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To identify the behavioral determinants—both barriers and enablers—that may impact physician hand hygiene compliance.
A qualitative study involving semistructured key informant interviews with staff physicians and residents.
An urban, 1,100-bed multisite tertiary care Canadian hospital.
A total of 42 staff physicians and residents in internal medicine and surgery.
Semistructured interviews were conducted using an interview guide that was based on the theoretical domains framework (TDF), a behavior change framework comprised of 14 theoretical domains that explain health-related behavior change. Interview transcripts were analyzed using thematic content analysis involving a systematic 3-step approach: coding, generation of specific beliefs, and identification of relevant TDF domains.
Similar determinants were reported by staff physicians and residents and between medicine and surgery. A total of 53 specific beliefs from 9 theoretical domains were identified as relevant to physician hand hygiene compliance. The 9 relevant domains were knowledge; skills; beliefs about capabilities; beliefs about consequences; goals; memory, attention, and decision processes; environmental context and resources; social professional role and identity; and social influences.
We identified several key determinants that physicians believe influence whether and when they practice hand hygiene at work. These beliefs identify potential individual, team, and organization targets for behavior change interventions to improve physician hand hygiene compliance.
Infect Control Hosp Epidemiol 2014;35(12):1511–1520
Velo-cardio-facial syndrome (VCFS) is one of a number of syndromes which are associated with monosomic deletions of chromosome 22q11.2. In the older child, school issues are common and the physician can often provide insight into the optimal learning environment for the child; however, this seldom is affected by the presence of immunodeficiency. The immunodeficiency does not correlate with any other clinical feature. This makes it difficult to determine which infants should be screened for immunodeficiency. The most conservative approach would be to perform simple screening studies for T-cell defects. Infants suspected of having VCFS/chromosome 22q11.2 deletion syndrome should have FISH analyses performed. The 22q11.2 deletion and the 10p deletion should be sought and can be tested simultaneously. Humoral immunity should be assessed in patients with recurrent infections. Although chromosome 22q11.2 deletion syndrome is classically considered a T-cell defect, there may be secondary antibody deficits.
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