Healthcare Workers Wash Hands More When Observed

A new study reports that healthcare workers' adherence to hand hygiene guidelines is better when they are in the proximity of other healthcare workers.

Researchers at the University of Iowa (Iowa City, USA) conducted an observational study at the 20-bed medical intensive care unit (ICU) of the University of Iowa Hospital and Clinics during a 10-day period, for 24-hours a day. Using a custom-built, badge-based, automated hand-hygiene monitoring system, the researchers detected whether a healthcare worker had practiced hand hygiene on entering or exiting a patient's room, and estimated the location of other healthcare workers, with respect to each other healthcare worker. In total, 47,694 hand hygiene opportunities were recorded.

The results showed that estimated hand hygiene rate was 33% higher (28% versus 21% of total) when healthcare workers were in close proximity to peers, compared with the rate when healthcare workers were alone. The results were consistent at different times of day, for different measures of social context, and after controlling for possible confounding factors. The researchers found that the magnitude of the peer effects increased in the presence of additional healthcare workers, but only up to a point. The study was published in the October 2014 issue of Infection Control and Hospital Epidemiology.

“Social network effects, or peer effects, have been associated with smoking, obesity, happiness and worker productivity. As we found, this influence extends to hand hygiene compliance, too,” concluded senior author Philip Polgreen, MD, and colleagues. “The results speak to the importance of the social environment in healthcare and have important implications for understanding how human behavior affects the spread of diseases within healthcare settings.”

Following effective hand hygiene practices has long been recognized as the most important way to reduce the transmission of pathogens in healthcare settings. The World Health Organization (WHO), the US Centers for Disease Control and Prevention (CDC), and others have issued guidelines for that specify a wide range of hand hygiene behaviors, but despite this, adherence by healthcare workers remains staggeringly low, and improvement efforts frequently lack sustainability.

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