Background:
Considerable resources have been devoted to improving hand hygiene compliance, yet true compliance remains unacceptably low, especially among physicians. Estimates from U.S. hospitals conclude that 2 million hospital‐acquired infections occur yearly, resulting in 100,000 deaths and direct costs, according to the CDC, of $30‐$40 billion. Few studies have observed physician team dynamics in relation to hand hygiene compliance. We aimed to determine whether the compliance of attendings (and/or first person entering/exiting the patient room) influenced the compliance of physician teams. By studying team dynamics, we may be able to create a new focus for hand hygiene compliance efforts.
Methods:
Four medical students individually shadowed physician teams in a variety of departments as they conducted morning rounds. The students measured hand hygiene compliance on entering and exiting each patient room. They collected data on hand hygiene compliance of the attending, the first person entering or exiting the room, and the entire team. Compliance was defined as using the gel dispenser or sink. The students also noted whether any member of the team had contact with the patient or the room environment. Physician teams were not informed that their hand hygiene compliance was being measured so as to not influence their habits.
Results:
Observations of 349 hand hygiene opportunities during physician team rounding showed a hand hygiene compliance rate of 40% among physicians. When broken down into entering verses exiting a patient room, compliance rates were 31% and 48%, respectively. A subset of 2 teams within internal medicine and inpatient oncology was then observed for compliance in relation to the attending and first person entering (n = 103 opportunities). Overall analysis (for combined in and out) showed that when the attending washed, a greater percentage of the team washed (90% verses 71%, P = 0.03). When broken down by in/out, the attending always washed when entering. On exiting, a greater percentage of the team washed if the attending washed (90% vs. 71%, P = 0.05). Overall analysis for when the first person entering the room washed was identical to when the attending washed (90% vs. 71%, P = 0.03) because the occurrences where the attending did not wash were the same as when the first person did not wash. When there was patient/environment contact, there were no observations where the attending/first person did not wash.
Conclusions:
Physician team members were more likely to wash their hands on entering and exiting patient rooms if their attendings or if the first person entering the room washed. Additional team observations are being conducted to better study the influence of attending vesus first person entering, as well as to conduct root cause analysis.
Author Disclosure:
S. Carr, none; L. Shieh, none; S. Sinha, none; K. Carpenter, none; J. Pederson, none; N. Meng, none; N. Fijalkowski, none; R. Eisenhut, none.