Baseline observations occurred for five weekdays, during morning rounds (2–4 hours), on acute care medicine units. 10 Observers were instructed to document “unknown” if they were unable to observe or unsure that they witnessed mindful behavior. 18 Additional training was provided regarding the observation of mindfulness behaviors, which were identified in two ways: first, if a person paused from walking, talking, or engaging with their environment and appeared to focus on the process of rubbing soap/gel into hands and, second, when a person was noted to take multiple, slow, deliberate breaths while performing hand hygiene. 17 Five observers with previous experience observing hand hygiene adherence (3 research specialists, two students) received training regarding the established recommendations for hand hygiene auditing (i.e., type of hand hygiene performed, upon entry and exit of patient room, and when to document “unknown”) ( Online Supplement 1). We hypothesized that participants exposed to mindfulness would exhibit increased hand hygiene and mindfulness behaviors compared to those randomized to the control group.īaseline rates of hand hygiene before and after patient room entry for each member of the team on the medicine wards were collected using a standardized, secret shopper auditing approach. This proof of concept intervention sought to understand whether physicians were receptive to mindfulness as a means to improve hand hygiene. ![]() 6 Using a pilot, randomized controlled mixed methods trial, we examined the effectiveness of a brief, mindfulness educational session on hand hygiene adherence and mindful attention for inpatient physician teams. We selected physicians in particular for hand hygiene compliance among physicians lags behind that of most other professional groups. We sought to assess if mindful hand hygiene would promote hand hygiene adherence and mindful attention among physicians and medical students in a hospital setting. 7, 9 Adoption of mindful practice, in turn, may have other benefits including enhanced attention, 13 situational awareness, 14 provider well-being, 10 and reduction of diagnostic medical errors by addressing cognitive biases. This group effect could lead to collective mindfulness, 12 where the behavior of peers affects others to improve hand hygiene rates of others. Further, the role modeling of mindful hand hygiene within a clinical setting may have a cascading effect on others. 11 Teaching healthcare providers informal practices, such as mindful hand hygiene, could similarly bring mindfulness into clinical practice. A recent systematic review found that brief mindfulness interventions aimed at healthcare providers improve myriad clinical outcomes. The practice of mindfulness is described as paying attention in the present moment, in a purposeful and non-judgmental way.10 Mindfulness is meant to help move a person from a state where thoughts are unobserved and actions are on automatic pilot, to a state where situations are observed, acknowledged, and accepted. 8 Therefore, innovative strategies are needed to improve hand hygiene among healthcare providers. 2, 7 Although myriad strategies including education, feedback, and incentives have been implemented to encourage hand hygiene, most have had only transient or modest impact. ![]() ![]() ![]() 2– 4 Of note, hand hygiene adherence is known to be lower among physicians than nurses, 5– 7 and before patient encounters relative to after. 1 Unfortunately, healthcare provider adherence to hand hygiene practices are relatively low, even when education programs for hand hygiene are well-resourced and well-coordinated. Hand hygiene is broadly accepted as an integral component for preventing infection in hospitalized patients.
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