staff category and one individual interview with a nurse from the Department for Communicable Disease Control. Additionally, a structured questionnaire interview was performed with environmental services staff. The results were analysed based on the inductive qualitative content analysis approach.ResultsThe analysis revealed four themes and 12 subthemes. Communication and hindering hierarchy were found to be crucial. Healthcare professionals sought more personal and direct feedback. All participants believed that there were routines that should be adhered to but did not know where to find information on them. Staff in the operating theatre were most meticulous in adhering to standard hygiene precautions. The need to give observers a clear mandate and support their work was identified. The staff had different opinions concerning the patient’s awareness of the importance of hygiene following surgery. The INVIPS Trial had mediated the Hawthorne effect.ConclusionThe results of this study indicate that the themes identified, encompassing communication, behaviour, rules and routines, and work environment, influence the adherence of healthcare professionals to standard precautions to a considerable extent of which many factors could be mediated by a Hawthorne effect. It is important that managers within the healthcare system put into place an improved and sustainable hygiene care to reduce the rate of surgical site infections after vascular surgery.
Highlights
Surgical site infections (SSIs) continue to be of major concern for both patients and the healthcare system, and can jeopardise the results of vascular surgery [1], leading to increased length of hospital stay and costs, and higher rates of readmission, amputation and mortality [1, 2]
As the Environmental services staff (ESS) did not carry out observations, they had no way of expressing their opinions to the Department for Communicable Disease Control (DCDC)
A lack of communication was reported between healthcare professionals (HCPs) and ESS concerning the clinical condition of inpatients, concerning those with infections or recently operated patients
Summary
Surgical site infections (SSIs) continue to be of major concern for both patients and the healthcare system, and can jeopardise the results of vascular surgery [1], leading to increased length of hospital stay and costs, and higher rates of readmission, amputation and mortality [1, 2]. Hand hygiene could be improved when healthcare professionals (HCPs) know that they are under observation, such observation has some potential bias. These changes in behaviour are often attributed to the well-known HE [11]. To obtain a sustainable and constant Hawthorne effect associated with improved compliance with hand hygiene routines, decreased infection and cross-transmission rates could certainly represent an ideal perspective [17]. Increased adherence to standard precautions, mediated via the HE, would probably reduce the rate of SSIs after vascular surgery under ongoing prospective randomized INVIPS-trial at the present study centre
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