Measuring the effect of sousveillance in increasing socially desirable behaviour

Hospital acquired infections (HAIs) occur frequently in hospitalized patients. Staff compliance with hand hygiene (HH) policy during patient care has been shown to reduce HAIs. Currently, hospitals evaluate adherence to HH policies through direct observation by human auditors. The auditors do not have authority over staff members; thus, this process is more akin to sousveillance (watching from below) than surveillance (watching from above). When behaviour change occurs due to awareness of being observed, it is referred to as the “Hawthorne effect”. We quantified the effect of sousveillance by comparing the frequency of HH events with an auditor present to when no auditor was present. The data analysed in the present work is from an ongoing study on hand hygiene compliance monitoring. A monitoring network recorded 290,000 hand hygiene events over 6 months; auditors were present on five occasions for about an hour each visit. When using an exponential underlying distribution we found that the change in the HH event rate was significant (p <; 0.01) in 4 of the 5 auditor visits. Finally, with a hyper-exponential underlying distribution, 5 of 5 were significant (p <; 0.01). There was no significant change in the HH event rate among dispensers located within patient rooms (not visible to the auditor), irrespective of auditor's presence.