‘And you’ll suddenly realise ‘I’ve not washed my hands’: medical students’, junior doctors’ and medical educators’ narratives of hygiene behaviours

Abstract

ObjectiveCompliance to hygiene behaviours has long been recognised as important in the prevention and control of healthcare associated infections, but medical doctors still display some of the lowest rates of compliance of all healthcare workers. We aim to understand compliance to hygiene behaviours by analysing medical students’, junior doctors’ and medical educators’ narratives of these behaviours to identify their respective attitudes and beliefs around compliance and how these are learnt during training. Such an understanding can inform future interventions to improve compliance targeted to areas of greatest need.DesignA qualitative study, using narrative interviews (nine focus groups and one individual interview). Data were analysed thematically using inductive framework analysis.SettingTeaching hospitals in the UK.ParticipantsConvenience sample of 25 participants: third-year medical students in their first clinical year (n=13), junior doctors (n=6) and medical educators (n=6).ResultsWe identified four main themes: (1) knowledge, (2) constraints, (3) role models/culture and (4) hygiene as an added extra. Knowledge varied across participant groups and appeared to influence behaviours; medical students relied on what they have been told by seniors, while medical educators relied on their own knowledge and experience. There was a strong belief that evidence for the effectiveness of good hygiene behaviours is lacking. Furthermore, medical educators’ behaviour appears to strongly influence others. Finally, hygiene was predominately viewed as an added extra rather than an integral part of the process.ConclusionsAwareness of the evidence around good hygiene needs to be improved at all levels. Medical students and junior doctors should be encouraged to consider why they are asked to perform certain hygiene behaviours in order to improve ownership of those behaviours. Medical educators need to recognise their responsibilities as role models for their junior counterparts, thereby understanding their role in developing the culture of hygiene practices within their clinical domains.

Are Australian medical interns adequately prepared for the optimal use of personal protective equipment?

“…Other team members who use PPE incorrectly, if at all, make it di cult for junior doctors to do so safely. This concurs with Cresswell and Monrouxe's (30) nding that social pressures experienced by medical students and junior doctors are a barrier to optimal IPC practice. This illustrates the tension between what students have learnt in the classroom and what they are subsequently taught through the hidden curriculum in the clinical setting.…”

“…This illustrates the tension between what students have learnt in the classroom and what they are subsequently taught through the hidden curriculum in the clinical setting. Senior medical staff can have a major in uence on the use of PPE by junior medical staff, but there is a paucity of appropriate peer and/or senior role modelling (30).…”

Why hand hygiene is not sufficient: modeling hygiene competence of clinical staff as a basis for its development and assessment

“…Here, various starting points are promising. First, various recent studies pursue the question which knowledge or attitudes clinical staff refer to when they describe their own behavior on the topic of hygiene in the clinical daily routine [24], [36], [37], [38]. A deeper, systematic reprocessing of this literature can provide an insight into central components related to this.…”

“…A further aspect important in this respect are role-models, who influence young clinicians in their behavior [30], [31], [43], [44]. It is very important that these models work hygienically correct [31], [36]. In order to implement promoters, instruments can be used to detect the most important reasons for non-adherence to hand hygiene and for custom-fit implementation of corresponding interventions [45].…”

Measuring Hygiene Competence: A Vignette-Based Situational Judgement Test

“…In pandemics like COVID-19 in the year 2020, the prevention of infection through good hygiene is crucial. Some pre-existing forms of intervention are designed to increase awareness and improve attitudes towards hygiene in daily clinical work [3][4][5].…”