Overestimation of personal hand hygiene performance and barriers to hand hygiene among healthcare providers

Hand hygiene (HH) performance in our facility declined during the COVID-19 pandemic and failed to return to baseline despite a widespread education campaign and increased HH rounding. To better understand provider perceptions and inform future interventions, we conducted a survey examining self-evaluation of HH performance.

The survey assessed perceived HH performance relative to peers, opportunities for improvement, factors causing variation in personal HH practice (workload/acuity, time of day, and patient characteristics), and burnout using a validated, single-item scale. Surveys were conducted in-person with clinical providers on high-performing and lower-performing units. Non-clinical staff were excluded. Self-perception of performance was compared against other variables using the Kruskal-Wallis test, using SAS 9.4, Cary, NC.

One hundred surveys were completed. The majority of those surveyed believed themselves to be in the top quartile of HH performers (87%). The actual HH compliance measured on these 4 units for 1/2024-11/2024 was 65% based on 7,436 directly-observed opportunities. No one selected bottom quartiles. There was no difference in perceived performance by unit (P = .4006), years of experience (P = .9679), or burnout (P = .2621).

HH performance was perceived to be better than average by the majority of inpatient healthcare providers surveyed, despite data from these units indicating opportunities. Further improvement in HH will be difficult without efforts to move perception closer to reality for individual healthcare providers.