This document summarizes a study that observed hand hygiene compliance at a petting zoo through hidden video recordings. The study implemented various interventions to increase hand washing but had limitations like the Hawthorne effect from visitors aware of cameras. Future studies could improve by adding more hand sanitation stations, collecting longer-term data from multiple zoos, and concealing cameras better to get more accurate results on effective interventions.

1. Abstract word count:
Body word count: 1462
Total word count:
What Happens in a Petting Zoo, Does Not Always Stay in a Petting Zoo
A review of the article: Video observation of hand hygiene practices at a petting zoo and the
impact of hand hygiene interventions.
Anderson, M. E. C., & Weese, J. S. (2011). Video observation of hand hygiene practices at a
petting zoo and the impact of hand hygiene interventions. Epidemiology & Infection:
Cambridge University Press, 140(1), 182-190. doi:10.1017/S095026881100029X
Michael Kabzenell
Program in Public Health
University of California, Irvine
Irvine, CA 92697
This study observes hand hygiene interventions and resulting compliance with visitors at
petting zoos. Although preexisting hand-washing facilities, personnel, and signs were
present throughout the zoo, there is a substantial amount of visitors who do not follow
hand hygiene regulations. New interventions involving provisions of additional hand
washing and sanitation resources, increased personnel verbally recommending visitors to
clean their hands as well as personally dispensing hand sanitizer to visitors, and increasing
visual signage throughout the petting zoo, result in various finding from one or more of
these interventions. While the observations of the study were consistent with similar
research, there were limitations that hindered reliable data. Due to altered behavior from
the knowledge of being monitored on camera, lack of available hand hygiene stations, and
insufficient amount of data from other zoos and short duration of observation, results for
the research are bias and weakened. To create a successful observational study on hand
hygiene compliance at petting zoos, these limitations must be resolved. Such issues can be
fixed by concealing cameras thoroughly, providing additional hand sanitation materials,
and gathering additional data from other petting zoos and allotting longer durations for the
observation of interventions. By doing so, certain interventions can be proven to be
successful in increasing hand hygiene. In conclusion, this will decrease the potential of
zoonotic disease outbreak.

2. Michael Kabzenell
PH195W – Practicum
ROA – Frist Draft
05/04/2016
Abstract word count: 220
Body word count: 1245
Total word count: 1465
2
2
Introduction
Love for animals is contagious but when people neglect proper hand hygiene, love
might not be the only contagion a person is infected with. Proximity with animals at petting
zoos drastically increases the potential spread of zoonotic diseases. Although zoos are
required to include designated hand sanitation zones and signage, staggering rates of zoo-
visitors disregard hand hygiene. An observational intervention-based research study is
performed using simple random sampling through hidden video coverage to monitor
peoples’ hand hygiene compliance (Anderson & Weese, 2001). In this 6-hour study, one
baseline and five interventions are initiated in 1-hour increments to view changes in
success rates of hand hygiene. These interventions include increased availability of hand
hygiene resources, visual reminders, and verbal recommendations. Researchers predict
increases in hand hygiene due to one intervention or a combination of interventions.
However, there are limitations to this study such as visible cameras altering participant
behavior, the lack of available hand hygiene stations resulting in overcrowded washing
facilities and discouraging participants to commit proper hand hygiene, and finally,
observing one petting zoo for a single day, which creates bias due to lacking comparable
data from multiple petting zoos. By addressing these limitations, future studies will
produce accurate data and successful interventions to prevent zoonotic disease outbreaks.
Narrative

3. Michael Kabzenell
PH195W – Practicum
ROA – Frist Draft
05/04/2016
Abstract word count: 220
Body word count: 1245
Total word count: 1465
3
3
When people know they are recorded on camera, they alter their personality and
normal behavior to satisfy the audience. The same situation applies for participants
observed through cameras for research on hand hygiene. In this study, researchers do well
to position the video cameras in moderately concealed locations around the petting zoo.
Still, a limitation is present when spectators notice the cameras, resulting in altered
behavior. One example refers to visitors who would likely ignore hand hygiene after
petting an animal without noticing a camera. However, seeing the video camera redirects
the visitors to wash their hands. An article describes this irregular behavior as the
Hawthorne effect, which is the principle that someone changes their behavior if they feel
their actions are being monitored (Roethlisberger, 2006). A different research study, taking
place in a veterinary hospital, observes hand hygiene policies by medical staff and
addresses the issue of false data from “artificially improved behavior” after seeing the
location of the camera (Anderson, Sargeant, & Weese, 2014). Once the staff is aware of the
cameras filming their actions, the assumption is that the staff will become acclimated to the
cameras and will continue their normal behavior. However, the study conveys a constant
change in behavior from staff members because they know a video camera is in the room.
Being placed under a spotlight forces people to make decisions they may not agree with
because they believe it is what the audience demands. This is why using video footage in
observational studies can be a limitation to valuable research.
Standing in a line is a waste of time when a person would rather be doing something
else productive. Some visitors contemplate washing their hands after petting an animal and
assume that petting an animal will not harm someone’s health. Therefore, they will skip

4. Michael Kabzenell
PH195W – Practicum
ROA – Frist Draft
05/04/2016
Abstract word count: 220
Body word count: 1245
Total word count: 1465
4
4
cleaning their hands. However, petting zoos carry pathogenic organisms, and by skipping
hand hygiene, a person becomes a vector for the pathogens since the viruses are living on
the skin or fingernails of the living host. An article states that since 2005, some of the
largest rates of Salmonella infections relate to human interaction with reptiles at petting
zoos (Smith, 2013). The United States has also sparked in rates of E. coli infection from
farms and petting zoos housing cattle, sheep, and goats (Kiang et al., 2006). With these
studies, it is apparent how dangerous the consequences are for ignoring proper hand
hygiene. One study shows that a possible reason for opting out of washing hands or using
hand sanitizers is a result of overcrowded lines of people attempting to wash their hands
simultaneously due to a lack of cleaning materials (Hamzah, Hussein, & Khalef, 2013). For
locations like public restrooms in many public settings, such as restaurants, concerts, or
games, surprisingly large numbers of men and women neglect hand hygiene after using the
toilet due to the overcrowding of washing areas during busy hours (Parker, 2005).
However, other studies indicate that during less crowded periods in settings such as
hospitals, increased rates of staff and visitors contribute to voluntary hand sanitation due
to the availability of sanitation facilities (Ellison, Barysauskas, Rundunsteiner, Wang, &
Barton, 2015). Although rates of hand hygiene are higher when fewer people are present,
this is not a solution to hand hygiene implementation during busy hours in private and
public settings. By incorporating additional hand sanitation zones along hallways, exits,
and entrances, disease spread by human-to-animal contact will reduce.
Without repeatable data from partnering sources in specific research studies,
concluded findings from researchers are unreliable and bias. A limitation to this study is

5. Michael Kabzenell
PH195W – Practicum
ROA – Frist Draft
05/04/2016
Abstract word count: 220
Body word count: 1245
Total word count: 1465
5
5
the lack of data gathered from a single day at one petting zoo within six hours, rather than
using multiple zoos throughout a longer duration of time. Different observations may be
present when video footage is taken on days with fewer visitors at the petting zoo, allowing
participants entering petting zoos to wash their hands without waiting in line. An example
of a reliable and unbiased observational study is the research of hand hygiene within 52
participating veterinary clinics (Anderson et al., 2014). Although 11 of the 52 clinics
provide false data due to software and electronic malfunctions, the overall data is still
accurate, because of the larger number of clinics used in the study throughout a longer
duration of observational interventions. Similar limitations have been present in research
studies from the impacts of automated group monitoring and feedback to promote hand
hygiene towards medical personnel. The flaw is that interventions being implemented to
improve hand hygiene are performed at a single community hospital (Conway et al., 2015).
This disproves the data, however successful the singular data may be, due to the inability to
relate itself to various types of community hospitals within the region, state, or country.
Another setback in a different research study is a consequence of video surveillance’s
absence of portraying outside factors that will hinder predicted outcomes from being
available. The article describes the difficulties the study faces when the researchers’ video
footage does not portray the “potential loss of the larger environmental context outside the
view of the lens” (Haidet, Tate, Divirgilio-Thomas, Kolanowski, & Happ, 2009). Video
footage is a major advantage, compared to in-person observational memory that can be
biased or inaccurate, because the data gathered can be repeated and rewound. However,

6. Michael Kabzenell
PH195W – Practicum
ROA – Frist Draft
05/04/2016
Abstract word count: 220
Body word count: 1245
Total word count: 1465
6
6
without multiple sources involved in a given research study, and acquiring data over a
larger timeframe, conclusions will lack unbiased reliability.
Conclusion
Video coverage of observational research studies is helpful in many occasions.
However, every type of study has a limitation in one aspect or another. The study by the
University of Guelph addressing the increasing rates of zoonotic disease outbreak from the
lack of hand hygiene is an important topic that must be resolved. The issue with this study
is the lack of sufficient evidence to convince public health policies to implement new
interventions. By placing video cameras inconspicuously where they can no longer be seen
by visitors, providing additional hand sanitation resources throughout the zoo, and
gathering data from multiple petting zoos during longer periods of time, future research on
intervention-based analysis of hand hygiene will be successful in identifying new
interventions to reduce zoonotic disease outbreaks at petting zoos.
References:
Anderson, M. E. C., Sargeant, J. M., & Weese, J. S. (2014). Video observation of hand hygiene
practices during routine companion animal appointments and the effect of a post

7. Michael Kabzenell
PH195W – Practicum
ROA – Frist Draft
05/04/2016
Abstract word count: 220
Body word count: 1245
Total word count: 1465
7
7
intervention on hand hygiene compliance. BMC Veterinary Research, 10(106).
doi: 10.1186/1746-6148-10-106
Conway, L. J., Riley, L., Saiman, L., Cohen, B., Alper, P., Larson, E. L., (2015). Implementation
and Impact of an Automated Group Monitoring and Feedback System to Promote
Hand Hygiene Among Health Care Personnel. Jt Comm J Qual Patient Saf., 40(9), 408-
417. PMCID: PMC4465594
Ellison, R. T., Barysauskas, C. M., Rundensteiner, E. A., Wang, D., Barton, B., (2015). A
Prospective controlled trial of an electronic hand hygiene reminder system. Open
Forum Infectious Diseases, 2(4), 121. doi:10.1093/ofid/ofv121
Hamzah, A. M., Hussein, A. M., Khalef, J. M., (2013). Isolation of Escherichia coli 0157:H7
strain from fecal samples of zoo animal. The Scientific World Journal 2013(2013), 5
pages. http://dx.doi.org/10.1155/2013/843968
Hobson, J., (2006). The Hawthorne effect. Occupational Medicine: Oxford Journals, 56(3),
217. doi: 10.1093/occmed/kqj046
Kiang, K. M., Scheftel, J. M., Leano, F. T., Taylor, C. M., Belle-Isle, P. A., Cebelinski, E. A., Danila,
R., Smith, E. K., (2006). Recurrent outbreaks of cryptosporidiosis associated with
calves among students at an education farm programme, Minnesota, 2003.
Epidemiology and Infection, 134(4), 878-886. doi: 10.1017/S0950268805005649
Parker, K., (2006). Publicly-accessible moist hand cleaning wipe station. BibTex, RefMan.
USID: US 20060289558 A1

8. Michael Kabzenell
PH195W – Practicum
ROA – Frist Draft
05/04/2016
Abstract word count: 220
Body word count: 1245
Total word count: 1465
8
8
Smith, (2013). Compendium of measures to prevent disease associated with animals in
public settings, 2013. Journal of the American Veterinary Medical Association. 243(9),
1270-1288. doi: 10.2460/javma.243.9.1270