Hand hygiene is considered an important tool to prevent the spread of healthcare acquired infections (HAI) in the intensive care unit (ICU). A hand hygiene education programme using WHO recommendations was implemented in an ICU. Compliance with the protocol was assessed by scheduled observations and improvement from 8% to 42% was achieved, but no further progress was observed. To understand why healthcare workers (HCW) were resisting further improvements, researchers from Riga Stradins University, Riga, Latvia, conduct a socio-anthropological study.
Infection control practices were examined by anthropological approaches to everyday HCWs regarding communication, beliefs, and practices and was carried out by a professional anthropologist. Observation covered all HCWs as well as Infection Control staff and, in total, extended to 48 days.
The researchers found that surveillance to insure compliance creates feelings of anxiety and oppression among the ICU staff. Therefore, the HCWs see hand-washing requirements as a part of a power struggle rather than a part of good infection control practice. Contrary to frequently held views, refusal to wash hands in ICU is not due to the lack of information or time, but rather is a conscious resistance strategy that originates from the surveillance environment.