Barriers and facilitators on hand hygiene and hydro-alcoholic solutions' use: representations of health professionals and prevention perspectives

Uncovering the obstacles: a comprehensive analysis of barriers to hand hygiene adherence among healthcare providers: a systematic review

BACKGROUND

Hand hygiene is the most effective and feasible infection prevention and control measure within the healthcare facilities. Despite the ease and simplicity of the technique, the adherence rate among health professionals remains suboptimal. Hence, developing targeted interventions to improve adherence requires a clear understanding of these obstacles. Therefore, this systematic reviews of existing literature aims to fully understand the context specific barriers of hand hygiene to answer why barriers persisted despite the interventions to maintaining hand hygiene practices among healthcare providers.

METHODS

This systematic review was conducted to synthesize existing evidence according to the Joanna Briggs Institute (JBI) qualitative studies review methodology on qualitative studies publish between the year 2010 and 2024. The study is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guideline (PRISMA) and the protocol for the study was published on PROSPERO (CRD42024573753) before commencing the study.

RESULT

The review included twenty eight studies that are conducted in different regions of the world representing six of the continents. The study identified four interconnected themes of barriers with many subthemes. Behavioural barriers and organizational barriers were the most highlighted themes within the review. Physical barriers were one of the significant themes, where unavailability and inconvenience of hand hygiene resources gain the most attention by study participants across the studies. The fourth theme was societal/interpersonal barriers characterized by negative social influence and unsupportive colleagues.

CONCLUSION

The study highlights that the barriers to hand hygiene adherence among healthcare professionals are intertwined and complex, with the main interplaying among behavioural, societal/interpersonal, physical, and organizational barriers. The findings underscore that the intertwined nature of these barriers requires a multifaceted approach involving the relevant stakeholders to improve hand hygiene adherence among healthcare providers.

Italian National Surveillance of Alcohol-Based Hand Rub Consumption in a Healthcare Setting-A Three-Year Analysis: 2020-2022

Background/Objectives: Hand hygiene (HH) is pivotal in mitigating infectious disease transmission and enhancing public health outcomes. This study focuses on detailing the national surveillance system for alcohol-based hand rub (ABHR) consumption in healthcare facilities across Italy, presenting results from a comprehensive three-year evaluation period, from 2020 to 2022. It aims to delineate this surveillance system and report on ABHR consumption trends in various Regions/Autonomous Provinces (Rs/APs). Methods: ABHR consumption data, collected through the ABHR Italian national surveillance system, coordinated by the Istituto Superiore di Sanità (ISS), were analyzed. Statistical methods, e.g., the Mann-Whitney test, were used to assess trends in ABHR consumption, expressed in liters per 1000 patient days (L/1000PD). Results: The results show significant variation in ABHR consumption across Rs/APs and over the years studied. National median ABHR consumption decreased from 2020 to 2022, with a significant reduction from a median of 24.5 L/1000PD in 2020 to 20.4 L/1000PD in 2021 and 15.6 L/1000PD in 2022. Conclusions: The decline in ABHR consumption raises concerns about the ongoing adherence to HH practices in Italian healthcare settings. This underscores the essential role that systematic ABHR monitoring and improved surveillance play in enhancing HH compliance, suggesting that sustained and strategic efforts are fundamental to uphold high standards of hygiene and to effectively respond to fluctuating ABHR usage trends over time. Further research is needed to explore barriers to effective ABHR use and to develop targeted strategies to improve HH practices.

"In their own words": delineating the contours of dyspnea invisibility in patients with advanced chronic obstructive pulmonary disease from quantitative discourse analysis

BACKGROUND

Dyspnea conveys an upsetting or distressing experience of breathing awareness. It heavily weighs on chronic respiratory disease patients, particularly when it persists despite maximal treatment of causative abnormalities. The physical, psychological and social impacts of persistent dyspnea are ill-appreciated by others. This invisibility constitutes a social barrier and impedes access to care. This study aimed to better understand dyspnea invisibility in patients with chronic obstructive pulmonary disease (COPD) through quantitative discourse analysis.

METHODS

We conducted a lexicometric analysis (lemmatization, descending hierarchical classification, multicomponent analysis, similarity analysis) of 11 patients' discourses (6 men, severe COPD; immediate postexacerbation rehabilitation) to identify semantic classes and communities, which we then confronted with themes previously identified using interpretative phenomenological analysis (IPA).

RESULTS

Class#1 ("experience and need for better understanding"; 38.9% of semantic forms, 50% of patients) illustrates the gap that patients perceive between their experience and what others see, confirming the importance of dyspnea invisibility in patients' concerns. Class#2 ("limitations"; 28.7% of forms) and Class#3 (management"; 13.1% of forms) point to the weight of daily limitations in performing basic activities, of the need to accept or adapt to the constraints of the disease. These three classes matched previously identified IPA-derived themes. Class#4 ("hospitalization"; 18.2% of forms) points to the importance of interactions with the hospital, especially during exacerbations, which constitutes novel information.

CONCLUSIONS

Lexicometry confirms the importance of dyspnea invisibility as a burden to COPD patients.