Differences in psychosocial determinants of hand hygiene between health care professional groups: Insights from a mixed-methods analysis

Psychosocial determinants of handwashing compliance intention among physicians and nurses in Taiwan: A theory-driven comparison using the Health Belief Model

Most healthcare-associated infections are transmitted through the hands of healthcare workers (HCWs). However, handwashing compliance remains a challenge in Taiwan. This study examined handwashing compliance intention among 705 HCWs (103 physicians and 602 nurses), using an extensive set of survey items informed by the Health Belief Model (HBM). Exploratory factor analysis of items measuring the HBM's reflective latent constructs (perceived susceptibility, perceived severity, perceived benefits, and perceived barriers) revealed a 10-factor structure, representing distinct dimensions with nuanced differentiation within HBM's original constructs. These 10 factors, along with cues to action (a formative construct), comprised the 11 HBM factors in this study. Perceived benefits of infection prevention emerged as the strongest driver of HCWs' handwashing compliance intention, followed by cues to action. Conversely, perceived barriers-time constraints significantly decreased compliance intention. Stratified comparisons showed that physicians and nurses endorsed different benefits of handwashing and cues to action, highlighting the need for profession-specific interventions. While physicians were motivated by concerns regarding perceived professional competence, nurses were motivated by infection prevention and praise/respect at work. Notably, a hospital policy mandating handwashing also increased compliance intention. Our findings offer practical insights for developing theory-driven and tailored interventions to enhance handwashing compliance among HCWs.

Factors associated with correction of personal protective equipment nonadherence in a multidisciplinary emergency department setting: A retrospective video review

BACKGROUND

Despite local and national recommendations, health care provider adherence to personal protective equipment (PPE) varied during the COVID-19 pandemic. Previous studies have identified factors influencing initial PPE adherence but did not address factors influencing behaviors leading to correction after initial nonadherence.

METHODS

We conducted a retrospective video review of 18 pediatric resuscitations involving aerosol-generating procedures from March 2020 to December 2022 to identify factors associated with nonadherence correction. We quantified adherent and nonadherent providers, instances of PPE nonadherence, and time to correction. We also analyzed correction behaviors, including provider actions and correction locations.

RESULTS

Among 434 providers, 362 (83%) were nonadherent with at least 1 PPE. Only 186 of 1,832 instances of nonadherence were corrected, primarily upon room entry and during patient care. Correction time varied by PPE type and nonadherence level (incomplete vs absent). Most corrections were self-initiated, with few reminders from other providers.

DISCUSSION

Potential barriers to correction include a lack of social pressure and external reminders. Solutions include optimizing PPE availability, providing real-time feedback, and educating on double gloving.

CONCLUSIONS

Most providers were nonadherent to PPE requirements during high-risk infection transmission events. The low correction rate suggests challenges in promoting collective responsibility and maintaining protective behaviors during medical emergencies.

Psychometric Properties of Scales Assessing Psychosocial Determinants of Staff Compliance with Surgical Site Infection Prevention: The WACH-Study

Purpose

Psychosocial determinants influence healthcare workers' compliance with surgical site infection (SSI) preventive interventions. In order to design needs-based interventions promoting compliance, such determinants must first be assessed using valid and reliable questionnaire scales. To compare professional groups without bias, the scales must also be measurement-equivalent. We examine the validity/reliability and measurement equivalence of four scales using data from physicians and nurses from outside the university sector. Additionally, we explore associations with self-reported SSI preventive compliance.

Participants and Methods

N = 90 physicians and N = 193 nurses (response rate: 31.5%) from nine general/visceral or orthopedic/trauma surgery departments in six non-university hospitals in Germany participated. A written questionnaire was used to assess the compliance with SSI preventive interventions and the determinants of compliance based on the Capability-Opportunity-Motivation-Behavior-Model. Psychometric testing involved single- and multiple-group confirmatory factor analyses, and explorative analyses used t-tests and multiple linear regression.

Results

The scales assessing individual determinants of compliance (capability, motivation, and planning) were found to be reliable (each Cronbach's α ≥ 0.85) and valid (each Root-Mean-Square-Error of Approximation ≤ 0.065, each Comparative-Fit-Index = 0.95) and revealed measurement equivalence for physicians and nurses. The scale assessing external determinants (opportunity) did not demonstrate validity, reliability, or measurement equivalence. Group differences were found neither in compliance (p = 0.627) nor determinants (p = 0.192; p = 0.866; p = 0.964). Capability (β = 0.301) and planning (β = 0.201) showed associations with compliance for nurses only.

Conclusion

The scales assessing motivation, capability, and planning regarding SSI preventive compliance provided reliable and valid scores for physicians and nurses in surgery. Measurement equivalence allows group comparisons of scale means to be interpreted without bias.

Building capacity for point of care alcohol-based handrub (ABHR) and hand hygiene compliance among health care workers in the rural maternity and surgical units of a hospital in Cameroon

BACKGROUND

Hand hygiene (HH) is challenging in health care, but particularly in resource-limited settings due to a lack of training, resources, and infrastructure. This study aimed to evaluate the implementation of wall-mounted alcohol-based handrub (ABHR) at the point of care (POC) on HH compliance among health care workers in a Cameroon hospital.

METHODS

It was a three-stage before and after study. The first stage involved baseline collection of ABHR utilization and HH compliance data. The second stage included the implementation of ABHR at the POC, supported by an implementation strategy involving HH training, monitoring and feedback, and HH champions. The third stage involved postimplementation data collection on ABHR use and HH compliance.

RESULTS

5,214 HH opportunities were evaluated. HH compliance significantly increased from 33.3% (baseline) to 83.1% (implementation stage) (P < .001) and to 87.2% (postimplementation stage) (P < .001). Weekly ABHR usage increased significantly during implementation (5,670 ml), compared to baseline, (1242.5 ml, P = .001), and remained high in postimplementation (7,740 ml).

CONCLUSIONS

Continuous availability of ABHR at POC, supported by implementation strategy, significantly increased HH compliance and ABHR use. Learning from this study could be used to implement ABHR at POC in other facilities.

Gender differences in psychosocial determinants of hand hygiene among physicians

OBJECTIVE

We investigated gender differences in psychosocial determinants that affect hand hygiene (HH) performance among physicians.

DESIGN

The survey included a structured questionnaire with 7 parts: self-assessment of HH execution rate; knowledge, attitude, and behavior regarding HH; internal and emotional motivation for better HH; barriers to HH; need for external reminders; preference for alcohol gel; and embarrassment due to supervision.

SETTING

The study was conducted across 4 academic referral hospitals in Korea.

PARTICIPANTS

Physicians who worked at these hospitals were surveyed.

METHODS

The survey questionnaire was sent to 994 physicians of the hospitals in July 2018 via email or paper. Differences in psychosocial determinants of HH among physicians were analyzed by gender using an independent t test or the Fisher exact test.

RESULTS

Of the 994 physicians, 201 (20.2%) responded to the survey. Among them, 129 (63.5%) were men. Male physicians identified 4 barriers as significant: time wasted on HH (P = .034); HH is not a habit (P = .004); often forgetting about HH situations (P = .002); and no disadvantage when I do not perform HH (P = .005). Female physicians identified pain and dryness of the hands as a significant obstacle (P = .010), and they had a higher tendency to feel uncomfortable when a fellow employee performed inadequate HH (P = .098). Among the respondents, 26.6% identified diversifying the types of hand sanitizers as their first choice for overcoming barriers to improving HH, followed by providing reminders (15.6%) and soap and paper towels in each hospital room (13.0%).

CONCLUSION

A significant difference in the barriers to HH existed between male and female physicians. Promoting HH activities could help increase HH compliance.

Hand hygiene knowledge, attitude, barriers and improvement measures among healthcare workers in the Republic of Korea: a cross-sectional survey exploring interprofessional differences

BACKGROUND

Hand hygiene (HH) is a fundamental component of infection prevention and control in healthcare settings. This study aimed to identify knowledge, attitude, and barriers to HH according to occupational groups and strategies to increase the rate of HH compliance among healthcare workers (HCWs).

METHODS

This cross-sectional survey was conducted in July 2018 at four university-affiliated hospitals. The survey comprised seven parts with 49 items, including self-reported HH compliance, knowledge, attitudes, behaviours, barriers to HH, and improvement strategies.

RESULTS

A total of 1046 HCWs participated in the survey. The nursing group's self-reported HH compliance rate was the highest, followed by other HCWs and physicians. The scores regarding knowledge, attitudes, and behaviours regarding HH were the highest in the nursing group. The nursing group also had higher internal and emotional motivation scores. Physicians and nurses found HH the most challenging in emergencies, while other HCWs considered skin problems caused by HH products the most significant barrier. Among 12 improvement measures, approximately 20% of the respondents ranked "diversify types of hand sanitisers," "install soap and paper towels in each hospital room," and "change perception through various HH campaigns" as the top three priorities. The physician group deemed the timely reminder of HH compliance as the second most critical improvement measure.

CONCLUSION

Differences in knowledge, attitude and barriers hindering HH compliance and improvement plans were identified for each group. The findings suggest that targeted interventions tailored to the specific needs of different occupational groups may effectively improve HH compliance in healthcare settings.

Psychosocial determinants of healthcare personnel's willingness to carry real-time locating system tags during daily inpatient care in hospital managing COVID-19 patients: insights from a mixed-methods analysis

Objective

Real-time locating systems (RTLS) enable contact tracing and hand hygiene reminders, to improve hospital safety. Successful implementation requires healthcare personnel (HCP) to carry RTLS tags continuously. We assessed for determinants of HCP’s willingness to use RTLS tags during routine inpatient care, and evaluated concerns using mixed-methods analysis.

Materials and Methods

We conducted a cross-sectional study in the 330-bed purpose-built National Centre for Infectious Diseases in Singapore, from January 15 through February 4, 2020. The anonymous survey comprised 24 questions based on constructs from behavioral models and an open-ended question. Principal component analysis was performed to derive the latent factor structure applied in the multivariable logistic regression analysis. Concerns were analyzed using thematic analysis.

Results

Of 260 HCP (nurses [40.8%], ancillary and administrative staff [23.1%], allied health professionals [18.5%], and physicians [17.7%]), 75% were willing to use the RTLS tag. After adjusting for age, gender, healthcare professional group, and duration of practice, the acceptance of the use of the RTLS tag (adjusted OR 11.28 [95% CI 4.39–29.00], P < .001) was highly associated with the willingness to use the RTLS tag. HCP who perceived the tag to be easy to use (adjusted OR 2.80 [95% CI 1.37–5.72], P = .005), were also more willing to use the tag. HCP were willing to carry the RTLS tag for the purpose of contact tracing despite privacy concerns.

Conclusion

More communications on the intentions and data protection standards of the RTLS, and accessory enhancements for HCP’s convenient and sustained use of the RTLS tag are crucial, to optimize RTLS’s usefulness during the COVID-19 pandemic.

Association between well-being and compliance with COVID-19 preventive measures by healthcare professionals: A cross-sectional study

IMPORTANCE

Knowledge and attitude influence compliance and individuals' practices. The risk and protective factors associated with high compliance to these preventive measures are critical to enhancing pandemic preparedness.

OBJECTIVE

This survey aims to assess differences in mental health, knowledge, attitudes, and practices (KAP) of preventive measures for COVID-19 amongst healthcare professionals (HCP) and non-healthcare professionals.

DESIGN

Multi-national cross-sectional study was carried out using electronic surveys between May-June 2020.

SETTING

Multi-national survey was distributed across 36 countries through social media, word-of-mouth, and electronic mail.

PARTICIPANTS

Participants ≥21 years working in healthcare and non-healthcare related professions.

MAIN OUTCOME

Risk factors determining the difference in KAP towards personal hygiene and social distancing measures during COVID-19 amongst HCP and non-HCP.

RESULTS

HCP were significantly more knowledgeable on personal hygiene (AdjOR 1.45, 95% CI -1.14 to 1.83) and social distancing (AdjOR 1.31, 95% CI -1.06 to 1.61) compared to non-HCP. They were more likely to have a positive attitude towards personal hygiene and 1.5 times more willing to participate in the contact tracing app. There was high compliance towards personal hygiene and social distancing measures amongst HCP. HCP with high compliance were 1.8 times more likely to flourish and more likely to have a high sense of emotional (AdjOR 1.94, 95% CI (1.44 to 2.61), social (AdjOR 2.07, 95% CI -1.55 to 2.78), and psychological (AdjOR 2.13, 95% CI (1.59-2.85) well-being.

CONCLUSION AND RELEVANCE

While healthcare professionals were more knowledgeable, had more positive attitudes, their higher sense of total well-being was seen to be more critical to enhance compliance. Therefore, focusing on the well-being of the general population would help to enhance their compliance towards the preventive measures for COVID-19.

Methicillin-resistant Staphylococcus aureus contamination of hospital-use-only mobile phones and efficacy of 222-nm ultraviolet disinfection

BACKGROUND

Mobile phones may be contaminated with nosocomial pathogens such as methicillin-resistant Staphylococcus aureus (MRSA). The aim of this study was to investigate the MRSA contamination rate on doctors' hospital-use-only mobile phones and the efficacy of 222-nm ultraviolet light (UV) disinfection.

METHODS

We investigated the MRSA contamination rate of doctors' hospital-use-only mobile phones, as well as the reduction in MRSA counts on plastic plates and aerobic bacteria (AB) on mobile phones before and after exposure to 222-nm UV irradiation.

RESULTS

Five (10%) of the 50 mobile phones investigated were contaminated with MRSA. Exposure to 0.1 mJ/cm² 222-nm UVC irradiation for 1.5 and 2.5 min (9 and 15 mJ/cm²) achieved mean log₁₀ MRSA colony-forming units reductions of 2.91 and 3.95, respectively. Exposure to 9 mJ/cm² 222-nm UVC irradiation (0.1 mW/cm² for 1.5 minutes) significantly reduced AB contamination on mobile phones (P < .001).

CONCLUSIONS

The use of 222-nm UV disinfection resulted in effective in vitro reduction of MRSA and significantly reduced AB contamination of mobile phone surfaces.

[Evolution of adherence to hand hygiene in health care professionals in a third level hospital in relation to the SARS-CoV-2 pandemic]

OBJECTIVE

Proper hand hygiene is the main measure in the prevention and control of infection associated with healthcare. It describes how the pandemic period of 2020 has influenced the evolution of the degree of compliance with hand hygiene practices in health professionals at the Hospital Universitario Insular de Gran Canaria with respect to previous years.

METHODS

Descriptive cross-sectional study of direct observation on compliance with the five moments of hand hygiene in the 2018-2020 period. Adherence is described with the frequency distribution of the different moments in which it was indicated.

RESULTS

Total adherence has increased from 42.5% in 2018, to 47.6% in 2019, and 59.2% in 2020 (p <0.05). Total adherence was greater in the moments after contact with the patient (67%) than in the moments before contact (48%). The area with the highest adherence was dialysis (83%). There is a greater adherence in open areas than in hospitalization areas (65% vs 56%). Higher adherence was determined in physicians (73%) and nurses (74%), than in nursing assistants (50%) (p<0.05).

CONCLUSIONS

In 2020 there was an increase in adherence to hand hygiene compared to previous years. A higher percentage of adherence was determined in physicians and nurses than in nursing assistants. We consider that the current SARS-CoV-2 pandemic has played a relevant role in this increase in adherence.

A new approach to infection prevention: A pilot study to evaluate a hand hygiene ambassador program in hospitals and clinics

BACKGROUND

A pilot study was conducted to assess the perceptions of visitors, patients, and staff to the presence of a hand hygiene ambassador (HHA).

METHODS

Two hundred and twenty-five entrants to various health care settings were surveyed. Only entrants who failed to clean their hands at the alcohol-based handrub (ABHR) station on entry to the lobby were offered application of ABHR by an HHA. Several questions were also asked to assess their attitudes about the presence of an HHA.

RESULTS

When asked whether they think it is a good idea to have an HHA place ABHR on an entrant's hands, the majority of staff, visitors, and patients agreed. No one refused administration of handrub by the HHA.

DISCUSSION

HHA programs have direct and indirect benefits. Although the cost of such an initiative should be considered prior to implementation, it should be weighed against the annual spending for health care-associated infections.

CONCLUSIONS

Considering that hand hygiene compliance and health care-associated infection are clearly linked, a new approach using an HHA may help reduce infection, acting as a source of hand hygiene on entry to the hospital and possibly as a reminder to perform hand hygiene elsewhere in the hospital and clinics.

Does Physician Leadership Influence Followers' Hand Hygiene Compliance?

The aim of this study was to determine factors influencing the hand hygiene compliance of a physician. We found a strong correlation between a leader’s (staff member’s or fellow’s) and a follower’s (resident’s) hand hygiene compliance. Followers’ appropriate hand hygiene compliance was significantly associated with the compliance of the leader (P = .01).