Abstract
BackgroundEffective hand hygiene is one of the most important measures for protecting nursing home residents from nosocomial infections. Infections with multi-resistant bacteria’s, associated with healthcare, is a known problem. The nursing home setting differs from other healthcare environments in individual and organisational factors such as knowledge, behaviour, and attitude to improve hand hygiene and it is therefore difficult to research the influential factors to improve hand hygiene. Studies have shown that increasing knowledge, behaviour and attitudes could enhance hand hygiene compliance in nursing homes. Therefore, it may be important to examine individual and organisational factors that foster improvement of these factors in hand hygiene. We aim to explore these influences of individual and organisational factors of hand hygiene in nursing home staff, with a particular focus on the function of role modelling by nursing managers.MethodsWe conducted a mixed-methods study surveying 165 nurses and interviewing 27 nursing managers from nursing homes in Germany.ResultsMost nurses and nursing managers held the knowledge of effective hand hygiene procedures. Hygiene standards and equipment were all generally available but compliance to standards also depended upon availability in the immediate work area and role modelling. Despite a general awareness of the impact of leadership on staff behaviour, not all nursing managers fully appreciated the impact of their own consistent role modelling regarding hand hygiene behaviours.ConclusionThese results suggest that improving hand hygiene should focus on strategies that facilitate the provision of hand disinfectant materials in the immediate work area of nurses. In addition, nursing managers should be made aware of the impact of their role model function and they should implement this in daily practice.
Highlights
Effective hand hygiene is one of the most important measures for protecting nursing home residents from nosocomial infections
While a large proportion of multidrug-resistant infections in nursing homes could be avoided through appropriate hand hygiene behaviour of nurses, this behaviour is influenced by organisational factors such as hygiene training, availability of resources and improved role modelling of nursing managers [24,25,26,27,28]
Our research questions considered the perspectives of nurses and nursing managers on their hand hygiene knowledge (What knowledge do nurses have / How do nursing managers perceive nurses’ knowledge concerning hygiene management and infection prevention?), their hygiene practices and compliance with hygiene guidelines (Which hygiene behaviours do nurses report / nursing managers observe in their staff?) as well as how these behaviours are supported or hindered by organisational aspects and role modelling by nursing managers (What are the perceptions of nurses and nursing managers of organisational structures and processes supporting hand hygiene? In what way do nurses perceive nursing managers / do nursing managers regard themselves as role models for hand hygiene?)
Summary
Effective hand hygiene is one of the most important measures for protecting nursing home residents from nosocomial infections. Yeung et al [11] showed that hygiene programmes and education could effectively increase adherence to hand rubbing and reduce the incidence of serious infections in nursing homes Apart from these individual factors, effective hand hygiene requires adequate organisational factors including availability of hand rub, stock of protective clothing, and strong local efforts from the nursing management such as role modelling. While a large proportion of multidrug-resistant infections in nursing homes could be avoided through appropriate hand hygiene behaviour of nurses, this behaviour is influenced by organisational factors such as hygiene training, availability of resources and improved role modelling of nursing managers [24,25,26,27,28]
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