Is handwashing teachable?: failure to improve handwashing behavior in an urban emergency department

To assess handwashing frequency according to CDC recommendations; and to test a simple intervention to increase handwashing compliance, designed for the unique setting of the ED.

A prospective, observational, before-and-after study design with a convenience sampling technique was used to assess handwashing compliance in the ED of a 742-bed urban, university-affiliated medical center with 65,000 visits annually. Emergency physicians (EPs), registered nurses (RNs), and nurse practitioners (NPs) were informed that their patient encounters were being monitored, but the nature of the study was kept confidential. A single observer evaluated individual EPs, RNs, and NPs in one-, two-, or three-hour blocks, recording compliance with CDC handwashing recommendations. After two weeks, brightly colored signs with CDC recommendations for handwashing were posted at all sinks and a copy of a related publication on handwashing by medical personnel was distributed to all staff. Handwashing behaviors were again observed.

A total of 252 situations requiring handwashing were observed, 132 pre-intervention and 120 post-intervention. Total handwashing, handwashing by each staff designation, and handwashing in each CDC recommendation category--except handwashing between contacts with different patients--all showed tendencies toward improvement, though none was significant (p > 0.05). Both the NPs and RNs demonstrated significantly higher adherence to recommended handwashing between patients after the intervention than did the EPs (85% vs 71% vs 31%, p < 0.01 and p < 0.05, respectively).

Despite a trend in improvement of compliance with CDC recommendations, handwashing among ED personnel remained unacceptably low.