Handwashing compliance depends on professional status

Pamela A Lipsett, Sandra M. Swoboda

Research output: Contribution to journalArticle

Abstract

Background: Nosocomial infections can be transmitted from microorganisms on the hands of health care workers to patients. Handwashing (HW) has a proven benefit in preventing transmission of infection, yet compliance with handwashing, especially in intensive care units, ranges between 28% and 74%. Methods: To determine if HW behavior varies as a function of health care professional status and patient interaction, we conducted an observational study of a surgical intermediate care unit in a large university teaching hospital. HW compliance was observed among all health care workers (HCW): physicians (MD; N = 46), nurses (RN; N = 295), and nursing support personnel (NSP; N = 93). Over an 8-week period, unidentified, trained observers documented all HCW interactions in 1-h random blocks. HW opportunities were classified into low and high risk of pathogen acquisition and transmission. Results: A total of 493 HW opportunities were observed, of which 434 involved MD, RN, and NSP. Two hundred and sixty-one low-risk (MD 35, RN 171, NSP 55) and 173 (MD 11, RN 124, NSP 38) high-risk interactions were observed. Overall HW rates were low (44%). Significant differences existed among HCW, with MDs being the least likely to wash (15% versus RN 50%, NSP 37%, p <0.01). In adjusting for high-risk situations, MDs (odds ratio [OR] 5.58, 95% CI 2.49-12.54; NSP, OR 1.73, 95% CI 1.13-2.64; RN, OR 0.98, 95% CI 0.77-1.23) were significantly less likely to perform HW when compared to RNs. Nursing groups were significantly less likely to wash in low-risk versus high-risk situations (MD 9.2% versus 17.1%; RN 69.4% versus 39.6%; NSP 85% versus 23.3%), suggesting individual discrimination of the importance of HW. Although nurses were less likely to wash in high-risk situations compared to NSP, the overall number of opportunities was greater, suggesting that improvement in HW to the level of NSP could have a major impact on infection transmission. Conclusion: Significant opportunities exist for quality improvement, novel educational strategies, and assessment of reasons why MDs and, to a lesser extent, RNs fail to follow simple HW practices.

Original languageEnglish (US)
Pages (from-to)241-245
Number of pages5
JournalSurgical Infections
Volume2
Issue number3
StatePublished - 2001

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Hand Disinfection
Compliance
Infectious Disease Transmission
Delivery of Health Care
Odds Ratio
Nurses
Educational Measurement
Cross Infection
Quality Improvement
Teaching Hospitals
Observational Studies
Intensive Care Units
Nursing
Hand

ASJC Scopus subject areas

  • Surgery
  • Microbiology (medical)

Cite this

Handwashing compliance depends on professional status. / Lipsett, Pamela A; Swoboda, Sandra M.

In: Surgical Infections, Vol. 2, No. 3, 2001, p. 241-245.

Research output: Contribution to journalArticle

Lipsett, Pamela A ; Swoboda, Sandra M. / Handwashing compliance depends on professional status. In: Surgical Infections. 2001 ; Vol. 2, No. 3. pp. 241-245.
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abstract = "Background: Nosocomial infections can be transmitted from microorganisms on the hands of health care workers to patients. Handwashing (HW) has a proven benefit in preventing transmission of infection, yet compliance with handwashing, especially in intensive care units, ranges between 28{\%} and 74{\%}. Methods: To determine if HW behavior varies as a function of health care professional status and patient interaction, we conducted an observational study of a surgical intermediate care unit in a large university teaching hospital. HW compliance was observed among all health care workers (HCW): physicians (MD; N = 46), nurses (RN; N = 295), and nursing support personnel (NSP; N = 93). Over an 8-week period, unidentified, trained observers documented all HCW interactions in 1-h random blocks. HW opportunities were classified into low and high risk of pathogen acquisition and transmission. Results: A total of 493 HW opportunities were observed, of which 434 involved MD, RN, and NSP. Two hundred and sixty-one low-risk (MD 35, RN 171, NSP 55) and 173 (MD 11, RN 124, NSP 38) high-risk interactions were observed. Overall HW rates were low (44{\%}). Significant differences existed among HCW, with MDs being the least likely to wash (15{\%} versus RN 50{\%}, NSP 37{\%}, p <0.01). In adjusting for high-risk situations, MDs (odds ratio [OR] 5.58, 95{\%} CI 2.49-12.54; NSP, OR 1.73, 95{\%} CI 1.13-2.64; RN, OR 0.98, 95{\%} CI 0.77-1.23) were significantly less likely to perform HW when compared to RNs. Nursing groups were significantly less likely to wash in low-risk versus high-risk situations (MD 9.2{\%} versus 17.1{\%}; RN 69.4{\%} versus 39.6{\%}; NSP 85{\%} versus 23.3{\%}), suggesting individual discrimination of the importance of HW. Although nurses were less likely to wash in high-risk situations compared to NSP, the overall number of opportunities was greater, suggesting that improvement in HW to the level of NSP could have a major impact on infection transmission. Conclusion: Significant opportunities exist for quality improvement, novel educational strategies, and assessment of reasons why MDs and, to a lesser extent, RNs fail to follow simple HW practices.",
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