Hostname: page-component-586b7cd67f-r5fsc Total loading time: 0 Render date: 2024-12-01T00:13:09.608Z Has data issue: false hasContentIssue false
  • English
  • Français

Focus Group Study of Hand Hygiene Practice among Healthcare Workers in a Teaching Hospital in Toronto, Canada

Published online by Cambridge University Press:  02 January 2015

Ti-Hyun Jang ,
Samantha Wu ,
Debra Kirzner ,
Christine Moore ,
Gomana Youssef ,
Agnes Tong ,
Jenny Lourenco ,
Robyn B. Stewart ,
Liz J. McCreight  and
Karen Green
...Show all authors
Ti-Hyun Jang
Affiliation:
Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada
Samantha Wu
Affiliation:
Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada
Debra Kirzner
Affiliation:
Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada
Christine Moore
Affiliation:
Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada
Gomana Youssef
Affiliation:
Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada
Agnes Tong
Affiliation:
Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada
Jenny Lourenco
Affiliation:
Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada
Robyn B. Stewart
Affiliation:
Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada
Liz J. McCreight
Affiliation:
Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada
Karen Green
Affiliation:
Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada
Allison McGeer*
Affiliation:
Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
*
Department of Microbiology, Room 210, Mount Sinai Hospital, 600 University Avenue, Toronto, ON M5G 1X5, Canada([email protected])
Get access Rights & Permissions [Opens in a new window]

Extract

Objective.

To understand the behavioral determinants of hand hygiene in our hospital.

Design.

Qualitative study based on 17 focus groups.

Setting.

Mount Sinai Hospital, an acute care tertiary hospital affiliated with the University of Toronto.

Participants.

We recruited 153 healthcare workers (HCWs) representing all major patient care job categories.

Methods.

Focus group discussions were transcribed verbatim. Thematic analysis was independently conducted by 3 investigators.

Results.

Participants reported that the realities of their workload (eg, urgent care and interruptions) make complete adherence to hand hygiene impossible. The guidelines were described as overly conservative, and participants expressed that their judgement is adequate to determine when to perform hand hygiene. Discussions revealed gaps in knowledge among participants; most participants expressed interest in more information and education. Participants reported self-protection as the primary reason for the performance of hand hygiene, and many admitted to prolonged glove use because it gave them a sense of protection. Limited access to hand hygiene products was a source of frustration, as was confusion related to hospital equipment as potential vehicles for transmission of infection. Participants said that they noticed other HCWs' adherence and reported that others HCWs' hygiene practices influenced their own attitudes and practices. In particular, HCWs perceive physicians as role models; physicians, however, do not see themselves as such.

Conclusions.

Our results confirm previous findings that hand hygiene is practiced for personal protection, that limited access to supplies is a barrier, and that role models and a sense of team effort encourage hand hygiene. Educating HCWs on how to manage workload with guideline adherence and addressing contaminated hospital equipment may improve compliance.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 2 , February 2010 , pp. 144 - 150
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Pittet, D, Hugonnet, S, Harbarth, S, et al.Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Lancet 2000;356:1307–1312.CrossRefGoogle ScholarPubMed
2.Capretti, MG, Sandri, F, Tridapalli, E, Galletti, S, Petracci, E, Faldella, G. Impact of a standardized hand hygiene program on the incidence of nosocomial infection in very low birth weight infants. Am J Infect Control 2008;36:430–435.CrossRefGoogle ScholarPubMed
3.Nguyen, KV, Nguyen, PTM, Jones, SL. Effectiveness of an alcohol-based hand hygiene programme in reducing nosocomial infections in the urology ward of Binh Dan Hospital, Vietnam. Trop Med Int Health 2008;13:1297–1302.CrossRefGoogle ScholarPubMed
4.Picheansathian, W, Pearson, A, Suchaxaya, P. The effectiveness of a promotion programme on hand hygiene compliance and nosocomial infections in a neonatal intensive care unit. Int J Nurs Pract 2008;14:315–321.CrossRefGoogle Scholar
5.Smith, A, Carusone, SC, Loeb, M. Hand hygiene practices of health care workers in long-term care facilities. Am f Infect Control 2008;36:492–494.CrossRefGoogle ScholarPubMed
6.Hofer, CB, Abreu, TF, Silva, EG, et al.Quality of hand hygiene in a pediatric hospital in Rio de Janeiro, Brazil. Infect Control Hosp Epidemiol 2007;28:622–624.Google Scholar
7.Saint, S, Bartoloni, A, Virgili, G, et al.Marked variability in adherence to hand hygiene: a 5-unit observational study in Tuscany. Am J Infect Control 2009;37:306–310.CrossRefGoogle ScholarPubMed
8.Venier, AG, Zaro-Goni, D, Pefau, M, et al.Performance of hand hygiene in 214 healthcare facilities in South-Western France. J Hosp Infect Dis 280–282.Google Scholar
9.Ontario Ministry of Health and Long-Term Care. Hand Hygiene. Toronto, ON: Government of Ontario; 2009. Available at: http://www.health.gov.on.ca/patient_safety/public/hh/hh_pub.html#. Accessed May 12, 2009.Google Scholar
10.Saba, R, inan, D, Seyman, D, et al.Hand hygiene compliance in a hematology unit. Acta Haematol 2005;113:190–193.Google Scholar
11.Whitby, M, Pessoa-Silva, CL, McLaws, ML. Behavioural considerations for hand hygiene practices: the basic building blocks. J Hosp Infect 2007;65:1–8.Google Scholar
12.Erasmus, V, Brouwer, W, van Beeck, EF, et al.A qualitative exploration of reasons for poor hand hygiene among hospital workers: lack of positive role models and of convincing evidence that hand hygiene prevents cross-infection. Infect Control Hosp Epidemiol 2009;30:415–419.CrossRefGoogle ScholarPubMed
13.Crabtree, BMW. Doing Qualitative Research. Newbury Park, CA: Sage; 1992.Google Scholar
14.Ontario Ministry of Health. Just Clean Your Hands Campaign. Available at: http://www.justcleanyourhands.ca/. Accessed July 25, 2009.Google Scholar
15.Pittet, D, Simon, A, Hugonnet, S, Pessoa-Silva, CL, Sauvan, V, Perneger, TV. Hand hygiene among physicians: performance, beliefs, and perceptions. Ann Intern Med 2004;141:1–8.Google Scholar
16.Karabey, S, Ay, P, Derbentli, S, Nakipoglu Esen, F. Handwashing frequencies in an intensive care unit. J Hosp Infect 2002;50:36–41.Google Scholar
17.Lam, BC, Lee, J, Lau, YL. Hand hygiene practices in a neonatal intensive care unit: a multimodal intervention and impact on nosocomial infection. Pediatrics 2004;114:e565–571. http://pediatrics.aappublications.org/cgi/content/ftill/114/5/e565. Published October 18, 2004. Accessed May 9, 2009.CrossRefGoogle Scholar
18.Lausten, S, Lund, E, Bibby, BM, Kristensen, B, Thulstrup, AM, Moller, JK. Cohort study of adherence to correct hand antisepsis before and after performance of clinical procedures. Infect Control Hosp Epidemiol 2009;30:172–178.Google Scholar
19.Shigayeva, A, Green, K, Raboud, JM, et al.Factors associated with critical-care healthcare workers' adherence to recommended barrier precautions during the Toronto severe acute respiratory syndrome outbreak. Infect Control Hosp Epidemiol 2007;28:1275–1283.CrossRefGoogle ScholarPubMed
20.Kellerman, SE, Saiman, L, San Gabriel, P, Besser, R, Jarvis, WR. Observational study of the use of infection control interventions for Mycobacterium tuberculosis in pediatric facilities. Pediatr Infect Dis 2001;20:566–570.CrossRefGoogle ScholarPubMed
21.Cutter, J, Jordan, S. Uptake of guidelines to avoid and report exposure to blood and body fluids. J Adv Nurs 2004;46:441–452.Google Scholar
22.Raboud, J, Saskin, R, Wong, K, et al.Patterns of handwashing behavior and visits to patients on a general medical ward of healthcare workers. Infect Control Hosp Epidemiol 2004;25:198–202.CrossRefGoogle ScholarPubMed
23.Whitby, M, McLaws, ML, Ross, MW. Why healthcare workers don't wash their hands: a behavioral explanation. Infect Control Hosp Epidemiol 2006;27:484–492.Google Scholar
24.Curtis, VA, Danquah, LO, Aunger, RV. Planned, motivated and habitual hygiene behaviour: an eleven country review. Health Educ Res 2009;24:655–673.CrossRefGoogle ScholarPubMed
25.Scott, B, Curtis, V, Rabie, T, Garbrah-Aidoo, N. Health is in our hands, but not in our heads: understanding hygiene motivation in Ghana. Health Policy Plan 2007;22:225–233.CrossRefGoogle ScholarPubMed
26.Stelfox, HT, Bates, DW, Redelmeier, DA. Safety of patients isolated for infection control. JAMA 2003;290:1899–1905.CrossRefGoogle ScholarPubMed
27.Jeske, HC, Tiefenthaler, W, Hohlrieder, M, Hinterberger, G, Benzer, A. Bacterial contamination of anaesthetists' hands by personal mobile phone and fixed phone use in the operating theatre. Anaesthesia 2007;62:904–906.CrossRefGoogle ScholarPubMed
28.Zachary, KC, Bayne, PS, Morrison, VJ, Ford, DS, Silver, LC, Hooper, DC. Contamination of gowns, gloves, and stethoscopes with vancomycin-resistant enterococci. Infect Control Hosp Epidemiol 2001;22:560–564.CrossRefGoogle ScholarPubMed
29.Treakle, AM, Thom, KA, Furano, JP, Strauss, SM, Harris, AD, Perencevich, EN. Bacterial contamination of health care workers' white coats. Am J Infect Control 2009;37:101–105.CrossRefGoogle ScholarPubMed
30.de Gialluly, C, Morange, V, de Gialluly, E, Loulerque, J, van der Mee, N, Quentin, R. Blood pressure cuff as a potential vector of pathogenic microorganisms: a prospective study in a teaching hospital. Infect Control Hosp Epidemiol 2006;27:940–943.Google Scholar
31.Sax, H, Uçkay, I, Richet, H, Allegranzi, B, Pittet, D. Determinants of good adherence to hand hygiene among healthcare workers who have extensive exposure to hand hygiene campaigns. Infect Control Hosp Epidemiol 2007;28:1267–1274.Google Scholar
32.Muto, CA, Sistrom, MG, Farr, BM. Hand hygiene rates unaffected by installation of dispensers of a rapidly acting hand antiseptic. Am J Infect Control 2000;28:273–276.CrossRefGoogle ScholarPubMed
33.Lankford, MG, Zembower, TR, Trick, WE, Hacek, DM, Noskin, GA, Peterson, LR. Influence of role models and hospital design on hand hygiene of healthcare workers. Emerg Infect Dis 2003;9:217–223.Google Scholar