title: Handwashing compliance depends on professional status.
abstract: BACKGROUND
  Nosocomial infections can be transmitted from microorganisms on the hands of health care workers to patients. Handwashing (HW) has a proven benefit in preventing transmission of infection, yet compliance with handwashing, especially in intensive care units, ranges between 28% and 74%.
  
  
  METHODS
  To determine if HW behavior varies as a function of health care professional status and patient interaction, we conducted an observational study of a surgical intermediate care unit in a large university teaching hospital. HW compliance was observed among all health care workers (HCW): physicians (MD; N = 46), nurses (RN; N = 295), and nursing support personnel (NSP; N = 93). Over an 8-week period, unidentified, trained observers documented all HCW interactions in 1-h random blocks. HW opportunities were classified into low and high risk of pathogen acquisition and transmission.
  
  
  RESULTS
  A total of 493 HW opportunities were observed, of which 434 involved MD, RN, and NSP. Two hundred and sixty-one low-risk (MD 35, RN 171, NSP 55) and 173 (MD 11, RN 124, NSP 38) high-risk interactions were observed. Overall HW rates were low (44%). Significant differences existed among HCW, with MDs being the least likely to wash (15% versus RN 50%, NSP 37%, p < 0.01). In adjusting for high-risk situations, MDs (odds ratio [OR] 5.58, 95% CI 2.49-12.54; NSP, OR 1.73, 95% CI 1.13-2.64; RN, OR 0.98, 95% CI 0.77-1.23) were significantly less likely to perform HW when compared to RNs. Nursing groups were significantly less likely to wash in low-risk versus high-risk situations (MD 9.2% versus 17.1%; RN 69.4% versus 39.6%; NSP 85% versus 23.3%), suggesting individual discrimination of the importance of HW. Although nurses were less likely to wash in high-risk situations compared to NSP, the overall number of opportunities was greater, suggesting that improvement in HW to the level of NSP could have a major impact on infection transmission.
  
  
  CONCLUSIONS
  Significant opportunities exist for quality improvement, novel educational strategies, and assessment of reasons why MDs and, to a lesser extent, RNs fail to follow simple HW practices.
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. plipsett@jhmi.edu
authors.forename: P A
authors.initials: PA
authors.lastname: Lipsett
authors.forename: S M
authors.initials: SM
authors.lastname: Swoboda
mesh_terms: D003428:Cross Infection / Q000517:prevention & control; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006235:Hand Disinfection / Q000592:standards*; D006801:Humans; D017757:Infectious Disease Transmission, Professional-to-Patient / Q000517:prevention & control; D009726:Nurses / Q000706:statistics & numerical data*; D009728:Nursing Assistants / Q000706:statistics & numerical data*; D019370:Observation; D010820:Physicians / Q000706:statistics & numerical data*