Healthcare Workers View Hand Hygiene Reminders Unfavorably

Joe Barber Jr, PhD

September 04, 2012

September 4, 2012 — Healthcare workers do not appear to support being reminded to wash their hands by patients, according to the findings of a cross-sectional study.

Yves Longtin, MD, from Centre Hospitalier Universitaire de Quebec in Quebec City, Canada, and colleagues presented their findings in an article published online September 3 in the Archives of Internal Medicine.

The authors mention that the concept of having patients remind healthcare workers about the importance of hand hygiene has been promoted. "This strategy has been recommended by a large number of organizations and authorities worldwide, including the World Health Organization and the US Centers for Disease Control and Prevention," the authors write. "However, very little is known about [healthcare workers'] views of such programs."

The authors sent anonymous, confidential surveys to the home addresses of 700 healthcare workers in a single institution in 2009 and assessed the views and opinions of the respondents by using a 5-point Likert scale (from 1, strongly agree, to 5, strongly disagree). Of the 277 respondents (41.1% response rate), 29% did not wish to be reminded by patients to wash their hands, 27% believed that this request was beyond the bounds of the patient's role, and 37% did not wish to wear a name badge that prompted patients to remind them about hand hygiene.

Multivariate analysis revealed that the endorsement of patient inquiry was positively associated with the belief that patients could help prevent medical errors (adjusted odds ratio [AOR], 8.4; 95% confidence interval [CI], 3.2 - 22.1; P < .001) and improve healthcare worker hand hygiene compliance (AOR, 6.4; 95% CI, 2.4 - 16.8; P < .001).

Conversely, support for patient inquiry was negatively associated with the concepts that neglecting hand hygiene was inconsequential (AOR, 0.1; 95% CI, 0.02 - 0.5; P = .006), that patient inquiry would be embarrassing (AOR, 0.3; 95% CI, 0.1 0.8; P = .02), and that patient inquiry would question their competency (AOR, 0.4; 95% CI, 0.2 - 1.0; P = .05).

This study was limited by its low response rate, its single-institution nature, and the possibilities of participation and desirability biases.

The authors note that the low rate of endorsement of patient inquiry might be explained by the embarrassment associated with the admitted omission of hand washing. "Similar to their tendency not to disclose minor medical errors, [healthcare workers] may prefer to keep patients in relative ignorance regarding appropriate hand hygiene behavior to avoid delicate situations," the authors write. "Support from HCWs is central to the success of patient participation endeavors, and failure to enlist their open support may undermine the outcome of such programs."

This study was partially supported by the Swiss National Science Foundation for hand hygiene research activities. The authors have disclosed no relevant financial relationships.

Arch Intern Med. Published online September 3, 2012. Abstract


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