Knowing is not doing

Draft for Małgorzata’s review before publication · based on published research

Hand hygiene is the most taught habit in healthcare. It is also one of the hardest to keep. In April 2023, with colleagues at our university hospital, we asked staff what they really know, using a 17-item questionnaire adapted from the WHO hand hygiene knowledge survey.

What 542 people told us

Of 6,749 eligible health workers, 542 answered. On twelve knowledge questions, they gave the right answer 74.4% of the time on average. That sounds reassuring until you look at the detail.

Almost everyone (96.5%) knew they did not need to sanitise after touching only the surroundings. But only 30.4% answered correctly when asked whether hand rubbing is more effective than hand washing. That is a question about the main tool they use every day: 97% said they usually use alcohol-based hand rub.

People can follow a rule for years without fully knowing why it works.

Training leaves a mark

Staff trained in the previous three years were more likely to answer correctly on washing hands after caring for patients with Clostridioides difficile, where soap and water matter. 87.2% reported recent training. Nurses scored best on several items.

What this means for a hospital

• Test understanding, not attendance. A signed register is not knowledge.
• Target the gaps you can measure, such as rub versus wash.
• Refresh training regularly; the effect fades.
• Combine the technical rule with the soft skills that make people act on it.

Our response rate was low, so the picture is partial. But it is enough to show where to look. Hand hygiene programmes fail less often in the classroom than in the hours after it.