Previous studies demonstrate that hand hygiene compliance among healthcare workers is suboptimal. To better understand drivers of poor compliance, we investigated changes in hand hygiene (HH) attitudes and practices among medical students to determine whether there is a discernable decline as training progresses.
Third-year medical students completed anonymized surveys to evaluate these categories: HH attitude, HH practice, personal hygiene (PH), and comfort level of reminding others to improve hand hygiene. Three different cohorts were surveyed: preclinical students, students beginning the internal medicine clerkship, and students completing the internal medicine clerkship. Survey questions were modeled after “Perception Survey for Health-Care Workers” from the World Health Organization and “Hand Hygiene Staff Survey” from the Minnesota Hospital Association. Responses were scored on a 5-point Linkert scale for all questions. We calculated a Pearson correlation between mean PH and mean HH attitude scores in preclinical students. For students in the internal medicine clerkship, we determined whether HH attitudes and practices changed throughout the clerkship and evaluated relationships between prior rotations and these scores. We compared the sum of the responses from each category and employed Mann-Whitney rank-sum test for comparison.
Ninety-seven students responded to the preclinical survey; 53 and 49 students responded at the beginning and end of the internal medicine clerkship, respectively. Across all cohorts, students reported strongly favorable HH attitudes (median score of 5). There was no significant correlation between PH and HH attitude, r(95) = -0.004, p=0.97. HH attitudes and practices did not change over the course of the internal medicine clerkship and were not impacted by previous rotation on the surgery clerkship (z=-0.31, p=0.76 and z=-0.22, p=0.83 respectively). Furthermore, no specific prior clerkship experience (surgery, pediatrics, neurology, OBGYN, and psychiatry) was correlated with significantly different HH attitudes and practices. Students were more comfortable reminding each other to perform hand hygiene as opposed to residents or attending physicians (z=4.12, p<0.00001 and z=5.82, p<0.00001 respectively).
Students begin the third year of medical school with strongly positive attitudes and self-reported practices toward hand hygiene, and there was no demonstrable evidence of decline throughout the internal medicine clerkship. Students’ reluctance to influence superiors to improve HH behaviors suggests that cultural factors exist that may contribute to a decline in performance as students transition to physicians.
To cite this abstract:Luo, CCK; Sasaki, RA; El-Kareh, R; Sebasky, M; Seymann, GB . PREDICTORS OF HAND HYGIENE ATTITUDE AND PRACTICE IN MEDICAL SCHOOL. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 33. Journal of Hospital Medicine. 2017; 12 (suppl 2). https://www.shmabstracts.com/abstract/predictors-of-hand-hygiene-attitude-and-practice-in-medical-school/. Accessed July 15, 2019.