Does empathy play a role in improved hand hygiene compliance? While we have often explored multi-modal approaches to improving hand hygiene in healthcare, a slowly growing body of research raises interesting questions.
A problem that persists
The WHO’s 5 Moments of Hand Hygiene provides a helpful, global framework for when hand disinfection should occur. One of the thorniest problems in healthcare is the well-researched finding that healthcare workers (HCW’s) are more likely to disinfect their hands after they have taken care of a patient than before.
Researchers have speculated about why this is. Some have wondered if the HCW’s are prioritizing, consciously or not, their own safety.
Measuring empathy and its results
Adding to a few studies from the past ten years that have examined the role of empathy in hand hygiene compliance, researchers from Germany studied nurses and doctors from 38 wards throughout a one year span from 2017-2018. These HCW’s filled out a questionnaire that included a section for self-reporting hand hygiene compliance and a section to assess their empathy. (This included questions like: “‘I often have tender, concerned feelings for people less fortunate than me.’, ‘When I see someone being taken advantage of, I feel kind of protective towards them.’, ‘I am often quite touched by things that I see happen.’, ‘I would describe myself as a pretty soft-hearted person.’”)
In addition to the self-reported hand hygiene compliance rate, the researchers carried out direction observance of hand hygiene behaviour.
The study found that the interaction between HCW’s empathy and compliance was “significant.” Wards and HCW’s with higher levels of empathy were more likely to disinfect hands in the ‘before moments.’ Low-levels of empathy correlated with the lowest compliance rates during these ‘before moments.’ Fascinatingly, both the lower-empathy and higher-empathy groups had similar compliance rates for the ‘after moments’—leading some credence to the theory that this behaviour reveals a prioritization of self over others.
As the researchers point out, the ‘before moments’ are especially crucial for improving patient outcomes “by preventing patients’ colonisation (Moment 1) and infections in patients (Moment 2); compliance with ‘after moments’, in contrast, besides preventing contamination of subsequently touched surfaces, is mostly beneficial for HCWs themselves.“
Can empathy be fostered?
These results are fascinating, but unlike some other studies we have examined, it does not have a simple application. Should hospitals try to hire more empathetic HCW’s? Can empathy be fostered through training? Can the work environment be set up to bring out the HCW’s existing and latent empathy? Will the move toward patient-oriented healthcare lead to greater hand hygiene compliance? The researchers note that there is a need for “more research about the psychological processes underlying [hand hygiene compliance] in order to optimise training and intervention programmes.”
The big picture
We believe that a multi-modal approach will lead to the greatest improvement in hand hygiene compliance for hospitals. Having plenty of dispensers near patients and using electronic hand hygiene monitoring—these are good steps to take to increase compliance. To use these tools as well as one can, it helps to understand the psychosocial side of hand hygiene. Whether it is the role of that power dynamics or empathy plays in compliance, we are beginning to get a deeper and more nuanced view of the multitude of factors that contribute to something as seemingly simple as disinfecting hands.
All quotes from:
Diefenbacher, S., Plotzki, C., Schneider-Brachert, W., Ambrosch, A., Keller, J., Niesalla, H., Gaube, S., Gastmeier, P., Sassenrath, C., & Kramer, T. S. (2022). Differences in observed and self-reported compliance with the 5 moments for hand hygiene as a function of healthcare workers’ empathy. Journal of Hospital Infection. https://doi.org/10.1016/j.jhin.2022.07.008