Hostname: page-component-8448b6f56d-sxzjt Total loading time: 0 Render date: 2024-04-24T02:24:40.431Z Has data issue: false hasContentIssue false
  • English
  • Français

A Qualitative Exploration of Reasons for Poor Hand Hygiene Among Hospital Workers Lack of Positive Role Models and of Convincing Evidence That Hand Hygiene Prevents Cross-Infection

Published online by Cambridge University Press:  02 January 2015

V. Erasmus ,
W. Brouwer ,
E. F. van Beeck ,
A. Oenema ,
T. J. Daha ,
J. H. Richardus ,
M. C. Vos  and
J. Brug
V. Erasmus*
Affiliation:
Departments of Public Health, University Medical Center Rotterdam, Rotterdam, the Netherlands
W. Brouwer
Affiliation:
Departments of Public Health, University Medical Center Rotterdam, Rotterdam, the Netherlands
E. F. van Beeck
Affiliation:
Departments of Public Health, University Medical Center Rotterdam, Rotterdam, the Netherlands
A. Oenema
Affiliation:
Departments of Public Health, University Medical Center Rotterdam, Rotterdam, the Netherlands
J. H. Richardus
Affiliation:
Departments of Public Health, University Medical Center Rotterdam, Rotterdam, the Netherlands
M. C. Vos
Affiliation:
Medical Microbiology and Infectious Diseases, University Medical Center Rotterdam, Rotterdam, the Netherlands
J. Brug
Affiliation:
EMGO Institute, Amsterdam, the Netherlands
*
Department of Public Health, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands (v.erasmus@erasmusmc.nl)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To study potential determinants of hand hygiene compliance among healthcare workers in the hospital setting.

Design.

A qualitative study based on structured-interview guidelines, consisting of 9 focus group interviews involving 58 persons and 7 individual interviews. Interview transcripts were subjected to content analysis.

Setting.

Intensive care units and surgical departments of 5 hospitals of varying size in the Netherlands.

Participants.

A total of 65 nurses, attending physicians, medical residents, and medical students.

Results.

Nurses and medical students expressed the importance of hand hygiene for preventing of cross-infection among patients and themselves. Physicians expressed the importance of hand hygiene for self-protection, but they perceived that there is a lack of evidence that handwashing is effective in preventing cross-infection. All participants stated that personal beliefs about the efficacy of hand hygiene and examples and norms provided by senior hospital staff are of major importance for hand hygiene compliance. They further reported that hand hygiene is most often performed after tasks that they perceive to be dirty, and personal protection appeared to be more important for compliance that patient safety. Medical students explicitly mentioned that they copy the behavior of their superiors, which often leads to noncompliance during clinical practice. Physicians mentioned that their noncompliance arises from their belief that the evidence supporting the effectiveness of hand hygiene for prevention of hospital-acquired infections is not strong.

Conclusion.

The results indicate that beliefs about the importance of self-protection are the main reasons for performing hand hygiene. A lack of positive role models and social norms may hinder compliance.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 30 , Issue 5 , May 2009 , pp. 415 - 419
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Donaldson, L. Dirty hands…the human cost. London, United Kingdom: UK Department of Public Health; 2006.Google Scholar
2.Group, HL. Hand washing. BMJ 1999;318:686.Google Scholar
3.Teare, L, Cookson, B, Stone, S. Hand hygiene. BMJ 2001;323:411–412.CrossRefGoogle ScholarPubMed
4.Stone, S, Teare, L, Cookson, B. Guiding hands of our teachers. Hand-.hygiene Liaison Group. Lancet 2001;357:479–480.Google Scholar
5.Pittet, D, Allegranzi, B, Sax, H, et al. Evidence-based model for hand transmission during patient care and the role of improved practices. Lancet Infect Dis 2006;6:641–652.Google Scholar
6.World Alliance for Patient Safety. Global patient safety challenge 2005-2006: clean care is safer care. Geneva, Switzerland: World Health Organization; 2005.Google Scholar
7.Day, M. Chief medical officer names hand hygiene and organ donation as public health priorities. BMJ 2007;335:113.Google Scholar
8.Jumaa, PA. Hand hygiene: simple and complex. Int J Infect Dis 2005;9:3–14.Google Scholar
9.Naikoba, S, Hayward, A. The effectiveness of interventions aimed at increasing handwashing in healthcare workers-a systematic review. J Hosp Infect 2001;47:173–180.Google Scholar
10.Larson, EL, Bryan, JL, Adler, LM, Blane, C. A multifaceted approach to changing handwashing behavior. Am J Infect Control 1997;25:3–10.Google Scholar
11.Pittet, D, Mourouga, P, Perneger, TV. Compliance with handwashing in a teaching hospital. Infection Control Program. Ann Intern Med 1999;130:126–130.CrossRefGoogle Scholar
12.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.CrossRefGoogle Scholar
13.Morgan, DL. Focus groups as qualitative research. 2nd ed. London, United Kingdom: Sage; 1997.CrossRefGoogle Scholar
14.Patton, MQ. Qualitative research and evaluation methods. 3rd ed. London, United Kingdom: Sage; 2002.Google Scholar
15.Bartholomew, LK, Parcel, GS, Kok, G, Gottlieb, NH. Planning health promotion programs; an intervention mapping approach. San Francisco, CA: Jossey-Bass; 2006.Google Scholar
16.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
17.Creedon, SA. Healthcare workers' hand decontamination practices: compliance with recommended guidelines. J Adv Nurs 2005;51:208–216.CrossRefGoogle ScholarPubMed
18.Lipsett, PA, Swoboda, SM. Handwashing compliance depends on professional status. Surg Infect (Larchmt) 2001;2:241–245.CrossRefGoogle ScholarPubMed
19.Pittet, D, Hugonnet, S, Harbath, S. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene (published correction appears in Lancet 2000;356:2196). Lancet 2000;356:1307–1312.Google Scholar
20.Feather, A, Stone, SP, Wessier, A, Boursicot, KA, Pratt, C. ‘Now please wash your hands’: the handwashing behaviour of final MBBS candidates. J Hosp Infect 2000;45:62–64.CrossRefGoogle ScholarPubMed
21.Ajzen, I. The theory of planned behavior. Organ Behav Hum Dec Processes 1991;50:179–211.Google Scholar
22.Duggan, JM, Hensley, S, Khuder, S, Papadimos, TJ, Jacobs, L. Inverse correlation between level of professional education and rate of handwashing compliance in a teaching hospital. Infect Control Hosp Epidemiol 2008;29:534–538.CrossRefGoogle ScholarPubMed
23.Aragon, D, Sole, ML, Brown, S. Outcomes of an infection prevention project focusing on hand hygiene and isolation practices. AACN Clin Issues 2005;16:121–132.Google Scholar
24.Golan, Y, Doron, S, Griffith, J, et al. The impact of gown-use requirement on hand hygiene compliance. Clin Infect Dis 2006;42:370–376.CrossRefGoogle ScholarPubMed
25.Lankford, MG, Zembower, TR, Trick, WE, Hacek, DM, Noskin, GA, Peterson, LR. Influence of role models and hospital design on hand hygiene of healthcare workers. Emerg Infect Dis 2003;9:217–223.CrossRefGoogle ScholarPubMed
26.MacDonald, A, Dinah, F, MacKenzie, D, Wilson, A. Performance feedback of hand hygiene, using alcohol gel as the skin decontaminant, reduces the number of inpatients newly affected by MRSA and antibiotic costs. J Hosp Infect 2004;56:56–63.CrossRefGoogle ScholarPubMed
27.O'Boyle, CA, Henly, SJ, Duckett, LJ. Nurses' motivation to wash their hands: a standardized measurement approach. Appi Nurs Res 2001;14:136–145.CrossRefGoogle Scholar
28.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.Google Scholar