Hand Hygiene: Doctors’ Hands Dirtier When No One Is Watching, Study Finds

In a world transfixed by the onset of infectious diseases such as the Zika virus, the lives of not only patients but society at large are in the hands of brave doctors and nurses in hospitals, for whom the highest level of personal hygiene is professionally mandated. While we trust — almost unquestioningly -0 that they maintain it, a recent hand hygiene study found that even doctors’ hands are dirtier when no one is watching. The study, undertaken by California-based Santa Clara Valley Medical Center, suggests that doctors, just like the rest of us, behave differently — behave better — when they are being monitored, a phenomenon called the “Hawthorne Effect.”

It was found that hand hygiene compliance at SCVMC changed dramatically when doctors and nurses knew they were being evaluated compared to when they did not.

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The idea of doctors and nurses only upholding hand hygiene compliance when monitored, as per the Hawthorne Effect, is concerning. [Photo by Christopher Furlong/Getty Images]

The doctors’ hand hygiene study was presented today at the Association for Professionals in Infection Control and Epidemiology (APIC) conference, and a statement was issued describing the “surprising” findings about the observation of hand hygiene practices in hospitals.

“The infection prevention department at Santa Clara Valley Medical Center in San Jose, California measured the differences in hand hygiene compliance rates when healthcare workers recognized the observers and when they did not…”

“The study found a difference of more than 30 percent in hand hygiene compliance depending on whether or not they recognized the auditors,” said the statement issued by APIC.

Nurses’ and doctors’ hand hygiene is considered one of the simplest, yet most important, factors in the containment of viral epidemics. Just as children spread colds, the flu, chicken pox, and measles, viruses and bacteria like Zika, swine flu, and Ebola are easily spread by hand-to-hand, -mouth or -skin contact, putting health professionals like doctors at the front line of defence against epidemic outbreaks. The priority in any case is to halt the spread of viruses by preventing transmission from infected persons to any others. This is particularly important for the health and safety of the vulnerable sick and injured in hospitals, but affects the millions of people at risk outside of them.

So, just how worried should we be that hand hygiene for doctors is better when they’re being watched, and their hands dirtier when no one is watching? ABC News explains that the biggest challenge is not hand hygiene, but human behavior.

“Because infection-causing bacteria are often carried from patient to patient on the hands of health care workers, breaking this chain of transmission is a top priority in hospitals nationwide. But this study — and many others — indicate that while the principle of hand hygiene is simple, human behavior is one of the hardest things to change,” said ABC News.

doctors hand hygiene prevents spread of epidemic such as zika virus
Women infected by Zika virus while pregnant often bear children with Microcephaly, and doctors must ensure they do not transmit the virus. [Photo by Mario Tama/Getty Images]

One of the recognizable nurses at SCVMC during the trial, Lisa Hansford, told ABC that she witnessed these behavioral changes regarding hand hygiene first-hand.

“When we would come on the floor, I would notice that the nurses or providers were not using the alcohol,” said Hansford to ABC, referring to the hand hygiene practice of dousing hands with alcohol to kill bacteria. “Then they would glance up and see me and bend over backwards to lather up.”

The Hawthorne Effect study come alongside another hospital-based interrogation of visual and non-visual triggers for hand hygiene compliance by health professionals presented at APIC this weekend. The findings show that medical imagery provoking disgust — for example, bacterial or viral cells under the microscope — impel doctors and nurses to wash their hands and generally uphold a higher standard of hand hygiene. Perhaps doctors’ hands — dirtier when no one is watching, according to SCVMC’s findings — would be cleaner with a little more “ick factor” imagery in the workplace.

[Photo by Oscar Siagian/Getty Images]