Program Schedule

Clean Hands Safe Hands: Behavioral Differences Between Doctors, Nurses and Allied Health Workers

Session: Poster Abstract Session: Hand Hygiene
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC


Although hand hygiene (HH) is known to be central in reducing healthcare-associated infections, it is not consistently practiced. Audit reports in our hospital have shown that adherence rates have persistently been suboptimal at 50-60%. More importantly, the audits also showed differences in compliance rates between the healthcare workers (HCWs): physicians, nurses and allied health professionals (AH). Understanding why these differences are present may be key to designing better HH compliance strategies.


This is a cross-sectional study of physicians, nurses and AH in Tan Tock Seng Hospital Singapore using an anonymous questionnaire survey. Personal motivation and cognitive domains influencing HH compliance were assessed and compared between the three groups.


We obtained 1064 valid surveys for analysis. Nurses reported the highest HH compliance (40.2% vs physicians 22.8%, AH 31.0%, p<0.01) and motivation for improving their own HH compliance compared to the other groups (98.9% vs physicians, 96.5% and AH, 94.1%, p<0.01).

Seven cognitive domains were identified from the survey: 1. Positive knowledge, attitude and behaviors (kno), 2. Personal motivators and enablers (pers), 3. Emotional motivators (emo), 4. Need for external reminders (ext), 5. Barriers to HH (bar), 6. Preference for alcohol hand-rub (alc) and 7. Embarrassed if reminded (emba). Of these, kno, bar, pers, ext and emo were independently associated with good HH compliance. The domains pers and ext were also independently associated with the perceived ability to improve HH compliance (Table 1).

In a subgroup analysis of each HCW, we found that factors significantly associated with HH compliance were different between the groups (Table 2). In nurses, pers was positively associated with HH compliance, while ext was associated negatively. In physicians, kno was positively associated with compliance, while ext, emba, bar were negatively associated. Lastly, the AH group's HH compliance was only associated with emo (positive).


Our study has shown differences in socio-cognitive domains influencing HH compliance between groups of HCWs. Understanding these differences would permit a more targeted approach to improve HH compliance in hospitals.

Andrew Green, MD1, Muhamad Alif Ibrahim2, Chengzi Chow2, Bee Fong Poh, RN3 and Angela Chow, MBBS, MMed, Grad Dip (FM), MS (Epi), FAMS2, (1)Preventive Medicine, National University Hospital Systems, Singapore, Singapore, (2)Clinical Epidemiology, Tan Tock Seng Hospital, Singapore, Singapore, (3)Infection Control, Tan Tock Seng Hospital, Singapore, Singapore


A. Green, None

M. A. Ibrahim, None

C. Chow, None

B. F. Poh, None

A. Chow, None

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