Division of Infectious Diseases, Baystate Medical Center, 759 Chestnut Street, Springfield, MA 01199, USA.
BMJ Qual Saf. 2012 Jun;21(6):499-502. doi: 10.1136/bmjqs-2011-000396. Epub 2012 Feb 22.
Despite ample evidence that hand hygiene (HH) can reduce nosocomial infections, physician compliance remains low. The authors hypothesised that attending physician role modelling and peer pressure among internal medicine teams would impact HH adherence.
Nine teams were covertly observed. Team member entry and exit order, and adherence to HH were recorded secretly. The mean HH percentage across encounters was estimated by compliance of the first person entering and exiting an encounter, and by the attending physician's HH compliance.
718 HH opportunities prior to contact and 744 opportunities after contact were observed. If the first person entering a patient encounter performed HH, the mean compliance of other team members was 64%, but was only 45% if the first person failed to perform HH (p=0.002). When the attending physician performed HH upon entering the patient encounter, the mean HH compliance was 66%, but only 42% if the attending physician did not perform HH (p<0.001). Similar results were seen on exiting the room. The effects of the first person were not driven solely by the attending physician's HH behaviour because the attending physician was first or second to enter 57% of the encounters and exit 44% of the encounters.
If the first person entering a patient room performs HH, then others were more likely to perform HH too, implying that peer pressure impacts team member HH compliance. The attending physician's behaviour also influenced team members regardless of whether the attending physician was the first to enter or exit an encounter, implying that role modelling impacts the HH behaviour of learners. These findings should be used when designing HH improvement programmes targeting physicians.
尽管有大量证据表明手部卫生（HH）可以减少医院感染，但医生的依从率仍然很低。作者假设内科团队中的主治医生的榜样作用和同伴压力会影响 HH 的依从性。
对 9 个团队进行了秘密观察。秘密记录团队成员的进入和离开顺序以及 HH 的依从性。通过进入和离开一个接触点的第一个人的 HH 依从性，以及主治医生的 HH 依从性，估计接触前和接触后的 HH 百分比。
观察到 718 次 HH 机会，744 次 HH 机会在接触前和接触后。如果第一个进入患者接触点的人进行 HH，其他团队成员的平均依从率为 64%，但如果第一个人不进行 HH，则依从率仅为 45%（p=0.002）。当主治医生在进入患者接触点时进行 HH，平均 HH 依从率为 66%，但如果主治医生不进行 HH，则依从率仅为 42%（p<0.001）。离开房间时也出现了类似的结果。第一个人的影响不仅仅是由主治医生的 HH 行为驱动的，因为主治医生是 57%的接触点的第一个或第二个进入者，44%的接触点的第一个或第二个离开者。
如果第一个进入患者房间的人进行 HH，那么其他人也更有可能进行 HH，这意味着同伴压力会影响团队成员的 HH 依从性。主治医生的行为也会影响团队成员，无论主治医生是否是第一个进入或离开接触点，这意味着榜样作用会影响学习者的 HH 行为。在设计针对医生的 HH 改进计划时，应考虑这些发现。
