Hand hygiene compliance: the elephant in the room

Introduction: Hand hygiene compliance rates for medical staff are consistently lower than those for nurses. Strong leadership to improve compliance has been repeatedly called for, but studies exploring medical staff leadership influence are limited. The qualitative study reported here aimed to explore the perceptions that medical staff have of their clinical leaders and the extent to which they influence hand hygiene practice in their clinical units, and to compare this with unit specific compliance data.

Method: Thirty junior doctors from a major tertiary hospital were interviewed or surveyed to uncover their perceptions of clinical leadership and its influence on hand hygiene behaviours. Compliance data for their clinical areas for the corresponding period was obtained and compared with their views on the influence of leadership on hand hygiene behaviour.

Findings: Consultants, rather than infection control nurses, were seen to have the most influence over medical hand hygiene practices. The unit that scored the best on compliance was also the one where the consultant was perceived to have the most influence.

Conclusions: Junior medical staff know that hand hygiene is important but the extent to which they comply with it depends on the influence of the consultant. Infection control staff need to engage consultants in order to improve medical compliance rates, rather than directing their efforts to medical staff in general.