Self-reported reasons for hand hygiene in 3 groups of health care workers

Hand hygiene: Attitudes and practices of nurses, a comparison between 2007 and 2015

BACKGROUND

Hand hygiene reduces health care-associated infections significantly. However, international evidence suggests that practices are suboptimal. The objective of this study was to compare and contrast hand hygiene attitudes and practices and alcohol-based handrub (ABHR) use among nurses between 2007 and 2015.

METHODS

In 2007, a random sample of nurses in a large teaching hospital was invited to complete a postal survey using a validated questionnaire. In 2015, the study was replicated among all nurses employed in a university hospital group, including the setting of the original study. Data were analyzed quantitatively and qualitatively using appropriate software.

RESULTS

Attitudes to hand hygiene were positive and >90% of respondents' self-reported compliance before and after patient contact. However, 13% fewer in 2015 (42%) reported using ABHR >90% of the time compared with in 2007 (55%). Of nurses with <2 years' experience, 90% reported using ABHR >50% of the time compared with 73% of nurses with 2-5 years' experience. Barriers to ABHR improved, but remained high (skin sensitivity: 2007: 23%, 2015: 17%; skin damage: 2007: 18%, 2015: 13%; poor user acceptability and tolerance: 2007 and 2015: 25%).

CONCLUSIONS

Use of positive role models, the adoption of a positive social and cultural norm within the organization, and the provision of continuing professional development opportunities may prove useful strategies in harnessing good practice among graduate nurses and in preventing negative socialization from occurring.

Factors that influence hand hygiene practice amongst occupational therapy students

Purpose

Hand hygiene is the single most important intervention to reduce the risk of acquiring infection. All healthcare workers and healthcare students have a responsibility to prevent transmission of infection. The purpose of this study is to investigate students’ attitudes to hand hygiene following university-based education and practice placement. Students attended a lecture, completed an e-learning module, participated in a practical session using a ultra-violet light hand inspection cabinet and engaged in clinical placement.

Design/methodology/approach

In all, 64 students participated in a multimodal hand hygiene education programme before clinical placement, with each student completing an in-class questionnaire after placement. Data were analysed using descriptive and comparative statistics. Students rated educational methods that had most influence on them. Their preference was for a practical hand hygiene education session. Students were also influenced by the therapist they were on placement with. They were least influenced by the didactic college presentation.

Findings

This study highlights that students may be influenced by different methods of education at different stages in their course and that placement may be an important influencing factor in the earlier years of occupational therapy education.

Research limitations/implications

This study highlights the importance of the availability of a multimodal educational approach and clinical placement to promote increased compliance with hand hygiene amongst students.

Practical implications

University healthcare course curricula should include multimodal approaches to the education of hand hygiene. While hand hygiene e-learning modules are beneficial, they should be used in conjunction with a multimodal educational strategy that incorporates practical elements. The influence of the therapist on a students’ behaviour should be utilised to improve both student and professionals hand hygiene adherence.

Originality/value

Original piece of work that is not widely discussed in Occupational Therapy literature.

Tell me how pleased you are with your workplace, and I will tell you how often you wash your hands

Hospital-acquired infections are the most common complication of treatment and the primary patient safety hazard. Hand hygiene (HH) is the most important tool for preventing these infections. Although thousands of research projects have been conducted, many articles written, and numerous therapeutic recommendations made, the goal has not yet been reached. The professional literature emphasizes that the reasons HH strategies fail are still only partially understood. The aim of this study was to examine the correlation between the psychological safety of an organization's nursing staff and its sense of personal responsibility for avoiding transmission of infections. Questionnaires were distributed to the 400 nurses in a children's hospital. Nurses' psychological safety and sense of responsibility for transmitting infections were positively correlated (r = 0.425; P < .001). In addition, 209 respondents (95.7%) believe that transmission of resistant infections between patients is preventable and 74% agree that transmission of infections is the responsibility of the care staff, but only 40% were willing to take personal responsibility in the department in which they were employed. There is a correlation between nurses' psychological safety and sense of responsibility for transmitting infections. To increase workers' sense of personal responsibility regarding infections as a way to increase the response to HH, hospital management must work toward increasing workers' psychological safety.

Adherence and factors related to acceptance of alcohol for antiseptic hand rubbing among nursing professionals

OBJECTIVE

Identify rates of adhesion and related factors to acceptance of an alcohol based preparation to hands antiseptic friction among nursing professionals in a unit of intensive therapy.

METHOD

A cross-sectional study, which involved direct observation of hand hygiene opportunities and nursing professionals' completion of questionnaires, was conducted at a university hospital between January and July 2015. Descriptive and univariate analyses were performed, with a 5% significance level.

RESULTS

It was observed 956 opportunities of hand hygiene among 46 nursing professionals. The rate of adhesion to alcohol-based handrub (ABH) was 34.8% and about 87.0% preferred handwashing. Nurses used ABH more frequently than nursing technicians (p <0.001), and the report of feeling of clean hands after using the alcohol product was directly related to higher rates of adherence to antiseptic friction through observation (P <0.05).

CONCLUSION

The finding indicating low ABH usage highlights the need for greater institutional investment in strategies that help health professionals to recognize the advantages of this type of HH with respect to time spent, ease of access to dispensers, effectiveness in eliminating microorganisms, and maintaining skin moisturization.

Hand hygiene after touching a patient's surroundings: the opportunities most commonly missed

BACKGROUND

Healthcare workers generally underestimate the role of environmental surfaces in the transmission of infection, and compliance with hand hygiene following contact with the environment is generally lower than following direct patient contact. To reduce the risk of onward transmission, healthcare workers must identify the need to wash hands with specific tasks or events.

AIM

To observe the movement of staff in critical care and general wards and determine the routes most commonly travelled and the surfaces most frequently touched with and without appropriate hand hygiene.

METHODS

Fifty-eight 90 min sessions of unobtrusive observation were made in open bays and isolation rooms. Link analysis was used to record staff movement from one location to another as well as the frequency of motion. Hand-hygiene audits were conducted using the World Health Organization 'five moments for hand hygiene' observational tool.

FINDINGS

In critical care, the majority of movement occurred within the bed space. The bedside computer and equipment trolley were the surfaces most commonly touched, often immediately after patient contact. In the general ward, movement between bed spaces was more common and observed hand hygiene ranged from 25% to 33%. Regardless of ward type, observed hand-hygiene compliance when touching the patient immediately on entering an isolation room was less than 30%.

CONCLUSIONS

Healthcare workers must be made aware that bacterial spread can occur even during activities of perceived low risk. Education and intervention programmes should focus on the potential contamination of ward computers, case notes and door handles.

Attitudes and beliefs about hand hygiene among paediatric residents: a qualitative study

BACKGROUND

Despite the knowledge that contaminated hands play an important role in the transmission of healthcare-associated pathogens, and that hand hygiene (HH) reduces the transmission of these organisms, healthcare worker's adherence with HH is poor.

OBJECTIVE

To understand the common beliefs and attitudes held by paediatric residents about HH.

DESIGN

Qualitative study design.

SETTING

Tertiary care paediatric hospital in Edmonton, Canada.

METHODS

Semistructured interviews were conducted and themes were identified from interviews.

PARTICIPANTS

22 paediatric residents.

RESULTS

Paediatric residents self-reported their HH adherence at 70-99% and perceived hospital-wide adherence at 45-80%. Four major themes were identified during interviews including the importance of role modelling, balancing time spent on HH with other competing factors, self-protection as a driving factor for HH and cues as an important part of habit that stimulate HH.

CONCLUSIONS

Staff physicians were viewed as integral to initiating group HH events, but at times, the first person in the room acted as a role model for the rest of the group. In certain instances, such as a cardiac arrest, decreased adherence with HH was viewed as acceptable. Residents engaged in HH to protect their own health. Residents relied on personal cues, which they integrated into their own HH habit. Future HH adherence strategies should ensure that the physician training environments permit the formation of good attitudes and habits towards HH. There are no additional data available.