title: Medical students' perceptions of their role as covert observers of hand hygiene.
abstract: BACKGROUND
  Medical students served as covert observers of hand hygiene (HH) compliance by health care workers (HCWs) during a recent 1-year study at a teaching hospital in Taiwan. This report describes the students' experience and their views of the major factors that led to good or poor compliance.
  
  
  METHODS
  Nine upper class medical students received a basic course in HH and attended a workshop using World Health Organization standard training materials. A standardized observation tool was used to collect data on HH performance by the HCWs. On completion of the study, structured face-to-face interviews were conducted to assess the students' experiences.
  
  
  RESULTS
  The medical students observed a total of 17,742 HH opportunities during the study period. Eight of the 9 students participated in the poststudy interviews. Overall, the students believed that they had gained considerable knowledge of the attitudes regarding HH compliance by nurses, physicians, and surgeons according to each of the 5 HH indications. Based on their experience, they recommended that compliance could be improved by ensuring an adequate supply of HH products and by promoting role modeling in the ward, reminding, education in small groups, and objective structured clinical examinations.
  
  
  CONCLUSIONS
  The opportunity for medical students to serve as covert observers broadened their knowledge of how infections are transmitted in hospitals and of the barriers that must be overcome to improve HCWs' HH compliance.
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
authors.forename: Sung-Ching
authors.initials: SC
authors.lastname: Pan
authors.affiliation: Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Pei-Hu Branch, Taipei, Taiwan.
authors.forename: Tai-Shuan
authors.initials: TS
authors.lastname: Lai
authors.affiliation: Center of Infection Control, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Kuei-Lien
authors.initials: KL
authors.lastname: Tien
authors.affiliation: Center of Infection Control, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: I-Chen
authors.initials: IC
authors.lastname: Hung
authors.affiliation: Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
authors.forename: Wei-Chu
authors.initials: WC
authors.lastname: Chie
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Center of Infection Control, National Taiwan University Hospital, Taipei, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan. Electronic address: yeechunchen@gmail.com.
authors.forename: Yee-Chun
authors.initials: YC
authors.lastname: Chen
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Center of Infection Control, National Taiwan University Hospital, Taipei, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Shan-Chwen
authors.initials: SC
authors.lastname: Chang
mesh_terms: D000328:Adult; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D063373:Hand Hygiene / Q000379:methods* / Q000592:standards*; D006801:Humans; D017053:Infection Control / Q000379:methods* / Q000592:standards*; D008297:Male; D011446:Prospective Studies; D013337:Students, Medical; D013624:Taiwan; D055815:Young Adult
keywords: Infection control; Medical education; Qualitative study