The Hawthorne Effect, The Real Rate of Hand Hygiene and What Happens Next?

We have had a hand hygiene observation program for years now. On a given week, our hand hygiene adherence is 80% to 90%, by direct observation. But what is the real hand hygiene (foam in / foam out) compliance? 

First, it is fair to acknowledge that there is no single best way or standard for observing hand hygiene, as we summarize here.

Having said that, it is also fair to say that when we change our hand hygiene observers so that they pass unrecognized for a short period, hand hygiene adherence drops by 10%-15%. This is the Hawthorne Effect, simply, a change in behavior due to a subject's awareness of being observed. 

Here is an excellent, recent article on the Hawthorne Effect, published in Infection Control and Hospital Epidemiology. Four important features of the Hawthorne Effect are summarized:

• The Hawthorne Effect follow a time dependent curve
• Behavior changes occur after participants become aware of being watched
• The Hawthorne Effect has performance ceiling
• The performance impact attributable to the Hawthorne Effect wanes with continued observation past peak performance

We are interested in challenging current hand hygiene tracking and monitoring paradigms. Can hand hygiene best practices be promoted and sustained with electronic reminder and monitoring technologies, particularly when done to scale? What will be the staff acceptability and what will be the impact, using a house wide, stepped wedge design roll out, on hand hygiene (performance ceiling, sustainability) and patient centered outcomes across wards and ICUs?

Hand hygiene technologies are limited as they can only (at present) measure foam in/foam out and not all 5 WHO moments for hand hygiene. Regardless, if the implementation of hand hygiene reminder and monitoring technologies is done to scale and sustained, we may learn a lot about engineering a lasting behavior change so as to ultimately have a measure of our real hand hygiene practice.

Stay tuned.

Medical Literary Messenger Fall 2015 Published!

The Fall 2015 Medical Literary Messenger has published!

Download it here.

Staphylococcal Colonization and Bacteremia- Not Equal Opportunity

Methicillin-resistant Staphylococcus aureus (MRSA) is not an equal opportunity pathogen. This intriguing article published in Clinical Infectious Diseases highlights gender differences in MRSA bacteremia.

MRSA carriage and bloodstream infection (BSI) shows a male predominance, Males are more prone to bacterial sepsis, but some studies suggest females may have a poorer prognosis from MRSA BSI. 

Why? 

Per the authors, hand-hygiene behavior varies according to gender. Males are less compliant, which in turn may predispose them to higher colonization and infection rates. Nose picking may also have a male gender predilection.  Female hormones such as estrogen affect the expression of virulence factors in Pseudomonas aeruginosa. This may also apply to S. aureus. The reasons are not all that clear.

I am not sure how this translates into new prevention or treatment strategies for MRSA bacteremia. Perhaps specialized hand hygiene campaigns can focus on at risk groups (men)?  Treatment for MRSA bacteremia is likely not to be tailored to gender without more convincing clinical data.

The purported gender differences in MRSA colonization and bacteremia, albeit interesting, may not lend themselves to practical interventions.

 Vexing.

Kicking for a Cause- 11th Annual Richmond City FC Copa Navidad

It is that time of year again, to kick for a cause.

The 11th Annual Richmond City FC Copa Navidad (Christmas Cup) took place today.

All proceeds, along with a matching contribution will be donated to the Fan Free Clinic.

Feliz Navidad!

RCFC- Blue

RCFC Maroon

RCFC Sky Blue

RCFC 2015 Copa Navidad

RCFC Senior (Old) Guard- L to R: Jaye Lewis, Andy Marr, me, Christian Falyar, Frank Fulco and Sean Samuel

Running Revisited- Impact on Health

I was having breakfast the other day in the VCU Faculty lounge perusing an issue of the Mayo Clinic Proceedings. 

This review on the effects of running on cardiovascular disease and mortality is quite informative. As many of us know, running decreases cardiovascular risk, stroke and lowers blood pressure. But running also decreases osteoarthritis of the knee and hip.

Most importantly, the positive benefits of running are seen with reasonable effort. In other words, one need not run excessive distances to receive benefit. Twenty-five minutes of running, several times per week, will likely suffice.

Off to my morning jog!

Cold and Flu Season Inquiries- Back to Common Sense stuff

It seems like I am receiving more than the usual number of inquiries this year on the common cold and influenza.

For the cold, there is no certain prevention or remedy. No antibiotics either.Quit smoking too.

Here is a recent NPR radio interview.