Evalutation of hand hygiene compliance in medical educational videos

Abstract

Introduction / objectives: Hand hygiene (HH) is widely regarded as the single most effective measure to prevent healthcare-associated infections. However, physicians' adherence to HH remains poor. Lack of knowledge regarding the proper indications is a known factor contributing to low compliance. However, teachings regarding this basic safety procedure are often overlooked when designing teaching material. Methods: Observational study of clinical videos published in the New England Journal of Medicine between Apr. 2006 and Dec. 2010 to measure reference to HH as recommended by WHO guidelines. An opportunity was defined as a need to perform HH directly related to the procedure. Results: 29 videos (total running time, 3h42min) depicting 17 sterile, 11 aseptic, and 5 clinical procedures were reviewed. Sixty-six opportunities to explicitly mention the need to perform HH were recorded. Indication to perform HH was properly mentioned 24% (16/66) of time. Proper reference to HH was higher before aseptic procedures (9/14 opportunities [64%]) and before performing a sterile task (7/16 opportunities [43%]). However, explicit indication to perform HH before touching a patient, after body fluid exposure and after touching a patient were never mentioned. Hand washing was more frequently mentioned than hand rubbing with an alcohol-based solution (ratio, 6:1). Additional information regarding HH was present in 3/29 (10%) of written supplements. Respect of guidelines regarding jewellery was high (28/29 videos). Gloves were uniformly used whenever indicated. However, 10 of the 29 videos (34%) depicted ≥1 sequence in which gloves were used despite a clear need to do so. Conclusion: There is a need to adequately portray proper hand hygiene and glove use in teaching material aimed at physicians.