Volume 38, Issue 7 , Pages 579-580, September 2010
Do as I say, not as I do: Handwashing compliance of infectious diseases experts during influenza pandemic
Article Outline
We are living in the middle of an influenza pandemic, and infectious diseases experts all over the world have made an enormous effort to provide guidelines for how to control the situation. The most important single recommendation is to wash hands with water and soap. Epidemiologic evidence indicates that handwashing with soap (HWWS) prevents approximately 30% to 47% of children's diarrheas1 and 23% of respiratory infections.2 As the risk of catching respiratory tract infections is increased in public places, one would expect HWWS to be favored at toilets, the only places where washbasins and soap are available. We carried out an observational study on HWWS compliance among infectious diseases experts after toilet use during the current pandemic.
A group of Finnish infectious diseases specialists attended in September 2009 2 scientific conferences, the 26th Meeting of the Scandinavian Society on Antimicrobial Chemotherapy (SSAC) in Tromsø, Norway, and the International Congress on Antimicrobial Agents and Chemotherapy (ICAAC) in San Francisco, CA, USA. Tromsø represented a low-risk and San Francisco a high-risk pandemic influenza area; the scientific program in both meetings included lectures on H1N1v influenza. An observational study on hand hygiene compliance after toilet use was carried out among conference participants, mostly infectious diseases experts from different countries. At the SSAC meeting, 1 female and 1 male, and, at the ICAAC, 5 female and 3 male doctors observed washbasin areas in ladies' and men's rooms between lectures. They were briefed to conceal their role, pretending to be occupied with something else (combing hair, adding make-up, talking on the mobile phone—preferably in Finnish—rummaging through their bags, and other things). Findings were written down secretly.
The handwashing practices of 732 male and 752 female attendees, 1474 participants altogether, were evaluated (Table 1). The total compliance (HWWS) proved higher in the high-risk area (ICAAC) than in the low-risk area (SSAC) (78% vs 61%, respectively; P < .001 by Pearson χ2 test). No difference was noted between females, whereas males performed significantly weaker in the low-risk than the high-risk area (38% vs 69%, respectively; P < .001). At both meetings, males proved less compliant than females (38% vs 84%, respectively, in SSAC and 69% vs 87% in ICAAC, respectively; P < .001 for both). No difference was found in the frequencies of congress participants who did not wash their hands at all in ICAAC and SSAC (4% vs 3%, respectively, P = .74), but, in ICAAC, total noncompliance was more frequent among men than women (6% vs 2%, respectively; P < .001). Soap was used by handwashers more frequently in ICAAC than in SSAC (81% vs 63%, respectively; P < .001), especially by men (73% vs 39%, respectively; P < .001).
Table 1. Hand hygiene compliance among infectious diseases experts in 2 international meetings after pandemic declaration: International Congress on Antimicrobial Agents and Chemotherapy (ICAAC), September 2009, USA, and Scandinavian Society on Antimicrobial Chemotherapy (SSAC), September 2009, Norway
| No handwashing, n (%) | Handwashing with water only, n (%) | Handwashing with water and soap, n (%) | |
|---|---|---|---|
| ICAAC | |||
 Females (n = 702) | 11 (2) | 88 (13) | 603 (86) |
| Males (n = 672) | 39 (6) | 168 (25) | 465 (69) |
| Total (n = 1374) | 50 (4) | 256 (19) | 1068 (78) |
| SSAC | |||
| Females (n = 50) | 2 (4) | 6 (12) | 42 (84) |
| Males (n = 50) | 1 (2) | 30 (60) | 19 (38) |
| Total (n = 100) | 3 (3) | 36 (36) | 61 (61) |
The overall hand hygiene compliance among the infectious diseases experts attending these congresses proved relatively high. However, because infectious diseases experts act as role models within hand hygiene, even the small proportion of total noncompliance can be regarded as unforgivable. A proper handwashing technique involves the use of soap, which intensifies rubbing and rinsing and enhances the antimicrobial effect. However, even among experts, personal compliance may falter for various reasons; at the SSAC meeting, for example, they needed to extend an arm to reach the dispenser on the wall, whereas, at the ICAAC, soap was available next to the water tap.
Despite the universally attested importance of hand hygiene in preventing many infectious diseases, HWWS is not, however, a common practice. Worldwide, hands are washed with soap on only about 5% to 15% of key occasions, such as after the toilet.3 Our observations would confirm earlier findings among health care workers, indicating that knowledge and practice in hand hygiene are not directly associated.4, 5 As for handwashing per se, only minor negligence was revealed in the present study. Regarding the use of soap, however, the results indicate that even infectious specialists need to sharpen up, especially men.
We did not remark on noncompliance, but, of course, we silently hoped that nonwashers and nonsoap users applied their personal pocket-size alcohol handrub afterwards, outside the toilet. Some studies have shown improved hand hygiene in situations where health care workers believe others are watching them.5 With this report, we strongly encourage even health care professionals to improve their hand hygiene. Watch out—you never know who of your dear colleagues and friends is observing your hand hygienic practices. After all, this is also a matter of professional credibility!
References
- Hand washing for preventing diarrhoea. Cochrane Database Syst Rev. 2008;23:CD004265
- . Evidence that handwashing prevents respiratory tract infection: a systematic review. Trop Med Int Health. 2006;11:1–10
- . Protecting children from diarrhoea and acute respiratory infections: the role of handwashing promotion in water and sanitation programmes. WHO Reg Health Forum. 2003;7:42–47
- . Opinions, knowledge and self-reported practices related to infection control among nursing personnel in long-term care settings. Am J Infect Control. 1994;22:367–370
- Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Lancet. 2000;356:1307–1312
Conflicts of interest: None to report.
PII: S0196-6553(10)00145-8
doi:10.1016/j.ajic.2010.03.001
© 2010 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc All rights reserved.
Volume 38, Issue 7 , Pages 579-580, September 2010
