A qualitative study of hand hygiene compliance among health care workers in intensive care units.

Pinar Ay,Pinar Tepe,Volkan Korten,Seyhan Hidiroglu,Uluhan Sili,Aysen Surmen,Ayse Gulsen Teker,Melda Karavus

doi:10.3855/jidc.10926

Pinar Ay, Pinar Tepe + Show 6 more

Open Access

https://doi.org/10.3855/jidc.10926

Copy DOI

Abstract

Studies indicate that adherence to hand hygiene guidelines is at suboptimal levels. We aimed to explore the reasons for poor hand hygiene compliance. A qualitative study based on the Theory of Planned Behavior as a framework in explaining compliance, consisting four focus group discussions and six in-depth interviews. Participants mostly practiced hand hygiene depending on the sense of "dirtiness" and "cleanliness". Some of the participants indicated that on-job training delivered by the infection control team changed their perception of "emotionally" based hand hygiene to "indication" based. Direct observations and individual feedback on one-to-one basis were the core of this training. There was low social cohesiveness and a deep polarization between the professional groups that led one group accusing the other for not being compliant. The infection control team should continue delivering one-to-one trainings based on observation and immediate feedback. But there is need to base this training model on a structured behavioral modification program and test its efficacy through a quasi-experimental design. Increasing social cohesiveness and transforming the blaming culture to a collaborative safety culture is also crucial to improve compliance. High workload, problems related to work-flow and turnover should be addressed.

Highlights

Studies indicate that adherence to hand hygiene guidelines is at suboptimal levels
While 30% of intensive care units (ICUs) patients in high-income countries are affected by Health-care associated infections (HCAIs), the rate is estimated as 2-3 folds higher in low and middle-income countries [1]
Self-protection which forms the basis for inherent behavior is the primary motive for Hand hygiene (HH) among health care workers (HCWs) [6,9,15,18,20,23]

Summary

Introduction

Studies indicate that adherence to hand hygiene guidelines is at suboptimal levels. Some of the participants indicated that on-job training delivered by the infection control team changed their perception of "emotionally" based hand hygiene to "indication" based. Conclusions: The infection control team should continue delivering one-to-one trainings based on observation and immediate feedback. Health-care associated infections (HCAIs) are an important cause of morbidity and mortality among hospitalized patients. While 30% of ICU patients in high-income countries are affected by HCAIs, the rate is estimated as 2-3 folds higher in low and middle-income countries [1]. Hand hygiene (HH) either performed by washing hands with soap and water or using alcohol-based hand rubs is considered as the most important measure for infection prevention in health care settings. The median compliance to HH guidelines is estimated as 40% and it is lower in ICUs compared to the other settings [3]

Objectives

Methods

Conclusion