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Understanding Practice: Factors That Influence Physician Hand Hygiene Compliance

Published online by Cambridge University Press:  10 May 2016

Janet E. Squires*
Affiliation:
School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
Stefanie Linklater
Affiliation:
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
Jeremy M. Grimshaw
Affiliation:
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada Department of Medicine, Ottawa Hospital/University of Ottawa, Ottawa, Ontario, Canada
Ian D. Graham
Affiliation:
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
Katrina Sullivan
Affiliation:
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
Natalie Bruce
Affiliation:
Infection Prevention and Control, Ottawa Hospital, Ottawa, Ontario, Canada
Kathleen Gartke
Affiliation:
Department of Surgery, Ottawa Hospital/University of Ottawa, Ottawa, Ontario, Canada
Alan Karovitch
Affiliation:
Department of Medicine, Ottawa Hospital/University of Ottawa, Ottawa, Ontario, Canada
Virginia Roth
Affiliation:
Department of Medicine, Ottawa Hospital/University of Ottawa, Ottawa, Ontario, Canada Infection Prevention and Control, Ottawa Hospital, Ottawa, Ontario, Canada
Karen Stockton
Affiliation:
Infection Prevention and Control, Ottawa Hospital, Ottawa, Ontario, Canada
John Trickett
Affiliation:
Department of Surgery, Ottawa Hospital/University of Ottawa, Ottawa, Ontario, Canada
Jim Worthington
Affiliation:
Medical Affairs, Quality and Patient Safety, Ottawa Hospital, Ottawa, Ontario, Canada
Kathryn N. Suh
Affiliation:
Department of Medicine, Ottawa Hospital/University of Ottawa, Ottawa, Ontario, Canada Infection Prevention and Control, Ottawa Hospital, Ottawa, Ontario, Canada
*
501 Smyth Road, Box 711, Ottawa, Ontario K1H 8L6, Canada (jasquires@ohri.ca).

Abstract

Objective.

To identify the behavioral determinants—both barriers and enablers—that may impact physician hand hygiene compliance.

Design.

A qualitative study involving semistructured key informant interviews with staff physicians and residents.

Setting.

An urban, 1,100-bed multisite tertiary care Canadian hospital.

Participants.

A total of 42 staff physicians and residents in internal medicine and surgery.

Methods.

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.

Results.

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.

Conclusions.

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

Type
Original Article
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved.

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