8įocus-group studies have highlighted differences in attitudes to hand hygiene between medical and non-medical hospital staff. 7 Also, doctors have influential positions in hospitals and their attitudes and behaviour disproportionately influence those of other staff. 6 Doctors' relatively poor compliance is important because, although doctors have fewer total patient contacts than nurses, they see more individual patients and perform most invasive procedures, providing relatively more opportunities for transmission of pathogens. The analysis of recent hand hygiene data by Azim and colleagues in this issue of the Journal shows that these differences are obscured, and the estimated overall compliance inflated by differential sampling of audited moments between doctors and nurses. Despite improvement since the National Hand Hygiene Initiative began in 2009 (from 46% and 68%, respectively), the gap remains. 3, 4 The latest Australian hand hygiene audit data, for the third period in 2013, 5 show that average compliance rates of doctors and nurses were 66% and 83%, respectively. Unfortunately, attempts to simplify can increase the confusion for example, the hand hygiene policy of the New South Wales health department, which merges moments 4 (after any non-procedural contact with a patient) and 5 (after contact with a patient's surroundings), 2 conflicts with the requirement to audit all five moments separately.ĭoctors have consistently been reported to be less compliant with hand hygiene practices than nurses. Nurses are more likely to understand the five moments because of repeated exposure to them - during in-service training and regular review of ward audit results - but doctors often avoid these opportunities, because of more pressing and important commitments. The “Five Moments For Hand Hygiene” 1 promoted by the World Health Organization are logical and uncomplicated, but some health care workers nevertheless find them confusing. Hospital infection prevention indices are improving, but reducing infection rates further requires professional culture change Statistics, epidemiology and research design.
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