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Hand Hygiene Behavior: Translating Behavioral Research into Infection Control Practice

Part of: BARRY FARR AWARD RECIPIENTS

Published online by Cambridge University Press:  02 January 2015

Thanee Eiamsitrakoon ,
Anucha Apisarnthanarak ,
Winitra Nuallaong ,
Thana Khawcharoenporn  and
Linda M. Mundy
Thanee Eiamsitrakoon
Affiliation:
Thammasat University Hospital, Pathumthani, Thailand
Anucha Apisarnthanarak*
Affiliation:
Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
Winitra Nuallaong
Affiliation:
Department of Psychiatry, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
Thana Khawcharoenporn
Affiliation:
Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
Linda M. Mundy
Affiliation:
LM Mundy, Bryn Mawr, Pennsylvania
*
Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathumthani, Thailand10120 (anapisarn@yahoo.com)
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Abstract

Background.

In 2009, the World Health Organization (WHO) recommended “My Five Moments for Hand Hygiene” (5MHH) to optimize hand hygiene (HH). Uptake of these recommendations by healthcare workers (HCWs) remains uncertain.

Methods.

We prospectively observed HCW compliance to 5MHH. After observations, eligible HCWs who consented to interviews completed surveys on factors associated with HH compliance based on constructs from the transtheoretical model of behavioral change (TTM) and the theory of planned behavior (TPB). Survey results were compared with observed HCW behaviors.

Results.

There were 968 observations among 123 HCWs, of whom 110 (89.4%) were female and 63 (51.3%) were nurses. The mean HH compliance for all 5MHH was 23.2% (95% confidence interval [CI], 18.1%-28.3%) by direct observation versus 82.4% (95% CI, 79.9%-84.9%) by self report. The HCW 5MHH compliance was associated with critical care unit encounters (P < .05), medicine unit encounters (P = 0.08, P <.001), immunocompromised patient encounters (P <. 05), and HCW prioritized patient advocacy (P <.001). Self-reported TTM stages of action or maintenance (P = .08) and the total TPB behavior score correlated with observed 5MHH (r = 0.21, P = .02) and with self-reported 5MHH compliance (r = 0.53, P < .001).

Conclusion.

Observed HCW compliance to 5MHH was associated with the type of hospital unit, type of provider-patient encounter, and theory-based behavioral measures of 5MHH commitment.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 11 , November 2013 , pp. 1137 - 1145
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

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References

1.Erasmus, V, Daha, TJ, Brug, H, et al. Systematic review of studies on compliance with hand hygiene guidelines in hospital care. Infect Control Hosp Epidemiol 2010;31:283–294.CrossRefGoogle ScholarPubMed
2.Pittet, D, Allegranzi, B, Boyce, J. The World Health Organization guidelines on hand hygiene in heath care and their consensus recommendations. Infect Control Hosp Epidemiol 2009;30(7): 611–622.CrossRefGoogle Scholar
3.World Health Organization (WHO). WHO guidelines on hand hygiene in healthcare. Geneva: World Health Organization, 2009.Google Scholar
4.Prochaska, JO, Velicer, WF. The transtheoretical model of health behavior change. Am J Health Promot 1997;12(1):38–48.CrossRefGoogle ScholarPubMed
5.Ajzen, I. The theory of planned behavior. Org Behav Human Dec Proc 1991;50(2):179–211.CrossRefGoogle Scholar
6.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):1–8.CrossRefGoogle ScholarPubMed
7.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(11):1267–1274.CrossRefGoogle ScholarPubMed
8.Whitby, M, Pessoa-Silva, CL, McLaws, ML, et al. Behavioral considerations for hand hygiene practices; the basic building blocks. J Hosp Infect 2007;65(1):1–8.CrossRefGoogle ScholarPubMed
9.Robinson, LM, Vail, SR. An integrative review of adolescent smoking cessation using the transtheoretical model of change. J Pediatr Health Care 2012;26(5):336–345.CrossRefGoogle ScholarPubMed
10.Kelly, CW. Commitment to health: a predictor of dietary change. J Clin Nurs. 2011;20(19-20):2830–2836.CrossRefGoogle Scholar
11.Cabral, RJ, Cotton, D, Semaan, S, Gielen, AC. Application of the transtheoretical model for HIV prevention in a facility-based and a community-level behavioral intervention research study. Health Promot Pract 2004;5(2):199–207.CrossRefGoogle Scholar
12.O'Boyle, CA, Henly, SJ, Larson, E. Understanding adherence to hand hygiene recommendations: the theory of planned behavior. Am Journal of Infect Control 2001;29(6):352–360.CrossRefGoogle ScholarPubMed
13.Sax, H, Allegranzi, B, Chrafti, MN, Boyce, J, Larson, E, Pittet, D. The World Health Organization hand hygiene observation method. Am J Infect Control 2009;37(10):827–834.CrossRefGoogle ScholarPubMed
14.World Health Organization. Evaluation and feedback tool: observation form, http://www.who.int/gpsc/5may/tools/en/. Accessed June 20, 2011.Google Scholar
15.Tai, JW, Mok, ES, Ching, PT, Seto, WH, Pittet, D. Nurses and physicians' perceptions of the importance and impact of healthcare-associated infections and hand hygiene: a multi-center exploratory study in Hong Kong. Infection 2009;37(4):320–333.CrossRefGoogle ScholarPubMed
16.Lee, A, Chalfine, A, Daikos, GL, et al. Hand hygiene practices and adherence determinants in surgical wards across Europe and Israel: a multicenter observational study. Am J Infect Control 2011;39(6):517–520.CrossRefGoogle Scholar
17.Stewardson, A, Sax, H, Longet-Di Pietro, S, Pittet, D. Impact of observation and analysis methodology when reporting hand hygiene data. J Hosp Infect 2011;77(4):358–359.CrossRefGoogle ScholarPubMed
18.Lebovic, G, Siddiqui, N, Muller, MP. Predictors of hand hygiene compliance in the era of alcohol-based hand rinse. J Hosp Infect 2013;83(4):276–283.CrossRefGoogle ScholarPubMed
19.Alsubaie, S, Maither, A, Alalmaei, W, et al. Determinants of hand hygiene noncompliance in intensive care units. Am J Infect Control 2013;41(2):131–135.CrossRefGoogle ScholarPubMed
20.Jenner, EA, Fletcher, BC, Watson, P, Jones, FA, Miller, L, Scott, GM. Discrepancy between self-reported and observed hand hygiene behavior in healthcare professionals. J Hosp Infect 2006;63(4): 418–422.CrossRefGoogle ScholarPubMed
21.Sax, H, Allegranzi, B, Uçkay, I, et al. ‘My five moments for hand hygiene’: a user-centred design approach to understand, train, monitor and report hand hygiene. J Hosp Infect 2007;67:9–21.CrossRefGoogle ScholarPubMed
22.Pittet, D, Mourouga, P, Perneger, TV. Compliance with handwashing in a teaching hospital: infection control program. Ann Intern Med 1999;130(2):126–130.CrossRefGoogle Scholar
23.Harbarth, S, Pittet, D, Grady, L, Goldmann, DA. Compliance with hand hygiene practice in pediatric intensive care. Pediatr Crit Care Med 2001;2(4):311–314.CrossRefGoogle ScholarPubMed
24.Lipsett, PA, Swoboda, SM. Handwashing compliance depends on professional status. Surg Infect (Larchmt) 2001;2(3):241–245.CrossRefGoogle ScholarPubMed
25.Pittet, D. Improving compliance with hand hygiene in hospitals. Infect Control Hosp Epidemiol 2000;21(6):381–386.CrossRefGoogle ScholarPubMed
26.Dedrick, RE, Sinkowitz-Cochran, RL, Cunningham, C, et al. Hand hygiene practices after brief encounters with patients: an important opportunity for prevention. Infect Control Hosp Epidemiol 2007;28(3):341–345.CrossRefGoogle ScholarPubMed
27.Mertz, D, Johnstone, J, Krueger, P, Brazil, K, Walter, SD, Loeb, M. Adherence to hand hygiene and risk factors for poor adherence in 13 Ontario acute care hospitals. Am J Infect Control 2011;39(8):693–696.CrossRefGoogle ScholarPubMed
28.Mathai, E, Allegranzi, B, Seto, WH, et al. Educating healthcare workers to optimal hand hygiene practices: addressing the need. Infection 2010;38(5):349–356.CrossRefGoogle ScholarPubMed