Manual Medico-Legal Issues in Infectious Diseases: Guide For Physicians

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It is unlikely that they will get an infection if they do not wash their hands. The risk for infecting a patient from one episode of noncompliance with hand hygiene practices is small. However, the patient bears the cumulative risk of all episodes of noncompliance, and there are a lot of issues regarding the perception of patient risk.

Medico-Legal - Duty to notify specified diseases

The benefit accrues to the patient. Many studies have shown that the principal reason HCWs do not wash their hands enough is because they are too busy, or there are not enough hand rub dispensers available, Landon said, adding that she does not think this is the problem. He compared it with the use of seatbelts: Most people do not even think about putting the seatbelt on when they get into a car. They do it on a subconscious level, and they are usually not even aware they put it on. However, for some, adoption of these guidelines means rethinking current habits.

With this positive deviance, you can slowly change the culture to make good hand hygiene the expectation. The gold standard in monitoring hand hygiene compliance is direct observation, Landon said, usually by infection control practitioners or a dedicated person such as the nursing manager of a group. But the reliability of this method to measure true, actual compliance with hand hygiene is questionable.

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Hand hygiene compliance increases dramatically when these observers, who are usually well known to the staff, are circulating in the unit, Landon said. Then compliance rates decline when those people are no longer around. In one study, Landon and colleagues hired a new student for hand hygiene observation in the same unit that a well-known practitioner had recently observed. It is the classic Hawthorne effect, Edmond said. People change their behavior when they know they are being watched.

In addition, another pitfall of direct observation is that it is difficult to observe a significant fraction of the total number of hand hygiene opportunities, he said, which in any given hospital on any given day is huge. Price also said any type of feedback is one of the most tried and true methods to make sure HCWs are practicing hand hygiene.

Many HCWs do not realize when they are making any errors. This can be done with direct observation, and there are also automated technologies to measure compliance.


Research is underway to identify more objective and reliable methods to measure hand hygiene compliance. There are many potential systems to accomplish this, each with their own benefits and drawbacks. One method for this is to have HCWs wear a wristband or badge that gives reminders to do hand hygiene. The HCW would receive a printout of their individual compliance rate in real time.

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However, in a recent study of a badge system utilizing radiofrequency identification RFID tracking, the researchers found that the accuracy for identifying hand hygiene events in a real-life clinical setting was only Another tool being evaluated is a counter that tracks how many times a soap or hand sanitizer dispenser is used.

Larson said a group monitoring system such as this is more in line with what is trying to be accomplished: creating an entire culture of patient safety so that everyone feels responsible. These systems are still investigational, however, and one of the drawbacks is that they require new technological platforms.

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Monitoring hand hygiene is only the first step. Policies also must be in place to hold people accountable for the hand hygiene. The Joint Commission recommends an approach that includes direct observation by different observers on a rotating basis, Landon said. The approach also includes an accountability piece: If hand hygiene has not improved, the offender receives warnings and undergoes other reinforcements such as online classes or discussions with an infection control committee member to encourage them to wash their hands.

Principles of medical law and ethics

The system also utilizes a human resources disciplinary system: After enough warnings, people can lose their jobs for not washing their hands. Price said the Agency for Healthcare Research and Quality and the CDC have produced materials to incorporate infection prevention into medical education, and many HCWs are required to regularly retake an infection control test module that incorporates in-depth information on hand hygiene. Although hand hygiene has long been a part of medical curricula, it does not always become ingrained into practitioners as it should. In a recent study, Landon and colleagues found that first- and second-year medical students believe that hand hygiene is extremely important and always do it, but not third- and fourth-year students.

Most hospitals have installed dispensers of hand sanitizer throughout the units to make it easier for HCWs to clean their hands. Larson said this is important because hand sanitizer works faster and is better for most things. Although these dispensers have not necessarily increased the frequency of hand hygiene, Larson said, their implementation has increased the number of times hand sanitizer is used compared with soap.

Any hand hygiene program will need to have a long-term benefit, Landon said. Many have a definite short-term effect at changing behaviors, such as signs on doors that remind HCWs about hand hygiene. But after a certain amount of time, behavior reverts to old patterns because the signs are no longer new. But one of the best ways to get someone to change their behavior is to subtly encourage them, Edmond said: getting someone to do something without forcing them to do it.

Limper H. Infect Control Hosp Epidemiol. Magill S. N Engl J Med. Pineles L. Am J Infect Control.

Medico-Legal Issues in Infectious Diseases - Guide For Physicians | I.W. Fong | Springer

Available at: whqlibdoc. Accessed March 27, Emily Landon, MD, did not respond to requests for contact information.

Medico-legal issues in clinical practice : Dr. M. C. Patel

Room , New York, NY ; email: ell23 columbia. Connie Price, MD, can be reached at: Connie. Disclosures: Edmond, Landon, Larson and Price report no relevant disclosures. Hand hygiene is the leading infection prevention measure. The reason the last moment is included was to take into account the role of the environment and its potential for infecting patients.