Abstract
BackgroundHand hygiene (HH), a cornerstone in infection prevention and control, lacks quality in emergency medical services (EMS). HH improvement includes both individual and institutional aspects, but little is known about EMS providers’ HH perception and motivations related to HH quality. Therefore, we aimed to investigate the HH perception and assess potential factors related to self-reported HH compliance among the EMS cohort.MethodsA cross-sectional, self-administered questionnaire consisting of 24 items (developed from the WHOs Perception Survey for Health-Care Workers) provided information on demographics, HH perceptions and self-reported HH compliance among EMS providers from Denmark.ResultsOverall, 457 questionnaires were answered (response rate 52%). Most respondents were advanced-care providers, males, had > 5 years of experience, and had received HH training < 3 years ago. HH was perceived a daily routine, and the majority rated their HH compliance rate ≥ 80%. Both infection severity and the preventive effect of HH were acknowledged. HH quality was perceived important to colleagues and patients, but not as much to managers. Access to supplies, simple instructions and having or being “a good example” were perceived most effective to improve HH compliance. Self-reported HH compliance was associated with years of experience and perceptions of HCAI’s impact on patient outcome, HH’s preventive effect, organizational priority, HH’s importance to colleagues and patients, and the effort HH requires (p ≤ 0.05).ConclusionDanish EMS providers acknowledged the impact of infections and the preventive effect of HH, and perceived access to HH supplies at the point of care, having or being “a good example” and simple instructions effective to improve HH compliance. Moreover, several behavioral-, normative- and control beliefs were associated with self-reported HH compliance, and thus future improvement strategies should be multimodal.
Highlights
Hand hygiene (HH), a cornerstone in infection prevention and control, lacks quality in emergency medical services (EMS)
This study aimed to investigate HH perception and factors related to self-reported HH compliance among the EMS cohort, using a behavioral theoretic approach
Most of the providers perceived the impact of Healthcare-associated infection (HCAI) on patient outcome (98%), the preventive effect of HH (98%) and the organizational priority of HH (71%) to be high or very
Summary
Hand hygiene (HH), a cornerstone in infection prevention and control, lacks quality in emergency medical services (EMS). The Theory of Planned Behavior is regularly applied, combining attitudes, subjective norms and perceived behavioral control to predict behavioral intentions, and a given HH behavior Such an approach implies that the intention to perform HH is influenced by three central elements: beliefs about outcome causes (e.g., the perception of HCAI severity, or HHs preventive effect); beliefs about other people’s expectations (e.g., the perception of managers,’ colleagues’ or patients’ expectations regarding HH performance) and control beliefs (e.g., the perceived effort HH demands). Given substantial control over the behavior, e.g. HH, people are expected to carry out their intentions when the opportunity arises [14, 15] Under such assumption, the intention to perform HH has been assessed by self-reported HH compliance and translated into presumed action [15]. This study aimed to investigate HH perception and factors related to self-reported HH compliance among the EMS cohort, using a behavioral theoretic approach
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