Comparing observed with self-reported hand hygiene adherence among bedside nurses and physicians at two hospitals in the United States

Background Hand hygiene is a core component of infection prevention in healthcare settings. One potential reason for lack of adherence to recommended hand hygiene practices is erroneous self-perception. We aimed to compare perceptions about hand hygiene compliance with objective data. Methods Direct observations of hand hygiene performance by nurses and physicians during typical workflow in inpatient general medicine wards were conducted from 12 September 2022 to 27 October 2022 at two academic Veterans Affairs medical centers. Participants were surveyed regarding perceptions about their hand hygiene performance relative to recommended practices. Results Among nurses, hand hygiene was performed in 1,397/3,690 (37.9%) room entry and 2,159/4,012 (53.8%) room exit opportunities (combined adherence, 46.2%). For physicians, hand hygiene was performed in 1,016/1,237 (82.1%) room entry and 1,073/1,285 (83.5%) room exit opportunities (combined adherence, 82.8%). Surveys were collected from 92/161 nurses (57.1%) and 189/294 physicians (64.3%). Nurses self-reported compliance in 95.1% of recommended situations, while physicians self-reported 91.0%. Conclusions We found a disconnect between actual and perceived adherence to hand hygiene recommendations among bedside nurses and physicians in inpatient general medicine wards. This disconnect may be due to social desirability, self-serving, or overestimation biases, or time pressures. Awareness of such a disconnect may help policymakers increase hand hygiene rates.