Although direct observation is expensive and time consuming, it is the gold standard to monitor HH adherence (WHO, 2009). Direct observation typically evaluates simply whether HH was performed, rather than HH quality or effectiveness. A conventional method is to calculate observations by defining the numerator as a HH action and the denominator as an opportunity. Training for observers improves inter-rater reliability. …show more content…
Direct observation may be confounded by the Hawthorne effect. However, nurses’ HH adherence in free standing LTCFs was only 11.3%, despite their awareness of the observer (Liu et al., 2014), suggesting an even lower adherence in day-to-day practice. Electronic counters may reduce the Hawthorne effect on hospital HCPs’ HH adherence (Whitby, et al., 2008) or quantify the Hawthorne effect on hospital HCPs’ HH adherence. For example, HCPs’ HH rate was threefold higher in hallways within view of an auditor compared to when no auditor was visible (Srigley, Furness, Baker, & Gardam, 2014). Finally, the Hawthorne effect may provide an opportunity to appeal to the desire for positive feedback and conformity (Haessler,