When we go into a hospital, we assume that the doctors taking care of us are highly educated professionals who take cleanliness very seriously.It turns out, that's only mostly true. A new study suggests that doctors are very serious about cleanliness, as long as they know they’re being watched.A study being presented via the Association for Professionals in Infection Control and Epidemiology (APIC), found that hand-washing routines differed dramatically depending on whether people knew they were being watched or not. It’s a phenomenon called the Hawthorne Effect, where people change their behavior if they know they’re being observed.The study used reporting from five infection prevention nurses known to staff and 15 volunteers who blended in with staff. They were trained to observe hand-washing routines at a San Jose, CA, hospital over the course of six months in 2015. The two groups found a difference in hand-washing compliance of almost 30% depending on whether hospital workers recognized the observer.Hand hygiene is a huge issue in hospitals, due to the possibility of infection transmission. Because doctors can see dozens of patients in a day, infection can easily be passed from one patient to the next, giving hospitals the potential to make you sick as much as the potential to make you healthy. The World Health Organization (WHO) recommends a health-care provider clean their hands before and after touching a patient or their surroundings and before any procedure, as well as if they come into contact with bodily fluids.Unfortunately, hand washing isn't happening as often as it should. In a 2002 report , The Center for Disease Control (CDC) found that hospital workers washed their hands an average of five times per shift and often failed to cover the entire surface of their hands, with only 40% of workers adhering to the hygiene recommendations. According to ABC News , the results when workers didn't know they were being observed were even worse, at a scant 22%.The study’s results suggest that it’s difficult to accurately measure hygiene in hospitals because of human nature — everybody wants to do a good job, but busy people tend to cut corners. Dr. Clifford McDonald, associate director for science at the CDC told ABC News that while health-care authorities are looking for ways to improve hygiene, one of the things that patients can do to ensure their surroundings are sterile is simple: remind doctors to wash their hands.“If we can get the patients more involved in that — and get them to be able to speak up, that is really the main thing,” he said. He encouraged people not to be afraid of rocking the boat by speaking up. “A lot of patients are nervous about that kind of thing — that’s another culture we’re trying to change.”