Hand-Washing Practices and Beliefs of Physicians

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The summary below is from the full report titled "Hand Hygiene among Physicians: Performance, Beliefs, and Perceptions." It is in the 6 July 2004 issue of Annals of Internal Medicine (volume 141, pages 1-8). The authors are D. Pittet, A. Simon, S. Hugonnet, C.L. Pessoa-Silva, V. Sauvan, and T.V. Perneger.

What is the problem and what is known about it so far?

Health care workers must use good hand hygiene to avoid spreading infections. Good hand hygiene involves cleansing hands before and after examining different patients or between examining an infected and a clean body site on the same patient. Cleansing may involve soap and water, water alone, or alcohol rubs. Although hand-washing is a simple task, research shows that doctors do not do it often enough. Little is known about why doctors have poor hand-washing practices.

Why did the researchers do this particular study?

To study doctors' hand-washing practices and their attitudes and beliefs about hand hygiene.

Who was studied?

163 medical students, residents, and staff physicians in a large Swiss university hospital.

How was the study done?

Trained observers watched doctors' hand hygiene during patient care activities. They counted the number of times that doctors should have cleansed their hands and the number of times that they actually did. They then asked doctors to answer written questions about their attitudes and beliefs toward hand hygiene.

What did the researchers find?

Doctors cleansed their hands 57% of the times that they should have. They cleansed hands most often when a hand-rub solution was easily available. They did not wash hands as often when they had busy workloads with many patient interactions and when they performed activities with high risks for spreading infections. These activities required cleansing hands immediately before examining patients or between examining different body sites on the same patient. Medical students and internists (internal medicine doctors) washed hands most often, whereas anesthesiologists, critical care physicians, and surgeons washed hands least often. Doctors who valued hand hygiene and considered themselves role models washed hands often.

What were the limitations of the study?

Doctors may have changed their normal hand-cleansing activities because they often knew they were being observed. In addition, only 1 hospital in Switzerland was studied. Doctors in hospitals in the United States may have different habits.

What are the implications of the study?

Many factors influence doctors' hand-washing practices. Providing easy access to cleansing materials and improving attitudes toward hand hygiene, particularly among doctors working in technical specialties, merit emphasis.