Hand hygiene in emergencies: Multiprofessional perceptions from a mixed methods based online survey in Germany

Area of Science:

• Healthcare-associated infections
• Infection control practices
• Medical education

Background:

• Hand disinfection compliance is critically low in emergency settings, with healthcare providers often prioritizing disposable gloves over disinfection.
• This practice is frequently justified by the perceived delay in life support procedures, despite simulation studies indicating higher achievable compliance.

Purpose of the Study:

• To investigate healthcare providers' attitudes towards hand disinfection and glove use during emergency situations.
• To identify barriers affecting adherence to hand hygiene protocols in critical care environments.

Main Methods:

• An anonymous online survey was conducted in Germany assessing attitudes and self-reported behaviors regarding the five moments of hand hygiene.
• Statistical analysis included paired t-tests, and qualitative data were analyzed using a single-coder approach.

Main Results:

• A low priority was assigned to hand hygiene moments WHO-1 (before patient contact) and WHO-2 (before aseptic procedures), even with awareness of associated risks.
• Self-assessment of hand hygiene practices was significantly higher than colleagues' assessments (p < 0.001).
• Wearing gloves was prioritized over disinfecting bare hands for WHO-3 (after body fluid exposure) in emergency contexts.

Conclusions:

• Hand disinfection before emergencies is de-prioritized and rationalized by the emergency context, irrespective of objective feasibility.
• Subjective and objective barriers to implementing essential hand hygiene moments (WHO-1, WHO-2) were identified, highlighting the need for targeted educational programs.