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Hand Hygiene among Physicians: Performance, Beliefs, and Perceptions

Didier Pittet, MD, MS; Anne Simon, MD; Stéphane Hugonnet, MD, MSc; Carmen Lúcia Pessoa-Silva, MD; Valérie Sauvan, RN; and Thomas V. Perneger, MD, PhD
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From University of Geneva Hospitals, Geneva, Switzerland.

Acknowledgments: The authors thank Dr. A. Golay from the Division d'Enseignement Thérapeutique pour Maladies Chroniques, Department of Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland, for helpful discussion on specific aspects of behavioral assessments among health care workers and Ms. R. Sudan for editorial assistance.

Grant Support: Dr. Pessoa-Silva is a postdoctoral fellow supported by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq, Brazil), grant 20.0694/99-5.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Didier Pittet, MD, MS, Infection Control Program (service PCI), University of Geneva Hospitals, 24 Rue Micheli-du-Crest, 1211 Geneva 14, Switzerland.

Current Author Addresses: Drs. Pittet, Hugonnet, and Pessoa-Silva and Ms. Sauvan: Infection Control Program, University of Geneva Hospitals, 24 Rue Micheli-du-Crest, 1211 Geneva 14, Switzerland.

Dr. Simon: Unité d'Hygiène Hospitalière, Cliniques Universitaires Saint-Luc 10/1754, Avenue Hippocrate 10, 1200 Brussels, Belgium.

Dr. Perneger: Quality of Care Unit, University of Geneva Hospitals, and Institute of Social and Preventive Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland.

Author Contributions: Conception and design: D. Pittet, A. Simon, S. Hugonnet, C.L. Pessoa-Silva, V. Sauvan, T.V. Perneger.

Analysis and interpretation of the data: D. Pittet, S. Hugonnet, C.L. Pessoa-Silva, T.V. Perneger.

Drafting of the article: D. Pittet, S. Hugonnet, C.L. Pessoa-Silva.

Critical revision of the article for important intellectual content: D. Pittet, S. Hugonnet, C.L. Pessoa-Silva, T.V. Perneger.

Final approval of the article: D. Pittet, S. Hugonnet, T.V. Perneger.

Provision of study materials or patients: D. Pittet.

Statistical expertise: S. Hugonnet, T.V. Perneger.

Obtaining of funding: D. Pittet.

Administrative, technical, or logistic support: D. Pittet.

Collection and assembly of data: D. Pittet, A. Simon, V. Sauvan.

Ann Intern Med. 2004;141(1):1-8. doi:10.7326/0003-4819-141-1-200407060-00008
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Although the hand hygiene procedure is simple, its application by health care workers is a complex phenomenon that is not easily explained or changed (7, 12, 28). To our knowledge, our study is the first to concurrently evaluate the association of determinants of hand hygiene behavior, such as work conditions (accessibility of hand hygiene supplies and workload), demographic characteristics of health care workers, and individual cognitive factors, with actual hand hygiene adherence. Observed physician adherence was predicted mainly by variables related to the environmental context, social pressure, and the actual and perceived risk for cross-transmission and to a positive individual attitude toward hand hygiene.

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Hand hygiene and risk for occupational dermatitis
Posted on August 6, 2004
Frank H.W. Jungbauer
University Hospital Groningen
Conflict of Interest: None Declared

Handdermatitis is an occupational health problem among nurses and physicians. Frequent en prolonged exposure to water and soap is a major risk factor for developing handdermatitis. The spectacular progress of medical science with Semmelweis' insight on the need for hygiene in natal care has its drawback when it is not applied judiciously. Pittet et al published a study on hand hygiene among physicians in Ann Intern med 2004; 141:1-8. Similar to Pittet we performed a study among nurses and found a lack of consistency between the observed and reported handhygiene activities(1). We found that about one third of the wet work activities in nursing are hand hygiene activities, making hand hygiene activities a major risk factor for hand dermatitis. Pittet found that in only 57% of the situations where hand hygiene was necessary, it was applied correctly. When the frequency of hand hygiene activities has to increase, as Pittet suggests, it is important to introduce methods for hand hygiene that are both effective and less irritating for the skin. Pittet found that adherence to regulations of hand hygiene with a hand-rub increased when the hand-rub-solutions were easy to access. In addition to our observations of wet work in nurses we performed a study to compare the irritating affect of two additional hand hygiene regulations(2): 1. Use a hand alcohol in stead of water and soap in disinfecting procedures 2. Use gloves in wet activities such as patient washing, to prevent the hands to become wet and dirty We found a decrease in skin irritation when these regulations would be implemented. These results, combined with the higher hygiene performance of hand-rub solutions, as published by Winnefield(3), justify the conclusion that a hand-rub is the preferred disinfectant

Conflict of Interest:

None declared

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Summary for Patients

Hand-Washing Practices and Beliefs of Physicians

The summary below is from the full report titled “Hand Hygiene among Physicians: Performance, Beliefs, and Perceptions.” It is in the 6 July 2004 issue of Annals of Internal Medicine (volume 141, pages 1-8). The authors are D. Pittet, A. Simon, S. Hugonnet, C.L. Pessoa-Silva, V. Sauvan, and T.V. Perneger.


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