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Determinants of Good Adherence to Hand Hygiene Among Healthcare Workers Who Have Extensive Exposure to Hand Hygiene Campaigns

Published online by Cambridge University Press:  02 January 2015

Hugo Sax ,
Ilker Uçkay ,
Hervé Richet ,
Benedetta Allegranzi  and
Didier Pittet
Hugo Sax
Affiliation:
Infection Control Program, University of Geneva Hospitals, Geneva, Switzerland
Ilker Uçkay
Affiliation:
Infection Control Program, University of Geneva Hospitals, Geneva, Switzerland
Hervé Richet
Affiliation:
Global Patient Safety Challenge, World Health Organization (WHO)World Alliance for Patient Safety, WHO Headquarters, Geneva, Switzerland
Benedetta Allegranzi
Affiliation:
Global Patient Safety Challenge, World Health Organization (WHO)World Alliance for Patient Safety, WHO Headquarters, Geneva, Switzerland
Didier Pittet*
Affiliation:
Infection Control Program, University of Geneva Hospitals, Geneva, Switzerland Global Patient Safety Challenge, World Health Organization (WHO)World Alliance for Patient Safety, WHO Headquarters, Geneva, Switzerland
*
Infection Control Program, University of Geneva Hospitals, 24 Rue Micheli-du-Crest, 1211 Geneva 14, Switzerland ([email protected])
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Abstract

Objective.

To quantify the different behavioral components of healthcare workers' motivation to comply with hand hygiene in a healthcare institution with a 10-year history of hand hygiene campaigning.

Design.

Cross-sectional study, by use of an anonymous, self-administered questionnaire.

Setting.

A 2,200-bed university teaching hospital.

Participants.

A stratified random sample of 2,961 medical and nursing staff.

Results.

A total of 1,042 questionnaires (35.2%) were returned. Of the respondents, 271 (26.0%) were physicians, 629 (60.4%) were nurses, and 141 (13.5%) were nursing assistants. Overall, 1,008 respondents provided information about sex; 718 (71.2%) of these were women. Respondents provided demographic information and data about various behavioral, normative, and control beliefs that determined their intentions with respect to performing hand hygiene. Among behavioral beliefs, the perception that healthcare-associated infections are severe for patients was highly ranked as a determinant of behavior by 331 (32.1%) of the respondents, and the perception that hand hygiene is effective at preventing these infections was ranked highly by 891 respondents (86.0%). Among normative beliefs, perceived social pressure from patients to perform hand hygiene was ranked highly by 760 respondents (73.7%), pressure from superiors was ranked highly by 687 (66.8%), pressure from colleagues was ranked highly by 596 (57.9%), and pressure from the person perceived to be most influential was ranked highly by 687 (68.8%). Among control beliefs, the perception that hand hygiene is relatively easy to perform was rated highly by 670 respondents (65.1%). High self-reported rates of adherence to hand hygiene (defined as performance of proper hand hygiene during 80% or more of hand hygiene opportunities) was independently associated with female sex, receipt of training in hand hygiene, participation in a previous hand hygiene campaign, peer pressure from colleagues, perceived good adherence by colleagues, and the perception that hand hygiene is relatively easy to perform.

Conclusions.

In a setting with a long tradition of hand hygiene campaigns, behavioral beliefs are strongly in favor of hand hygiene, but adherence is driven by peer pressure and the perception of high self-efficacy, rather than by reasoning about the impact of hand hygiene on patient safety. Female sex, training, and campaign exposure increased the likelihood of compliance with hand hygiene. This additional insight can help to shape future promotional activity.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 11 , November 2007 , pp. 1267 - 1274
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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References

1.World Health Organization (WHO). WHO Guidelines on Hand Hygiene in Health Care (Advanced Draft). Geneva: World Health Organization;2006.Google Scholar
2.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.Google Scholar
3.Whitby, M, Pessoa-Silva, CL, McLaws, ML, et al. Behavioural considerations for hand hygiene practices: the basic building blocks. J Hosp Infect 2007;65:1–8.CrossRefGoogle ScholarPubMed
4.Stone, S, Teare, L, Cookson, B. Guiding hands of our teachers. Hand-hygiene Liaison Group. Lancet 2001;357:479–480.CrossRefGoogle ScholarPubMed
5.Ajzen, I. Attitudes, Personality and Behavior. 2nd ed. Maidenhead, UK: McGraw-Hill;2005.Google Scholar
6.Kretzer, EK, Larson, EL. Behavioral interventions to improve infection control practices. Am J Infect Control 1998;26:245–253.Google Scholar
7.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.CrossRefGoogle ScholarPubMed
8.World Health Organization. The first Global Patient Safety Challenge. Available at: http://www.who.int/gpsc/en/. Accessed July 3, 2007Google Scholar
9.Pittet, D, Mourouga, P, Perneger, TV. Compliance with handwashing in a teaching hospital. Ann Intern Med 1999;130:126–130.Google Scholar
10.Johnson, PD, Martin, R, Burrell, LJ, et al. Efficacy of an alcohol/chlorhexidine hand hygiene program in a hospital with high rates of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection. Med J Aust 2005;183:509–514.Google Scholar
11.Storr, J. The effectiveness of the national Clean Your Hands campaign. Nurs Times 2005;101:50–51.Google Scholar
12.Pittet, D, Sax, H, Hugonnet, S, Harbarth, S. Cost implications of successful hand hygiene promotion. Infect Control Hosp Epidemiol 2004;25:264–266.Google Scholar
13.Conner, M, Norman, P. Predicting Health Behaviour: Research and Practice With Social Cognition Models. Buckingham, UK: Open University Press;1995.Google Scholar
14.Godin, G, Kok, G. The theory of planned behavior: a review of its applications to health-related behaviors. Am J Health Promot 1996;11:87–98.Google Scholar
15.Sheeran, P, Conner, M, Norman, P. Can the theory of planned behavior explain patterns of health behavior change? Health Psychol 2001;20:12–19.Google Scholar
16.Ajzen, I. Attitudes, Personality, And Behavior: A Review of its Applications to Health-Related Behaviors. Buckingham, UK: Open University Press;1988.Google Scholar
17.Sax, H, Perneger, T, Hugonnet, S, Herrault, P, Chraiti, MN, Pittet, D. Knowledge of standard and isolation precautions in a large teaching hospital. Infect Control Hosp Epidemiol 2005;26:298–304.Google Scholar
18.Pessoa-Silva, CL, Posfay-Barbe, K, Pfister, R, Touveneau, S, Perneger, TV, Pittet, D. Attitudes and perceptions toward hand hygiene among healthcare workers caring for critically ill neonates. Infect Control Hosp Epidemiol 2005;26:305–311.Google Scholar
19.Jaccard, J, Weber, J, Lundmark, J. A multitrait-multimethod analysis of four attitude assessment procedures. J Experiment Social Psy 1975;11:149–154.CrossRefGoogle Scholar
20.Pittet, D, Stephan, R, Hugonnet, S, Akakpo, C, Souweine, B, Clergue, F. Hand-cleansing during postanesthesia care. Anesthesiology 2003;99:530–535.CrossRefGoogle ScholarPubMed
21.Hugonnet, S, Perneger, TV, Pittet, D. Alcohol-based handrub improves compliance with hand hygiene in intensive care units. Arch Intern Med 2002;162:1037–1043.Google Scholar
22.Gopal Rao, G, Jeanes, A, Osman, M, Aylott, C, Green, J. Marketing hand hygiene in hospitals—a case study. J Hosp Infect 2002;50:42–47.CrossRefGoogle ScholarPubMed
23.Snow, M, White, GL Jr, Alder, SC, Stanford, JB. Mentor's hand hygiene practices influence student's hand hygiene rates. Am J Infect Control 2006;34:18–24.CrossRefGoogle ScholarPubMed
24.McGuckin, M, Waterman, R, Storr, IJ, et al. Evaluation of a patient-empowering hand hygiene programme in the UK. J Hosp Infect 2001;48:222–227.Google Scholar
25.McGuckin, M, Porten, LL. Handwashing education practices: a descriptive survey. Clin Perform Qual Health Care 1999;7:94–96.Google Scholar
26.McGuckin, M, Waterman, R, Porten, L, et al. Patient education model for increasing handwashing compliance. Am J Infect Control 1999;27:309–314.Google Scholar
27.O'Boyle, CA, Henly, SJ, Larson, E. Understanding adherence to hand hygiene recommendations: the theory of planned behavior. Am J Infect Control 2001;29:352–360.CrossRefGoogle ScholarPubMed
28.van de Mortel, T, Bourke, R, McLoughlin, J, Nonu, M, Reis, M. Gender influences handwashing rates in the critical care unit. Am J Infect Control 2001;29:395–399.Google Scholar
29.Smith, WA. Social marketing: an overview of approach and effects. Inj Prev 2006;12(suppl I):i38–i43.Google Scholar
30.Pittet, D. The Lowbury lecture: behaviour in infection control. J Hosp Infect 2004;58:1–13.Google Scholar
31.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
32.Jenner, EA, Fletcher, BC, Watson, P, Jones, FA, Miller, L, Scott, GM. Discrepancy between self-reported and observed hand hygiene behaviour in healthcare professionals. J Hosp Infect 2006;63:418–422.CrossRefGoogle ScholarPubMed
33.Pittet, D, Donaldson, L. Clean care is safer care: a worldwide priority. Lancet 2005;366:1246–1247.CrossRefGoogle Scholar
34.Pittet, D, Donaldson, L. Clean care is safer care: the first global challenge of the WHO World Alliance for Patient Safety. Infect Control Hosp Epidemiol 2005;26:891–894.Google Scholar