Hand hygiene compliance by physicians: Marked heterogeneity due to local culture?

Background Physician compliance with hand hygiene guidelines often has been reported as insufficient. Methods The study was conducted in 2 hospitals (Hadassah Ein Kerem [EK] and Mt Scopus [MS]) in Jerusalem, Israel. Covert observations were conducted during morning rounds by trained observers. The data were recorded as the percentage of times that hand hygiene was applied out of the total contacts with patients. After the observational step, an intervention—providing an alcohol gel and encouraging its use—was instituted in several wards. Results Physicians' compliance with hand hygiene averaged 77% at MS and 33% at EK ( P < .001), and was characterized by a marked additional heterogeneity among wards. Rates of adherence ranged from as low as 4% in a gynecology ward to as high as 96% in a neonatal unit. Availability of a handwashing basin in the room and seniority status of the physician were associated with higher compliance rates but explained only a small part of the variation. Compliance improved significantly in 2 wards exposed to the intervention. Conclusion The remarkable heterogeneity in physicians' hand hygiene compliance among sites within the same institution is consistent with an important role of the local ward culture.