Influence of role models and hospital design on hand hygiene of healthcare workers

Emerg Infect Dis. 2003 Feb;9(2):217-23. doi: 10.3201/eid0902.020249.


We assessed the effect of medical staff role models and the number of health-care worker sinks on hand-hygiene compliance before and after construction of a new hospital designed for increased access to handwashing sinks. We observed health-care worker hand hygiene in four nursing units that provided similar patient care in both the old and new hospitals: medical and surgical intensive care, hematology/oncology, and solid organ transplant units. Of 721 hand-hygiene opportunities, 304 (42%) were observed in the old hospital and 417 (58%) in the new hospital. Hand-hygiene compliance was significantly better in the old hospital (161/304; 53%) compared to the new hospital (97/417; 23.3%) (p<0.001). Health-care workers in a room with a senior (e.g., higher ranking) medical staff person or peer who did not wash hands were significantly less likely to wash their own hands (odds ratio 0.2; confidence interval 0.1 to 0.5); p<0.001). Our results suggest that health-care worker hand-hygiene compliance is influenced significantly by the behavior of other health-care workers. An increased number of hand-washing sinks, as a sole measure, did not increase hand-hygiene compliance.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Anti-Infective Agents, Local
  • Attitude of Health Personnel
  • Gloves, Protective
  • Hand Disinfection / standards*
  • Health Personnel*
  • Hospital Design and Construction*
  • Hospitals / standards
  • Humans
  • Hygiene
  • Occupational Health*
  • Odds Ratio
  • Patient Care
  • Role*
  • Time Factors


  • Anti-Infective Agents, Local