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Abstract
Physician adherence to hand hygiene remains low in most hospitals.
To identify risk factors for nonadherence and assess beliefs and perceptions associated
with hand hygiene among physicians.
Cross-sectional survey of physician practices, beliefs, and attitudes toward hand
hygiene.
Large university hospital.
163 physicians.
Individual observation of physician hand hygiene practices during routine patient
care with documentation of relevant risk factors; self-report questionnaire to measure
beliefs and perceptions. Logistic regression identified variables independently associated
with adherence.
Adherence averaged 57% and varied markedly across medical specialties. In multivariate
analysis, adherence was associated with the awareness of being observed, the belief
of being a role model for other colleagues, a positive attitude toward hand hygiene
after patient contact, and easy access to hand-rub solution. Conversely, high workload,
activities associated with a high risk for cross-transmission, and certain technical
medical specialties (surgery, anesthesiology, emergency medicine, and intensive care
medicine) were risk factors for nonadherence.
Direct observation of physicians may have influenced both adherence to hand hygiene
and responses to the self-report questionnaire. Generalizability of study results
requires additional testing in other health care settings and physician populations.
Physician adherence to hand hygiene is associated with work and system constraints,
as well as knowledge and cognitive factors. At the individual level, strengthening
a positive attitude toward hand hygiene and reinforcing the conviction that each individual
can influence the group behavior may improve adherence among physicians. Physicians
who work in technical specialties should also be targeted for improvement.