Healthcare providers still aren’t washing their hands enough

by Chris Emery

Nurses and other healthcare providers complied with hand hygiene guidelines less than half of the time before participating in medical procedures, results of a new study showed.

Compliance was better after procedures, with 72% following guidelines after procedures compared with 41.7% before procedures, according to a report published in the May issue of Applied Nursing Research.

Overall compliance with hand hygiene guidelines was just 34.3%.

“It is important to note that preprocedure hand hygiene intends to protect patients against infections and maximize risk reduction, whereas postprocedure hand hygiene intends to protect the healthcare provider and other patients who may contract patient-to-patient infections,” wrote Denise M. Korniewicz, PhD, RN, of the University of Miami, and Maher El-Masri, PhD, RN, of the University of Windsor, in Ontario, Canada.

“Thus,” they wrote, “these findings may suggest that healthcare providers are probably driven to wash their hands by their need to protect themselves more than their patients.”

Each year, an estimated 2.5 million patients in the U.S. develop healthcare-associated infections that result in 90,000 deaths and cost the healthcare system an estimated $4.5 to $5.7 billion dollars.

Practices that reduce hand-to-hand or hand-to-skin contamination are considered the most effective way to decrease the risk of healthcare-associated infections, yet previous studies suggest that compliance with hand hygiene guidelines is still poor.

To explore the factors associated with compliance, Korniewicz and El-Masri observed 612 procedures at an academic oncology hospital. Data were recorded for 47 healthcare providers and were collected over a 16-week period from inpatient and outpatient units during day, evening, and night shifts.

The researchers used the CDC definition of proper hand hygiene, which includes such things as hand washing, use of hand sanitizers, and gloving. Procedures were classified as high-risk — including drawing blood, changing surgical dressings, emptying a urinary bag, and airway suctioning — or low-risk, including giving oral medications and checking IV tubes.

They found that compliance was higher in high-risk procedures (OR 1.77; 95% CI 1.18 to 2.65) and when the healthcare providers were exposed to blood (OR 1.40; 95% CI 1.07 to 1.73). Yet noncompliance occurred even in cases where nurses were exposed to blood, urine, saliva, sweat, and feces.

They also noted that hand hygiene was better on medical-surgical oncology units than on the hematology-oncology unit.

“Regardless of the possible explanations of these findings, they are disturbing and reflect a continuing trend of poor compliance with proper hand hygiene practices among healthcare providers,” the authors wrote.

Despite their efforts to account for the possibility that observation might cause participants to change their behavior, Korniewicz and El-Masri cautioned that they could not rule this possibility out all together.

“Regardless of these limitations, our findings shed light on the issue of hand hygiene practices in acute healthcare settings and the factors impacting these practices,” they continued. “They also highlight the need to continue to uphold the issue of compliance with hand hygiene through many innovative approaches that go beyond traditional teaching and inservice training.”

Chris Emery is a MedPage Today contributing writer.

Originally published in MedPage Today. Visit for more infection control news.

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  • Stephen C Schimpff

    Handwashing, as the post emphasizes, is key to preventing hospital acquired infection. Years ago, as an oncology and infectious disease attending at a branch of the National Cancer Institute, I spent much time in July stressing the importance of infection prevention to the new oncology fellows, especially handwashing. The patients were those receiving intensive cancer chemotherapy and were at high risk. When my turn to attend came up again three months later, I decided to just watch and see if my previous exhortations had had an impact. To my dismay, only one fellow, on one occasion, washed his hands during the month!

    I have since learned some important concepts. First, the need for education, including signage about the importance of handwashing. Call this a “nudge.” Second, it is imperative that it be made easy with sinks or alcohol based sanitizer dispensers conveniently placed at the entrance to each patient’s room ,i.e., allow no reason to give excuses. Third, the patient needs to know the importance also and be taught to tell everyone to wash before contact (be their own policeman.) But finally, it is critical that everyone know that hand hygiene is not only important but the expected cultural norm. No surgeon would enter an OR without handwashing but we have all seen the same surgeon go from patient to patient changing wound dressing and not washing unless his or her hands got soiled. So we need a culture that insists. This must start with the chief of service (for docs) or the head nurse (for nurses and support staff.) He or she has to make it known that no exceptions will be tolerated. Once means a warning. Twice means a negative financial incentive such as baring a surgeon from the OR for a week or baring an internist form admitting patients for a week. The negative economic incentive will have an immediate impact on everyone but it only works if the boss says it must.

  • Kenneth


    Though most oral surgeons I’ve seen tend to glove prior to procedures, all of them neglect to wash their hands first.

    They simply stick their filthy fingers all over the glove box, contaminate the outer surface of the finger areas of the glove, struggle to put the gloves on (thus further contaminating more areas of the outer surface of the gloves), ultimately wiping all of this filth like peanut butter spread onto the teeth, lips, and gums of the patients.

    By the way, as part of all the, the glove box opening has also been contaminated (too bad for the next oral surgeon and all patients down the line being serviced by a surgeon using the same glove box.

    You would think that doctors have taken bio 101, 201, etc and have used a microscope before in their careers..

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