title: Hand hygiene of medical students and resident physicians: predictors of attitudes and behaviour.
abstract: OBJECTIVE
  We measured medical students' and resident trainees' hand hygiene behaviour, knowledge and attitudes in order to identify important predictors of hand hygiene behaviour in this population.
  
  
  METHODS
  An anonymous, web-based questionnaire was distributed to medical students and residents at Stanford University School of Medicine in August of 2012. The questionnaire included questions regarding participants' behaviour, knowledge, attitude and experiences about hand hygiene. Behaviour, knowledge and attitude indices were scaled from 0 to 1, with 1 representing superior responses. Using multivariate regression, we identified positive and negative predictors of superior hand hygiene behaviour. We investigated effectiveness of interventions, barriers and comfort reminding others.
  
  
  RESULTS
  280 participants (111 students and 169 residents) completed the questionnaire (response rate 27.8%). Residents and medical students reported hand hygiene behaviour compliance of 0.45 and 0.55, respectively (p=0.02). Resident and medical student knowledge was 0.80 and 0.73, respectively (p=0.001). The attitude index for residents was 0.56 and 0.55 for medical students. Regression analysis identified experiences as predictors of hand hygiene behaviour (both positive and negative influence). Knowledge was not a significant predictor of behaviour, but a working gel dispenser and observing attending physicians with good hand hygiene practices were reported by both groups as the most effective strategy in influencing trainees.
  
  
  CONCLUSIONS
  Medical students and residents have similar attitudes about hand hygiene, but differ in their level of knowledge and compliance. Concerns about hierarchy may have a significant negative impact on hand hygiene advocacy.
authors.affiliation: Department of Family Medicine, Kaiser, Vallejo Medical Center, Vallejo, California, USA.
authors.forename: Violeta
authors.initials: V
authors.lastname: Barroso
authors.affiliation: Department of Medicine, Stanford University, Stanford, California, USA.
authors.forename: Wendy
authors.initials: W
authors.lastname: Caceres
authors.affiliation: Department of Medicine, Stanford University, Stanford, California, USA.
authors.forename: Pooja
authors.initials: P
authors.lastname: Loftus
authors.affiliation: Department of Medicine, Stanford University, Stanford, California, USA.
authors.forename: Kambria H
authors.initials: KH
authors.lastname: Evans
authors.affiliation: Department of Medicine, Stanford University, Stanford, California, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Shieh
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003428:Cross Infection / Q000517:prevention & control*; D005260:Female; D063373:Hand Hygiene; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008505:Medical Staff, Hospital; D015999:Multivariate Analysis; D012044:Regression Analysis; D013337:Students, Medical; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: EDUCATION & TRAINING (see Medical Education & Training)