Hierarchy and hand hygiene: would medical students speak up to prevent hospital-acquired infection?

ciated with removal of 59% of unnecessary catheters. As did a previous study suggesting that physicians were unaware of their patients having urinary catheters, we found that reminders to physicians with less training who were directly involved in patient care enhanced the effectiveness the reminder systems. We also identified 2 potentially modifiable gaps in knowledge of inappropriate urinary catheter-prescribing behaviors: incontinence without skin breakdown and retained use after monitoring of urine output. Ongoing and future efforts will require an evidence-based educational program of systematic reminders among physicians directly involved in patient care, with emphasis on infection prevention control, patient safety, and institutional support.