Abstract
BackgroundImproving hand hygiene in hospitals is the most efficient method to prevent healthcare-associated infections. The hand hygiene behavior of hospital patients and visitors is not well-researched, although they pose a risk for the transmission of pathogens. Therefore, the present study had three aims: (1) Finding a suitable theoretical model to explain patients’ and visitors’ hand hygiene practice; (2) Identifying important predictors for their hand hygiene behavior; and (3) Comparing the essential determinants of hand hygiene behavior between healthcare professionals from the literature to our non-professional sample.MethodsIn total N = 1,605 patients and visitors were surveyed on their hand hygiene practice in hospitals. The employed questionnaires were based on three theoretical models: a) the Theory of Planned Behavior (TPB); b) the Health Action Process Approach (HAPA); and c) the Theoretical Domains Framework (TDF). Structural equation modeling was used to analyze the data. To compare our results to the determinants of healthcare workers’ hand hygiene behavior, we searched for studies that used one of the three theoretical models.ResultsAmong patients, 52% of the variance in the hand hygiene behavior was accounted for by the TDF domains, 44% by a modified HAPA model, and 40% by the TPB factors. Among visitors, these figures were 59%, 37%, and 55%, respectively. Two clusters of variables surfaced as being essential determinants of behavior: self-regulatory processes and social influence processes. The critical determinants for healthcare professionals’ hand hygiene reported in the literature were similar to the findings from our non-professional sample.ConclusionsThe TDF was identified as the most suitable model to explain patients’ and visitors’ hand hygiene practices. Patients and visitors should be included in existing behavior change intervention strategies. Newly planned interventions should focus on targeting self-regulatory and social influence processes to improve effectiveness.
Highlights
Worldwide, healthcare-associated infections pose a severe threat to patients’ health and impose massive financial burdens on health systems [1]
The employed questionnaires were based on three theoretical models: a) the Theory of Planned Behavior (TPB); b) the Health Action Process Approach (HAPA); and c) the Theoretical Domains Framework (TDF)
We focused on three theoretical models: a) the Theory of Planned Behavior (TPB, [24]); b) the Health Action Process Approach (HAPA [25, 26]); and c) the Theoretical Domains Framework (TDF [22, 27])
Summary
Healthcare-associated infections pose a severe threat to patients’ health and impose massive financial burdens on health systems [1]. Improving hand hygiene behavior has been confirmed as an efficient method to prevent healthcare-associated infections. Contaminated healthcare workers’ hands are known to be the most common vehicle for the transmission of pathogens causing healthcare-associated infections [5]. Non-healthcare professionals are a risk factor for the transmission of pathogens that can lead to infections. Patients’ and hospital visitors’ hand hygiene behavior is not well researched. Patients and their relatives were encouraged to sanitize their hands twice a day; as a result, methicillin-resistant Staphylococcus aureus (MRSA) infections decreased by 51% [11]. Improving hand hygiene in hospitals is the most efficient method to prevent healthcareassociated infections. The hand hygiene behavior of hospital patients and visitors is not well-researched, they pose a risk for the transmission of pathogens. The present study had three aims: (1) Finding a suitable theoretical model to explain patients’ and visitors’ hand hygiene practice; (2) Identifying important predictors for their hand hygiene behavior; and (3) Comparing the essential determinants of hand hygiene behavior between healthcare professionals from the literature to our non-professional sample
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