Education for Health

: 2015  |  Volume : 28  |  Issue : 2  |  Page : 148--149

Hand hygiene and health care hierarchy by year of medical education

Vic Sahai1, Karen Eden2, Shari Glustein2,  
1 Director of Research Institute and Business Development at Hotel Dieu Hospital; Assistant Professor, Department of Public Health Sciences, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
2 Research Assistant at Hotel Dieu Hospital Research Institute, Kingston, Ontario, Canada

Correspondence Address:
Vic Sahai
Hotel Dieu Hospital Research Institute, 166 Brock Street, Kingston, Ontario, K7L 5G2

How to cite this article:
Sahai V, Eden K, Glustein S. Hand hygiene and health care hierarchy by year of medical education.Educ Health 2015;28:148-149

How to cite this URL:
Sahai V, Eden K, Glustein S. Hand hygiene and health care hierarchy by year of medical education. Educ Health [serial online] 2015 [cited 2021 Mar 3 ];28:148-149
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Full Text

Dear Editor,

In the December 2014 (vol. 27, no. 3) issue of Education for Health, we [1] published a Letter to the Editor entitled Hand Hygiene and Health Care Hierarchy: A Resident's Perspective. We pointed out that Family Medicine residents were hesitant to approach other medical professionals who failed to perform Hand Hygiene (HH) as required in a health care setting. The impetus for the first letter was that HH among health care workers was poor and continues to be so despite major targeted campaigns.[2] As noted, learners can play an important role in reducing patient harm,[3] however they are often reluctant to do so in regards to HH offenders.[1]

We conducted a cross-sectional survey, approved by Queen's University Health Sciences Research Ethics Board, which assessed self-reported intentions of medical school students and residents to point out improper HH practices to others in the health care setting. Is this reluctance inherent in the students or an artifact of the hierarchy that exists in a medical educational setting?

Primary data was collected via a questionnaire that sought to obtain 3 types of data: (1) Demographic (age, gender, country of origin), (2) attitudinal (attitude/views on HH in healthcare settings) and (3) behavioral (when and who would the respondent approach regarding poor HH practice). The questionnaire (with the exception of the demographic data) was comprised of 5-point Likert scale questions (Strongly Disagree, Disagree, Undecided, Agree, Strongly Agree) and one open-ended knowledge question. As noted above, respondents' answers to the behavioral questions were based on self-reported intentions rather than actual behavior.

Data were analyzed using IBM SPSS (2012) Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.

A sample of 335 Queen's University medical students and Family Medicine residents took part in the survey. The medical students included 84first years, 75 second years, 38 third years, and 51 in the fourth or final year. Their participation rate was 69% (248/360 invited). Of the residents, 44 were first years and 43 second years. Their participation rate was 59% (89/150 invited). Overall, 55% of the students and residents were female and 45% were males. The median age was 25 years.

Overall, 171 (37%) of respondents indicated that they would feel comfortable reminding a physician to practice proper HH if they noticed that the physician had neglected to do so. The first year medical students had the highest reported comfort level (56%) in regards to approaching a physician who failed to perform HH. Although students in each subsequent year of the medical school program had lower reported comfort levels relative to first year students, overall the comfort level increased again with advancing years of education and residency, as noted by the decreasing odds ratio relative to first year students, resulting in a significant Chi-square test for trend (χ2 = 7.27, P = 0.007) [Table 1].{Table 1}

A previous study suggests that medical students begin medical school as idealists [4] and we note in this study that first year medical students were more apt to approach a physician who had neglected to perform HH compared to more advanced learners. Although our study focusses on intended self-reported behaviours which have been shown to be overstated relative to actual behaviours,[5] we note that the self-reported percentage dropped from 56.6% in first year to 10.5% in third year, rising only to 34.9% in the second year of residency. This suggests that the real, or perceived, power differential and resulting hierarchy within the educational setting prevents learners from approaching physicians who do not practice proper HH, thus the reluctance is an artifact of the hierarchy that exists in the medical educational setting rather than inherent in the students. If learners are to make a difference in patient care and safety, they must be encouraged to speak up in such situations, despite the hierarchy that exists.


We acknowledge the assistance of Dr. Lindsay Davidson at the Queen's University School of Medicine, Lindsey Jarrett at the Queen's University Department of Family Medicine and Karen Schultz at the Queen's University Centre for Studies in Primary Care.


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5Haas JP, Larson EL. Measurement of compliance with hand hygiene. J Hosp Infect 2007;66:6-14.