Hand Hygiene among Physicians: Performance, Beliefs, and Perceptions

Abstract

Background: Physician adherence to hand hygiene remains low in most hospitals.Objectives: To identify risk factors for nonadherence and assess beliefs and perceptions associated with hand hygiene among physicians.Design: Cross-sectional survey of physician practices, beliefs, and attitudes toward hand hygiene.Setting: Large university hospital.Participants: 163 physicians.Measurements: Individual observation of physician hand hygiene practices during routine patient care with documentation of relevant risk factors; self-report questionnaire to measure beliefs and perceptions. Logistic regression identified variables independently associated with adherence.Results: Adherence averaged 57% and varied markedly across medical specialties. In multivariate analysis, adherence was associated with the awareness of being observed, the belief of being a role model for other colleagues, a positive attitude toward hand hygiene after patient contact, and easy access to hand-rub solution. Conversely, high workload, activities associated with a high risk for cross-transmission, and certain technical medical specialties (surgery, anesthesiology, emergency medicine, and intensive care medicine) were risk factors for nonadherence.Limitations: Direct observation of physicians may have influenced both adherence to hand hygiene and responses to the self-report questionnaire. Generalizability of study results requires additional testing in other health care settings and physician populations. H and hygiene is recognized as the leading measure to prevent cross-transmission of microorganisms and to reduce the incidence of health care-associated infections (1, 2). Despite the relative simplicity of this procedure, adherence to hand hygiene recommendations is unacceptably low, usually well below 50% (1-4). Risk factors for nonadherence have been extensively studied (1, 4 -7), and physicians have been repeatedly observed as being poor compliers (1,3,4,8,9). ConclusionAt our hospital, physician behavior did not improve substantially despite a hospital-wide hand hygiene promotion campaign that had a positive and marked effect on adherence among all other health care workers (1). That study highlighted the need for improved knowledge of behavior determinants among physicians.Promotion of hand hygiene behavior is a complex issue (7, 10 -12). Adherence to hand hygiene recommendations is influenced by knowledge; awareness of personal and group performance; workload; and type, tolerance, and accessibility of hand hygiene agents (2,4,12). Over the past 50 years in particular, the assumption that an individual's perceptions have a strong effect on his or her behavior gave birth to social cognitive models of human behavior (13). Some of these models have been applied to individual factors (that is, knowledge, attitude, intentions, beliefs, and perceptions) to help build strategies that improve specific health behaviors (14). To date, individual cognitive factors related to hand hygiene have not been adequately studied among physicians. Our study aim...

Water, hygiene and sanitation practices amongst medical students in Moi University Eldoret, Kenya

“…These rates, though low, are higher than rates in some other studies where hand washing was actually observed [10,11]. Again, self reporting could account for this.…”

The current status of hand washing and glove use among care staff in Japan: its association with the education, knowledge, and attitudes of staff, and infection control by facilities

“…Preparing an environment readily conducive to hand washing brings about an improvement of hand hygiene, and, in fact there is a study demonstrating an improvement in the hand hygiene compliance rate by carrying a hand-rub in the pocket [20]. This study, however, did not show a correlation between carrying a hand-rub in the pocket and compliance with hand hygiene.…”

Monitoração da adesão à higienização das mãos: uma revisão de literatura

“…Estudos realizados com base nesta técnica encontraram taxas de adesão entre 7,6% -91,3% (2)(3)(4)(7)(8)(9)14,(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) . Vale lembrar ainda que mesmo se tratando de estudos observacionais os critérios utilizados em cada estudo variaram consideravelmente, sendo que, em alguns trabalhos, foram observadas as lavagens das mãos apenas antes do contato com o paciente; enquanto outros estudos foram além, observando a adesão durante a assistência inclusive de um mesmo paciente, diferenciando atenção nas áreas mais contaminadas para áreas menos contaminadas do corpo.…”

“…Embora não haja dúvidas a respeito da eficácia da higienização das mãos e da simplicidade dessa prática, uma baixa adesão à HM tem sido reportada por diversos estudos em todo o mundo (2)(3)(4)(5)(6)(7) . Por isso, a elevação das taxas de adesão à HM durante o cuidado assistencial é considerada uma prioridade por diversos órgãos nacionais e internacionais, como também é reafirmado pela Organização Mundial da Saúde (OMS) (1) .…”