Skip to main content

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

  • Joan M. Duggan (a1) (a2), Sandra Hensley (a1), Sadik Khuder (a1), Thomas J. Papadimos (a2) and Lloyd Jacobs (a3)...

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.

Corresponding author
3120 Glendale Ave. Toledo, OH 43614 (
Hide All
1.Larson E, Mayur K, Laughon BA. Influence of two hand-washing frequencies on reduction in colonizing flora with three hand-washing products used by health care personnel. Am J Infect Control 1989;17:8388.
2.Boyce JM, Pittet D. Guidelines for hand hygiene in health-care settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Society for Healthcare Epidemiology of America/Association for Professionals in Infection Control/Infectious Diseases Society of America. MMWR Morb Mortal Weekly Rep 2002;51(RR-16):145.
3.Simmons B, Bryant J, Neiman K, Spencer L, Arheart K. The role of handwashing in prevention of endemic intensive care unit infections. Infect Control Hosp Epidemiol 1990;11:589594.
4.Salemi C, Canola MT, Eck EK. Hand washing and physicians: how to get them together. Infect Control Hosp Epidemiol 2002;23:3235.
5.Pittet D, Mourouga P, Perneger TV, et al. Compliance with handwashing in a teaching hospital. Ann Intern Med 1999;130:126130.
6.Dubbert P, Dolce J, Richter W, Miller M, Chapman S. Increasing ICU staff handwashing: effects of education and group feedback. Infect Control Hosp Epidemiol 1990;11:191193.
7.Bischoff WE, Reynolds TM, Sessler CN, Edmond MB, Wenzel RP. Handwashing compliance by health care workers. Arch Intern Med 2000;160:10171021.
8.Farr BM. Reasons for noncompliance with infection control guidelines. Infect Control Hosp Epidemiol 2000;21:411416.
9.Lipsett PA, Swoboda SM. Handwashing compliance depends on professional status. Surg Infect (Larchmnt) 2001;2:241245.
10.Pittet D, Simon A, Hugonnet S, et al. Hand hygiene among physicians: performance, beliefs, and perceptions. Ann Intern Med 2004;141:18.
11.Larson E, Killien M. Factors influencing handwashing behavior of patient care personnel. Am J Infect Control 1982;10:9399.
12.Murthy R, Denny R, Harold JG, Silka P. Achieving sustained hand hygiene compliance by physicians. In: Program and abstracts of the 45th Annual Meeting of the Infectious Diseases Society of America (San Diego). Abstract 566.
13.Baldamus W, Behrend H. Variations in absenteeism during the week: an index of employee morale. Nature 1950;165:831832.
14.Vahtera J, Kivimaki M, Pentti J. The role of extended weekends in sickness absenteeism. Occup Environ Med 2001;58:811822.
15.Larson EL, Early E, Cloonan P, Sugrue S, Parides M. An organizational climate intervention associated with increased hand washing and decreased nosocomial infections. Behavioral Med 2000;26:1422.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 26 *
Loading metrics...

Abstract views

Total abstract views: 282 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 19th November 2017. This data will be updated every 24 hours.