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Inverse Correlation Between Level of Professional Education and Rate of Handwashing Compliance in a Teaching Hospital

Published online by Cambridge University Press:  02 January 2015

Joan M. Duggan*
Department of Medicine, University of Toledo Health Sciences Campus, Toledo, Ohio Department of Anesthesiology, University of Toledo Health Sciences Campus, Toledo, Ohio
Sandra Hensley
Department of Medicine, University of Toledo Health Sciences Campus, Toledo, Ohio
Sadik Khuder
Department of Medicine, University of Toledo Health Sciences Campus, Toledo, Ohio
Thomas J. Papadimos
Department of Anesthesiology, University of Toledo Health Sciences Campus, Toledo, Ohio
Lloyd Jacobs
University of Toledo, University of Toledo Health Sciences Campus, Toledo, Ohio
3120 Glendale Ave. Toledo, OH 43614 (



To evaluate educational level as a contributing factor in handwashing compliance.


Observation of hand washing opportunities was performed for approximately 12 weeks before an announced Joint Commission on Accreditation of Healthcare Organizations (JCAHO) visit and for approximately 10 weeks after the visit. Trained observers recorded the date, time, and location of the observation; the type of healthcare worker or hospital employee observed; and the type of hand hygiene opportunity observed.


University of Toledo Medical Center, a 319-bed teaching hospital.


A total of 2,373 observations were performed. The rate of hand washing compliance among nurses was 91.3% overall. Medical attending physicians had the lowest observed rate of compliance (72.4%; P < .001). Nurses showed statistically significant improvement in their rate of hand hygiene compliance after the JCAHO visit (P = .001), but no improvement was seen for attending physicians (P = .117). The compliance rate in the surgical intensive care unit was more than 90%, greater than that in other hospital units (P = .001). Statistically, the compliance rate was better during the first part of the week (Monday, Tuesday, and Wednesday) than during the latter part of the week (Thursday and Friday) (P = .002), and the compliance rate was better during the 3 PM-1 1 PM shift, compared with the 7 AM-3 PM shift (P < .001). When evaluated by logistic regression analysis, non-physician healthcare worker status and observation after the JCAHO accreditation visit were associated with an increased rate of hand hygiene compliance.


An inverse correlation existed between the level of professional educational and the rate of compliance. Future research initiatives may need to address the different motivating factors for hand hygiene among nurses and physicians to increase compliance.

Original Articles
Copyright © The Society for Healthcare Epidemiology of America 2008

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