Physician Hand Hygiene -- Dr. Semmelweis, Where Are You?

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Summary and Comment

Physician Hand Hygiene -- Dr. Semmelweis, Where Are You?

Hand hygiene is often poorest where risk is highest.

Despite the undisputed importance of clean hands in preventing nosocomial infections, physicians remain markedly deficient in their adherence to hand-hygiene policies. Researchers recently used direct observation followed by self-administered questionnaires to study factors affecting hand-cleansing behavior among 163 physicians at a Geneva teaching hospital that was well equipped for optimal hygiene practices.

Opportunities for hand-cleansing or glove-changing included treatment of sequential patients, handling of intravascular devices, and examination of clean body sites following examination of contaminated or dirty sites. Overall guideline adherence was 57%. Independent variables predicting better adherence were awareness of being observed, a positive attitude about hand cleansing after patient contact, perception of being a role model for colleagues, and carrying hand-rub solution in a pocket. Adherence varied greatly among specialties, being best in internal medicine, pediatrics, and geriatrics and worst in surgery, anesthesiology, and emergency medicine. Seniority was a negative factor: Medical students scored higher than did professors or attending physicians. Failure of senior physicians to practice good hand hygiene negatively affected adherence among junior personnel.

Comment: The merits of hand cleansing are clear. Unfortunately, despite the availability of sinks and portable cleansing solutions, many physicians continue to perceive hand hygiene as a difficult task. As an editorialist comments, adherence to good hand hygiene often is lowest where risk is highest. Active campaigns employing observation, embarrassment, and penalties might prove useful.

— Stephen G. Baum, MD

Published in Journal Watch Infectious Diseases August 9, 2004