Hand-washing Isn't So Simple; Trouble Staying Awake?; More

Marcy Tolkoff, JD

Disclosures

January 21, 2015

In This Article

Why "Wash Your Hands!" Isn't So Simple

Job demands and fatigue led to declines in hand-hygiene compliance with hospital healthcare workers, according to a new study in the Journal of Applied Psychology.[1] The study revealed an 8.7–percentage-point drop in compliance, measured from the beginning to the end of a typical 12-hour shift.

The researchers theorized that the impact of job demands (measured by job intensity and fatigue) would reduce compliance with professional standards. To test their hypothesis, they chose an area that represents one of the most significant compliance challenges in healthcare today: hand-washing. They analyzed 3 years of data from 4157 caregivers in 35 US hospitals and found that as job duties increased, hand-washing decreased.

The authors surmised this was probably because the demands of the job depleted the mental reserves that workers needed to follow the rules. In addition, the study showed that more time off between shifts appeared to restore these mental reserves, and workers followed hand-washing protocol more carefully after longer breaks. 

"Demanding jobs have the potential to energize employees, but the pressure may make them focus more on maintaining performance on their primary tasks (eg, patient assessment, medication distribution), particularly when they are fatigued," the lead author said. "For hospital caregivers, hand-washing may be viewed as a lower-priority task, and thus it appears compliance with hand hygiene guidelines suffers as the workday progresses."

Because hand-washing is critical to curbing the spread of infection, frustration with noncompliance abounds. In a BMC Infectious Diseases study on strategies to improve hand hygiene,[2] a senior manager in nonclinical services told researchers, "I cannot get my head around the fact that there seems to be very little performance management in relation to hand hygiene.... Considering how high the stakes are, I just can't understand how it's taking so long. I think we are overdue to actually start to use a hammer."

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