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Pilot randomised controlled trial to improve hand hygiene through mindful moments
  1. Heather Gilmartin1,
  2. Sanjay Saint2,3,
  3. Mary Rogers2,3,
  4. Suzanne Winter2,3,
  5. Ashley Snyder2,3,
  6. Martha Quinn3,
  7. Vineet Chopra2,3
  1. 1 Denver/Seattle Center of Innovation, Denver VA Medical Center, Denver, Colorado, USA
  2. 2 VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
  3. 3 Division of Hospital Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
  1. Correspondence to Dr Heather Gilmartin, Denver/Seattle Center of Innovation, Department of Veterans Affairs, Denver, CO 80220-3877, USA; Heather.Gilmartin{at}


Background To evaluate the effectiveness of a brief mindfulness intervention on hand hygiene performance and mindful attention for inpatient physician teams.

Design A pilot, pre-test/post-test randomised controlled mixed methods trial.

Setting One academic medical centre in the USA.

Participants Four internal medicine physician teams consisting of one attending, one resident, two to three interns and up to four medical students.

Intervention A facilitated, group-based educational discussion on how mindfulness, as practised through mindful hand hygiene, may improve clinical care and practices in the hospital setting.

Main outcomes and measures The primary outcome was hand hygiene adherence (percentage) for each patient encounter. Other outcomes were observable mindful moments and mindful attention, measured using the Mindfulness Attention Awareness Scale, from baseline to post-intervention, and qualitative evaluation of the intervention.

Results For attending physicians, hand hygiene adherence increased 14.1% in the intervention group compared with a decrease of 5.7% in the controls (P=0.035). For residents, the comparable figures were 24.7% (intervention) versus 0.2% (control) (P=0.064). For interns, adherence increased 10.0% with the intervention versus 4.2% in the controls (P=0.007). For medical students, adherence improved more in the control group (4.7% intervention vs 7.7% controls; P=0.003). An increase in mindfulness behaviours was observed for the intervention group (3.7%) versus controls (0.9%) (P=0.021). Self-reported mindful attention did not change (P=0.865).

Conclusions A brief, education-based mindfulness intervention improved hand hygiene in attending physicians and residents, but not in medical students. The intervention was well-received, increased mindfulness practice, and appears to be a feasible way to introduce mindfulness in the clinical setting. Future work instructing clinicians in mindfulness to improve hand hygiene may prove valuable.

Trial registration number NCT03165799; Results.

  • infection control
  • randomised controlled trial
  • hospital medicine
  • medical education

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  • Contributors HG, SS, MR and VC jointly designed the study. HG, SS, SW, AS, MQ and VC implemented the trial. AS and MR conducted the qualitative analyses. HG drafted the manuscript. All authors interpreted the results, critically revised the manuscript and approved the final version.

  • Funding This study was funded by the Agency for Healthcare Research and Quality (grant number P30HS024385).

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Institutional Review Board and the Research and Development Committee at the Veterans Affair Ann Arbor Health System (2016-020159-0004)

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Unpublished data from the study are available upon request. Please contact