Hand Hygiene among Physicians: Performance, Beliefs, and Perceptions

6 July 2004 | Volume 141 Issue 1 | Pages 1-8

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.

Conclusion: Physician adherence to hand hygiene is associated with work and system constraints, as well as knowledge and cognitive factors. At the individual level, strengthening a positive attitude toward hand hygiene and reinforcing the conviction that each individual can influence the group behavior may improve adherence among physicians. Physicians who work in technical specialties should also be targeted for improvement.

Editors' Notes Context Why do physicians fail to practice good hand hygiene? Contribution This observational study of 163 physicians in a university hospital found that overall adherence to hand hygiene guidelines was 57%. Factors associated with poor adherence included having busy workloads, performing activities with high risks for cross-transmission, and being in technical specialties (such as surgery and anesthesiology). Adherence was higher when hand-rub solutions were easily accessible and when physicians valued hand hygiene and considered themselves role models. Implications Providing easy access to cleansing materials and improving attitudes toward hand hygiene, particularly among physicians working in technical specialties, merit emphasis. –The Editors

 

Author and Article Information

From University of Geneva Hospitals, Geneva, Switzerland.

Acknowledgments: The authors thank Dr. A. Golay from the Division d'Enseignement Thérapeutique pour Maladies Chroniques, Department of Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland, for helpful discussion on specific aspects of behavioral assessments among health care workers and Ms. R. Sudan for editorial assistance.

Grant Support: Dr. Pessoa-Silva is a postdoctoral fellow supported by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq, Brazil), grant 20.0694/99-5.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Didier Pittet, MD, MS, Infection Control Program (service PCI), University of Geneva Hospitals, 24 Rue Micheli-du-Crest, 1211 Geneva 14, Switzerland.

Current Author Addresses: Drs. Pittet, Hugonnet, and Pessoa-Silva and Ms. Sauvan: Infection Control Program, University of Geneva Hospitals, 24 Rue Micheli-du-Crest, 1211 Geneva 14, Switzerland.

Dr. Simon: Unité d'Hygiène Hospitalière, Cliniques Universitaires Saint-Luc 10/1754, Avenue Hippocrate 10, 1200 Brussels, Belgium.

Dr. Perneger: Quality of Care Unit, University of Geneva Hospitals, and Institute of Social and Preventive Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland.

Author Contributions: Conception and design: D. Pittet, A. Simon, S. Hugonnet, C.L. Pessoa-Silva, V. Sauvan, T.V. Perneger.

Analysis and interpretation of the data: D. Pittet, S. Hugonnet, C.L. Pessoa-Silva, T.V. Perneger.

Drafting of the article: D. Pittet, S. Hugonnet, C.L. Pessoa-Silva.

Critical revision of the article for important intellectual content: D. Pittet, S. Hugonnet, C.L. Pessoa-Silva, T.V. Perneger.

Final approval of the article: D. Pittet, S. Hugonnet, T.V. Perneger.

Provision of study materials or patients: D. Pittet.

Statistical expertise: S. Hugonnet, T.V. Perneger.

Obtaining of funding: D. Pittet.

Administrative, technical, or logistic support: D. Pittet.

Collection and assembly of data: D. Pittet, A. Simon, V. Sauvan.

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