Doctors reject hand hygiene reminders

ALMOST a third of doctors and nurses don’t want their patients to remind them to perform hand hygiene, a Swiss study has found.

The study, of 277 doctors and nurses, also found that 27% believed it was not part of the patient’s role to ask about hand hygiene, and that 37% would not agree to wear a badge inviting patients to ask about hand hygiene. (1)

Seventeen per cent of health care workers (HCWs) who responded to the survey believed that patient reminders would be upsetting, and 27% felt it would be humiliating.

“The relatively low rate of endorsement is partly explained by the negative feelings associated with disclosing omission”, the authors wrote. “HCWs may prefer to keep patients in relative ignorance regarding appropriate hand hygiene behavior to avoid delicate situations.”

Professor Lindsay Grayson, director of Hand Hygiene Australia, and director of the Infectious Diseases Department at Austin Health in Melbourne, said it was no surprise that HCWs had misgivings.

“You are being ticked off”, he said. “If it were me, I’d feel frustrated that I had to be reminded, but not angry with the patient.”

Professor Grayson said that overall, trials in Australia that relied on patient prompts had not had great success, mainly because patients depended on HCWs for their care and did not want to be rude to them.

Although Australia’s National Hand Hygiene Initiative endorsed patient input, it preferred to avoid the “slightly confrontational path of patients ticking off health care workers”.

“Hand hygiene is the responsibility of health care workers and it’s up to us to get it right”, Professor Grayson said. “We should welcome it when patients do remind us, but the system should not depend on it.”

MyHospitals data on hospital staff adherence to hand hygiene procedures show there is still room for improvement. One in five Australian public hospitals is yet to reach the 70% national benchmark for hand hygiene, according to the data released in March. (2)

Professor Frank Bowden, a senior staff specialist in Infectious Diseases at the Australian National University, flagged the problem in his 2011 book Gone viral: the germs that share our lives.

Professor Bowden wrote that he was constantly amazed by his colleagues’ lack of concern for infection control.

“Adoption of hand antisepsis is often thwarted by the intransigence of senior and influential clinicians”, he wrote.

Professor Grayson agreed that doctors still lagged behind nurses in hand hygiene, but said there had been significant progress in recent years.

He said further change hinged on education and on making hand hygiene easy. “You need to make it a habit and the best analogy is like a seat belt where you don’t think, you just do it”, he said.

“The College of Surgeons recently announced no one can do surgical training unless they pass hand hygiene credentialing education. One of our aims is to have an online educational requirement for the annual registration of all health care workers.”

Professor Grayson also noted that alcohol rubs had come a long way in the past 5–10 years and now included skin softeners, which had made a huge difference to the practical application of hand hygiene.

“We are changing 200 years of health care practice in the space of a few years”, he said. “The National Hand Hygiene Initiative is the most successful national program worldwide thanks to its systematic approach.”

- Amanda Bryan

1. Arch Internal Med 2012; Online 3 September
2. Australian Institute of Health and Welfare. Hand hygiene information available on MyHospitals (media release)

Posted 10 September 2012

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