Saturday, June 02, 2012

Peer pressure teaches germ theory?

I post this abstract without comment.  I welcome your observations, though, about what this might mean about the effectiveness of education of health care professionals.  The photo above comes from an old blog post.  The disk on the left shows bacteria colonies that grew from my hand before it was washed with a disinfectant. The disk on the right shows the number of colonies that grew from my hand after it was cleaned with the waterless, alcohol-based antiseptic that is in dispensers outside every patient room in my former hospital.

BMJ Qual Saf. 2012 Jun;21(6):499-502. Epub 2012 Feb 22.

Getting doctors to clean their hands: lead the followers.


Division of Infectious Diseases, Baystate Medical Center, 759 Chestnut Street, Springfield, MA 01199, USA;



Despite ample evidence that hand hygiene (HH) can reduce nosocomial infections, physician compliance remains low. The authors hypothesised that attending physician role modelling and peer pressure among internal medicine teams would impact HH adherence.


Nine teams were covertly observed. Team member entry and exit order, and adherence to HH were recorded secretly. The mean HH percentage across encounters was estimated by compliance of the first person entering and exiting an encounter, and by the attending physician's HH compliance.


718 HH opportunities prior to contact and 744 opportunities after contact were observed. If the first person entering a patient encounter performed HH, the mean compliance of other team members was 64%, but was only 45% if the first person failed to perform HH (p=0.002). When the attending physician performed HH upon entering the patient encounter, the mean HH compliance was 66%, but only 42% if the attending physician did not perform HH (p<0.001). Similar results were seen on exiting the room. The effects of the first person were not driven solely by the attending physician's HH behaviour because the attending physician was first or second to enter 57% of the encounters and exit 44% of the encounters.


If the first person entering a patient room performs HH, then others were more likely to perform HH too, implying that peer pressure impacts team member HH compliance. The attending physician's behaviour also influenced team members regardless of whether the attending physician was the first to enter or exit an encounter, implying that role modelling impacts the HH behaviour of learners. These findings should be used when designing HH improvement programmes targeting physicians.


Marilyn Morrissey said...

From Facebook:

As a nurse, this is easy to understand and a brilliant observation. Medicine is completely hierarchical. Behavior is modeled, mimicked and passed on. I'd be interested to know if gender plays any role. If the attending is female, is HH compliance as high?

Anonymous said...

Given the first person effect irrespective of hierarchy, I wonder if a large part of it was just a reminder instead of peer pressure?

Recently I was a patient in an ER; all primed and rehearsed to object if the Dr. did not wash his hands. Therefore I was almost disappointed when the first thing he did upon entering was to wash his hands! But he sure got top marks from me on the subsequent patient survey!


Anonymous said...

We are expecting, and toured the Labor & Delivery dept, where I was pleased to note the waterless cleaner dispensers right on the outside of the room door, which led me to think that it would be remembered more often. However, now I'm wondering if that won't be a bad thing, because as we are in the room, it will be harder for me to figure out if someone entering will have used the dispenser...I'll have to pay close attention for sure.