Discrepancy between self-reported and observed hand hygiene behaviour in healthcare professionals
Introduction
The guidelines of the UK Department of Health state that hands should be washed ‘before and after contact with each patient’.1 This study examined practitioners' adherence to this guideline, taking particular note of practice when working with patients infected or colonized with meticillin-resistant Staphylococcus aureus (MRSA). It also examined whether observed hand hygiene behaviour on wards is consistent with healthcare professionals' self-reports of their actions.
Research suggests that healthcare professionals clean their hands much less often than they say they do.2 Understanding the link between self-reported and observed behaviours is of major importance in hand hygiene, but previous research has not concentrated on this. If there is no association, interventions designed to improve intentions or self-reported behaviours will not be effective in changing practice. One American study reported a correlation of only 0.21 between self-reported behaviours and actions, yet the study used a self-report averaging method likely to inflate correlations between self-reported and observed practice, suggesting that the actual correlation may be even less than that reported.3
This study examined the link between what carers say and what they do on two medical and two surgical wards linked by similar speciality and layout. Each ward had four bays, each with six beds, plus two side rooms and all were similar in terms of the number and location of sinks which were readily accessible at the entrance to each bay/side room. The sinks were therefore easy to observe, which has been reported to be of critical importance.4 At each sink, four different products were available: chlorhexidine gluconate; povidone iodine; liquid soap; and alcohol gel. Alcohol gel was also present at every bedside.
Section snippets
Methods
Observations were made on wards over a total period of 132 h, during which time 1284 opportunities for hand hygiene arose. An opportunity for hand hygiene was defined as any occasion when a participant performed any activity that required hand hygiene, including contact with the patient, equipment, medication or food, or prior to carers going on their break. Hand hygiene was operationalized as any attempt to clean hands with water alone, with water and one of the available handwashing products,
Results
The percentage of opportunities when hands were washed both before and after contact with the patient, before but not after contact with the patient, or after but not before contact with the patient for different categories of risk are shown in Table I. Risk assessment calculated the cross-infection risk in terms of degree [low (e.g. touching the patient), medium (e.g. administration of medicine via percutaneous endogastrostomy tube) and high (e.g. examining a wound)] and person (risk to self,
Discussion
Healthcare professionals' hand hygiene was poor despite the knowledge that they were being observed. The practices observed suggest that carers think it is more important to prevent cross-infection from one patient to another rather than preventing infection of the initial patient. This may arise from an emphasis on control rather than prevention. However, it is clear that hand hygiene was often not performed even when the care activity posed a high risk of cross-infection to other patients and
Acknowledgements
The authors wish to thank the participants in this study and the patients who kindly gave their consent to being observed.
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