Medical Students Unwilling to Speak Up to Senior Staff Regarding Poor Hand Hygiene Practices

In a letter to the editor published in the August 2012 issue of Infection Control and Hospital Epidemiology, Rohit Samuel, of Monash University in Melbourne, Victoria, Australia, and colleagues, conducted a cross-sectional study assessing the willingness of medical students to speak up about subpar hand hygiene practices among their colleagues and supervising physicians.

An anonymous survey was sent to Monash University medical students undertaking clinical placement from Jan. 23 to March 2, 2012. Survey questions involved demographic information, willingness to remind medical personnel to perform hand hygiene, reasons for not speaking up, perceived reactions of medical personnel and the individual student to being reminded to perform hand hygiene, and students beliefs about their role in preventing healthcare-acquired infections and the importance of hand hygiene.

A total of 209 students participated in the study; 83 percent reported that they were willing to speak up to fellow students about inadequate hand hygiene. However, this number decreased for those who were willing to do so to interns (30 percent), residents (16 percent), registrars (9 percent), and consulting physicians (6 percent). Female students were more likely to speak up to fellow medical students than were their male counterparts. There were no differences observed for medical year or country of birth in terms of students willingness to speak up.

The researchers report that the primary reason why students would not speak up was a reluctance to question senior staff (from 64 percent for interns to 74 percent for consulting physicians. This was followed by an unwillingness to interrupt (from 28 percent to 12 percent) and embarrassment (from 25 percent to 9 percent). Only 5 percent of students were concerned about how their actions might affect future job assessments.

Rohit, et al. (2012) conclude that their study demonstrated the unwillingness of medical students to speak up to senior staff regarding inappropriate hand hygiene, and they add that the hierarchical culture within the healthcare setting must be addressed to ensure that an equal voice is given to all members of the treating team so that the best outcomes in patient care are achieved.

Reference: Rohit S, et al. Hierarchy and Hand Hygiene: Would Medical Students Speak Up to Prevent Hospital-Acquired Infection? Infection Control and Hospital Epidemiology. August 2012.