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Effectiveness of a Behavioral Approach to Improve Healthcare Worker Compliance With Hospital Dress Code

  • Mireille Dekker (a1), Martine G. Caris (a1) (a2), Anne M. van Gunsteren (a3), Rosa van Mansfeld (a1), Cees Lucas (a4) and Christina M.J.E. Vandenbroucke-Grauls (a1)...

Abstract

BACKGROUND

The VU University Medical Center, a tertiary-care hospital in the Netherlands, has adopted a dress code based on national guidelines. It includes uniforms provided by the hospital and a ‘bare-below-the-elbow’ policy for all healthcare workers (HCWs) in direct patient care. Because compliance was poor, we sought to improve adherence by interventions targeted at the main causes of noncompliance.

OBJECTIVE

To measure compliance with the dress code, to assess causes of noncompliance and to assess whether a behavioral approach (combing a nominal group technique with participatory action) is effective in improving compliance

METHODS

Between March 2014 and June 2016, a total of 1,920 HCWs were observed in hospital hallways for adherence to the policy, at baseline, and at follow-up measurements. Based on the outcome of the baseline measurement, a nominal group technique was applied to assess causes of noncompliance. The causes revealed served as input for interventions that were developed, prioritized, and tailored to specific groups of HCWs and specific departments through participatory action.

RESULTS

We identified lack of knowledge, lack of facilities, and negative attitudes as the main causes of noncompliance. The importance of each cause varied for different groups of HCWs. Tailored interventions targeted at these causes increased overall compliance by 39.6% (95% CI, 31.7–47.5).

CONCLUSION

The combination of a nominal group technique and participatory action approach is an effective method to increase and sustain compliance with hospital dress code. This combined approach may also be useful to improve adherence to other guidelines.

Infect Control Hosp Epidemiol 2017;38:1435–1440

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited. All rights reserved.

Corresponding author

Address correspondence to M. Dekker, MSc, Department of Medical Microbiology & Infection Control, VU University Medical Center, De Boelelaan 1118, 1081 HV Amsterdam (m.vanoijen@vumc.nl).

Footnotes

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PREVIOUS PRESENTATION: Part of this manuscript was presented as a poster (no. 7048) at the SHEA Spring 2015 Conference in Orlando, Florida, on May 16, 2015.

Footnotes

References

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