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Year : 2014  |  Volume : 27  |  Issue : 3  |  Page : 297-298

Hand hygiene and health care hierarchy: A resident's perspective

1 Director of Research Institute and Business Development Hotel Dieu Hospital, Kingston, Ontario, Canada
2 Research Assistant, Research Institute, Hotel Dieu Hospital, Kingston, Ontario, Canada

Date of Web Publication26-Feb-2015

Correspondence Address:
Vic Sahai
Hotel Dieu Hospital, 166 Brock St., Kingston, Ontario, K7L 5G2
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1357-6283.152195

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How to cite this article:
Sahai V, Eden K, Glustein S. Hand hygiene and health care hierarchy: A resident's perspective. Educ Health 2014;27:297-8

How to cite this URL:
Sahai V, Eden K, Glustein S. Hand hygiene and health care hierarchy: A resident's perspective. Educ Health [serial online] 2014 [cited 2023 Jun 6];27:297-8. Available from:

Dear Editor,

In the August 2012 (Vol. 33, No. 8) issue of Infection Control and Hospital Epidemiology, Samuel et al. published an article entitled Hierarchy and Hand Hygiene: Would Medical Students Speak Up to Prevent Hospital-acquired Infection?

Samuel et al. [1] point out that hand hygiene (HH) is an important factor in reducing healthcare-associated infections (HAIs) and that despite several major campaigns, adherence remains low. HH among Canadian healthcare providers is poor, with compliance rates as low as 25%. [2] It has also been pointed out that learners play an important role in reducing patient harm. [3]

We conducted a cross-sectional study, approved by Queen's University Health Sciences Research Ethics Board, that assessed medical residents' willingness to point out poor HH practices to others. These included health care professionals, patients' family members, and volunteers.

An anonymous survey was administered to Queen's University family medicine residents. Demographic information such as age, sex, and medical school attended was collected for residents in this two-year program.

Data were analyzed using IBM SPSS (2012) Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.

Of 150 Queen's University family medicine residents in the program, 89 (59%) were available and accepted the invitation to complete the survey. This included 46 (52%) first year residents and 43 (48%) second year residents. Fifty-seven (64%) of the respondent residents were female and 32 (36%) were male. Their mean age was 29.5 years. Sixty-six (74%) of the respondents were born in Canada, while 23 (26%) were not.

A total of 26 (30%) of those surveyed agreed that they would feel comfortable reminding a physician to perform HH if they witnessed a situation when the physician neglected to do so [Table 1]. The percentage increased as the perceived hierarchy of the offender [4] decreased. Accordingly, 32 (37%) of the residents were willing to speak up to nurses; 31 (36%) to administrators; 35 (40%) to paramedics; and 38 (44%) to either dietitians or allied health professionals. Notably, 52 (60%) and 54 (62%) were willing to speak up to volunteers and patients' family members, respectively. Foreign students (48%) were more likely to speak up to physicians than their Canadian-born counterparts (24%) [OR = 2.84 (1.02, 7.92), χ2 = 4.16, df = 1, P = 0.04]. However, age did not relate to residents' willingness to remind others about HH (P = 0.97).
Table 1: Residents' reported willingness to approach hand hygiene offenders

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Further, 86 (98%) of the respondent residents reported that they had been involved in treating a patient with an HAI and of these, 39 (45%) agreed that better HH practices could have prevented this HAI. Of this subgroup that had witnessed a preventable HAI, 62% stated that they would be willing to approach physicians about neglecting HH, compared with only 39% of those who felt that the HAI they witnessed was not related to HH [OR = 2.50 (1.0, 6.5), χ2 = 3.6, df = 1, P = 0.5].

We found that the majority of family medicine residents surveyed reported that they were willing to speak to volunteers and family members of patients about the importance of HH. However, as in the study by Samuel et al., residents' willingness to speak to offenders declined for individuals above them in the medical hierarchy. Despite the hierarchies that exist within an educational environment, steps need to be taken to ensure that learners are able to remind a healthcare provider to wash their hands without fears about repercussions.

  Acknowledgements Top

The authors would like to acknowledge the assistance of Karen Schultz at the Queen's University Centre for Studies in Primary Care and Lindsey Jarrett at the Queen's University Department of Family Medicine in survey administration. The authors also thank Kelly Monaghan and Ian Kudryk at Hotel Dieu Hospital and Lisa Hope at Kingston General Hospital for their feedback during questionnaire development.

  References Top

Samuel R, Shuen A, Dendle C, Kotsanas D, Scott C, Stuart RL. Hierarchy and hand hygiene: Would medical students speak up to prevent hospital-acquired infection? Infect Control Hosp Epidemiol 2012;33:861-3.  Back to cited text no. 1
DiDiodato G. Has improved hand hygiene compliance reduced the risk of hospital-acquired infections among hospitalized patients in Ontario? Analysis of publicly reported patient safety data from 2008 to 2011. Infect Control Hosp Epidemiol 2013;34:605-10.  Back to cited text no. 2
Seiden SC, Gaivan C, Lamm R. Role of medical students in preventing patient harm and enhancing patient safety. Qual Saf Health Care 2006;15:272-6.  Back to cited text no. 3
Tiedens LZ, Unzueta MM, Young MJ. An unconscious desire for hierarchy? The motivated perception of dominance complementarity in task partners. J Pers Soc Psychol 2007;93:402-14.  Back to cited text no. 4


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