title: [One in five surgeons do not wash hands after visiting a toilet - an ethnographic field study].
abstract: BACKGROUND
  Non-compliance with regard to hand hygiene is a major problem in the health-care system especially among surgeons and anaesthetists. The purpose of this study was to examine the hand hygiene routines after toilet visits among participants attending an international surgical congress.
  
  
  METHODS
  An observational study was conducted at the American College of Surgeons (ACS) Clinical Congress 2012 and at the American Medical Writers Association (AMWA) Congress 2012 as comparison. The study was performed as an ethnographic field study. A standardized observational matrix was developed for observing whether hand washing (as a surrogate measure of hand hygiene) was performed after toilet visits by observers. Frequencies were compared using Fisher's exact test.
  
  
  RESULTS
  A total of 100 persons were observed (80% males). Of the 50 males observed at the ACS meeting, ten males did not use hand hygiene in relation to toilet visits (20%), while only one person at the AMWA meeting out of the 50 observed did not use hand hygiene (2%), p = 0.008. At both congresses only males did not use hand hygiene in relation to toilet visits.
  
  
  CONCLUSIONS
  One in five surgeons did not wash hands after visiting a toilet. Even though the observed surgeons were not observed in an operating theatre or in a setting that required a distinct degree of hand hygiene, it does reveal a worrying behaviour. It is not known whether this was a conscious act, the result of business, or if it was due to lack of knowledge about the effects of hand hygiene on bacterial transmission.
  
  
  BACKGROUND
  not relevant.
  
  
  BACKGROUND
  This study was neither registered at the National Committee of Health Research nor at Clinical Trials since it did not meet the requirements of registration.
authors.affiliation: Gastroenheden, Kirurgisk Sektion, Herlev Hospital, Herlev Ringvej, 75, 2730 Herlev. jakobburcharth@gmail.com.
authors.forename: Jakob
authors.initials: J
authors.lastname: Burcharth
authors.forename: Hans-Christian
authors.initials: HC
authors.lastname: Pommergaard
authors.forename: Mahdi
authors.initials: M
authors.lastname: Alamili
authors.forename: Anne Kjærgaard
authors.initials: AK
authors.lastname: Danielsen
authors.forename: Jacob
authors.initials: J
authors.lastname: Rosenberg
mesh_terms: D000884:Anthropology, Cultural; D003226:Congresses as Topic; D005260:Female; D006235:Hand Disinfection / Q000592:standards*; D006801:Humans; D008297:Male; D064887:Observational Studies as Topic; D066231:Surgeons / Q000592:standards* / Q000706:statistics & numerical data; D014038:Toilet Facilities; D014481:United States