1
|
Ataiyero Y, Dyson J, Graham M. The barriers and facilitators to hand hygiene practices in Nigeria: A qualitative study: "There are so many barriers ... the barriers are limitless.". Am J Infect Control 2023; 51:295-303. [PMID: 36804099 DOI: 10.1016/j.ajic.2022.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/23/2022] [Accepted: 10/24/2022] [Indexed: 02/18/2023]
Abstract
BACKGROUND Health care associated infections (HCAIs) are a global challenge and hand hygiene is the primary measure to reduce these. In developing countries, patients are between 2 and 20 times more likely to acquire an HCAI compared with developed countries. Estimates of hand hygiene in Sub-Saharan Africa suggests 21% concordance. There are few studies investigating barriers and facilitators and those published tend to be surveys. This study aimed to understand barriers and facilitators to hand hygiene in a hospital in Nigeria. METHODS A theoretically underpinned in-depth qualitative interview study with thematic analysis of nurses and doctors working in surgical wards. RESULTS There were individual and institutional factors constituting barriers or facilitators: (1) knowledge, skills, and education, (2) perceived risks of infection to self and others, (3) memory, (4) the influence of others and (5) skin irritation. Institutional factors were (1) environment and resources and (2) workload and staffing levels. CONCLUSIONS Our study presents barriers and facilitators not previously reported and offers nuances and detail to those already reported in the literature. Although the primary recommendation is adequate resources, however small local changes such as gentle soap, simple skills and reminder posters and mentorship or support could address many of the barriers listed.
Collapse
Affiliation(s)
- Yetunde Ataiyero
- School of Nursing and Midwifery, University of Hull, Hull, United Kingdom.
| | - Judith Dyson
- Centre for Social Care, Health and Related Research, Birmingham City University, Birmingham, United Kingdom
| | - Moira Graham
- School of Nursing and Midwifery, University of Hull, Hull, United Kingdom
| |
Collapse
|
2
|
Douno M, Rocha C, Borchert M, Nabe I, Müller SA. Qualitative assessment of hand hygiene knowledge, attitudes and practices among healthcare workers prior to the implementation of the WHO Hand Hygiene Improvement Strategy at Faranah Regional Hospital, Guinea. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001581. [PMID: 36963021 PMCID: PMC10021640 DOI: 10.1371/journal.pgph.0001581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/12/2023] [Indexed: 02/11/2023]
Abstract
Healthcare-associated infections are a serious burden globally. Few qualitative studies have explored healthcare workers' knowledge, attitudes and practices of hand hygiene. Prior to the implementation of the World Health Organization's Hand Hygiene Improvement Strategy at Faranah Regional Hospital in the Upper Region of Guinea in December 2018, we conducted a qualitative baseline assessment of knowledge, attitudes and practices of hand hygiene among healthcare workers to guide future hand hygiene interventions. The qualitative study consisted of direct observations, In-Depth Interviews (IDIs) and Focus Group Discussions (FGDs). We found that the 2013-16 Ebola outbreak had had a pivotal impact on healthcare workers' knowledge, attitudes and practices. The severity of the disease and the training provided for infection control were responsible for their knowledge acquisition and adoption of good attitudes and practices. However, negligence, resulting in poor hand hygiene practices, rose after the outbreak, once the "cue of fear" that had motivated workers for their own self-protection had waned. Our results suggest that local capacity building through training and availability of hand hygiene materials would be a sustainable approach to enhance hand hygiene culture at the hospital. Our study suggests that there is a need for a high and long-term commitment of authorities and healthcare workers at all levels for a sustainable hand hygiene culture.
Collapse
Affiliation(s)
- Moussa Douno
- Projet des Fièvres Hémorragiques en Guinée, Centre de Recherche en Virologie, Université Gamal Abdel Nasser de Conakry, Conakry, Guinée
| | - Carlos Rocha
- Center for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Matthias Borchert
- Center for International Health Protection, Robert Koch Institute, Berlin, Germany
| | | | - Sophie Alice Müller
- Center for International Health Protection, Robert Koch Institute, Berlin, Germany
| |
Collapse
|
3
|
Ahmadipour M, Dehghan M, Ahmadinejad M, Jabarpour M, Mangolian Shahrbabaki P, Ebrahimi Rigi Z. Barriers to hand hygiene compliance in intensive care units during the COVID-19 pandemic: A qualitative study. Front Public Health 2022; 10:968231. [PMID: 36062108 PMCID: PMC9433968 DOI: 10.3389/fpubh.2022.968231] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 07/28/2022] [Indexed: 01/25/2023] Open
Abstract
Background The practice of hand washing is an effective way to prevent contamination and disease transmission. Following the COVID-19 pandemic, hand washing has become increasingly important. Therefore, this qualitative study aimed to understand barriers to hand hygiene compliance among healthcare workers during the COVID-19 pandemic. Materials and methods Twenty-five healthcare workers from intensive care units were sampled using purposive sampling in a qualitative content analysis study. Data were collected through a semi-structured interview and field notes. Based on the Lundman and Graneheim approach, the data were analyzed. COREQ checklist was used to report the research. Results According to the findings, there are three main categories of barriers to hand hygiene practice: barriers related to individuals (including two subcategories of lack of knowledge of healthcare workers and healthcare workers' improper attitude), barriers related to management (including two subcategories of wrong behavioral patterns and unsuitable training and planning), and barriers related to organizations (including four subcategories of heavy workloads, improperly designed wards, a lack of equipment, and lack of quality equipment). Conclusions This research indicates that hand washing practice increased during the COVID-19 pandemic. Nevertheless, some barriers persist, resulting in a decline in hand washing compliance among health care workers. This finding can help managers and policymakers remove barriers to hand washing compliance and improve healthcare workers' adherence to hand washing.
Collapse
Affiliation(s)
- Maryam Ahmadipour
- Department of Pediatric, School of Medicine Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahlagha Dehghan
- Department of Critical Care Nursing, Facullty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
- Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Mehdi Ahmadinejad
- Department of Anaesthesiology, School of Medicine, Shahid Bahonar Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Maryam Jabarpour
- Clinical Research Unit, Shahid Bahonar Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Zahra Ebrahimi Rigi
- Department of Nursing, School of Nursing and Midwifery, Iranshahr University of Medical Sciences, Iranshahr, Iran
| |
Collapse
|
4
|
Ataiyero Y, Dyson J, Graham M. An observational study of hand hygiene compliance of surgical healthcare workers in a Nigerian teaching hospital. J Infect Prev 2022; 23:59-66. [PMID: 35340923 PMCID: PMC8941592 DOI: 10.1177/17571774211066774] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 11/17/2021] [Indexed: 11/17/2022] Open
Abstract
Background Patients sometimes contract healthcare associated infections (HCAI) which are unrelated to their primary reasons for hospital admission. Surgical site infections are the most investigated and most recurrent type of HCAI in developing countries, affecting up to one-third of surgical patients. Objective This study aimed to assess and offer context to the hand hygiene resources available in a Nigerian teaching hospital through ward infrastructure survey, and to determine the hand hygiene compliance rate among surgical healthcare workers (HCWs) in a Nigerian teaching hospital through hand hygiene observations. Methods Ward infrastructure survey was conducted in the two adult surgical wards of the hospital using the World Health Organisation (WHO) hand hygiene ward infrastructure survey form. Hand hygiene observations were monitored over seven days in the surgical wards using a modified WHO hand hygiene observation form. Results Hand hygiene resources were insufficient, below the WHO recommended minimum standards. Seven hundred hand hygiene opportunities were captured. Using SPSS version 24.0, we conducted a descriptive analysis of audit results, and results were presented according to professional group, seniority and hand hygiene opportunities of the participants. Overall hand hygiene compliance was 29.1% and compliance was less than 40% across the three professional groups of doctors, nurses and healthcare assistants. Conclusion Hand hygiene compliance rates of the surgical HCWs are comparable to those in other Sub-Saharan African countries as well as in developed countries.
Collapse
Affiliation(s)
- Yetunde Ataiyero
- School of Health, Science and Wellbeing,
Staffordshire University, Stafford, UK,Yetunde Ataiyero, School of Health, Science and
Wellbeing, Staffordshire University, Stafford, UK
| | - Judith Dyson
- School of Health Sciences, Birmingham City University, Birmingham, UK
| | - Moira Graham
- Faculty of Health Sciences, University of Hull, Hull, UK
| |
Collapse
|
5
|
Rahim MHA, Ibrahim MI, Noor SSM, Fadzil NM. Predictors of Self-Reported Hand Hygiene Performance among Nurses at Tertiary Care Hospitals in East Coast Malaysia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020409. [PMID: 33430195 PMCID: PMC7825618 DOI: 10.3390/ijerph18020409] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 12/27/2020] [Accepted: 01/05/2021] [Indexed: 12/22/2022]
Abstract
Background: Hand hygiene (HH) is the simplest and most effective way to reduce the incidence of healthcare-associated infections (HCAIs). Methods: This cross-sectional study aimed to determine factors associated with self-reported HH performance among nurses at Kelantan tertiary care hospitals. A sample of 438 registered nurses was selected through a stratified random sampling method. Self-reported HH performance was assessed using a validated WHO self-administered HH knowledge and perception questionnaire for healthcare workers. Results: A multiple linear regression analysis was performed to identify the predictors. The factors that significantly predicted self-reported HH performance among nurses included perception score (beta coefficient (β) = 0.260; 95% CI: 0.200, 0.417; p < 0.001), pediatric department (β = −0.104; 95% CI: −9.335, −2.467; p < 0.001), and orthopedic department (β = −5.957; 95% CI: −9.539, −0.720; p < 0.023), adjusted R2 = 0.102; p < 0.001. Nurses with a strong perception and belief in HH were more likely to have better HH performance. Compared to pediatric and orthopedic, surgical departments were associated with better self-reported HH performance. Conclusions: This study showed the importance of factors that could improve the intervention’s performance in HH strategy. Lack of perception and HH program intervention in departments engaged in patient care could lead to poor HH practices, thus increasing HCAIs and antimicrobial resistance (AMR).
Collapse
Affiliation(s)
- Mohamad Hazni Abd Rahim
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu 16150, Malaysia;
| | - Mohd Ismail Ibrahim
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu 16150, Malaysia;
- Correspondence: ; Tel.: +60-9767-6621
| | - Siti Suraiya Md Noor
- Department of Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu 16150, Malaysia;
| | - Norhana Mohamed Fadzil
- Head of Medical Quality Unit, Kelantan State Health Department, Kota Bharu 15590, Malaysia;
| |
Collapse
|
6
|
Nwaokenye J, Lakoh S, Morgan J. Perceptions of Nigerian healthcare workers towards hand hygiene: a qualitative study. Pan Afr Med J 2021; 36:204. [PMID: 32963670 PMCID: PMC7490143 DOI: 10.11604/pamj.2020.36.204.19869] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 06/01/2020] [Indexed: 01/14/2023] Open
Abstract
Introduction hand hygiene (HH) is an effective measure to reduce healthcare-associated infections and the growing burden of antimicrobial resistance. There is a need to understand the perceptions of healthcare workers towards its practice and the use of alcohol-based hand rubs (ABHR) to make recommendations to promote HH. Our study aimed to explore the perceptions of Nigerian healthcare workers towards HH and the use and availability of ABHR to suggest potential interventions to improve its practice as qualitative evidence in this field is limited in Nigeria. Methods a qualitative study design was utilized to understand the perceptions of healthcare workers towards HH and the use of ABHR at Adeoyo Maternity Hospital, Ibadan, Nigeria. Purposive sampling was used to recruit nineteen healthcare workers who were interviewed. Thematic content analysis was used to analyze the data generated. Results five themes emerged including discrepancies in what constitutes HH practice as participants, motivation for HH practice, a good knowledge of timing as regards practice, barriers to good practice and evidence of poor practice. Conclusion while many healthcare workers know about HH and self-reported compliance towards it seems to be high, knowledge gaps, lack of resources, absence of regulations and poor working conditions were impediments to the successful implementation of HH practices. We recommend that hospitals institute well-articulated HH regulations, continuous education and training of healthcare workers. Hospitals should also ensure adequate provision of resources for hand hygiene and institute a continuous monitoring and feedback program to evaluate compliance with regulations.
Collapse
Affiliation(s)
| | - Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.,Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Julia Morgan
- School of Public Health, University of Liverpool, Liverpool, United Kingdom
| |
Collapse
|
7
|
Ways in which healthcare interior environments are associated with perceived safety against infectious diseases and coping behaviours. J Hosp Infect 2020; 106:107-114. [PMID: 32585171 PMCID: PMC7308774 DOI: 10.1016/j.jhin.2020.06.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/17/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Global pandemic outbreaks are a cause of fear. Healthcare workers (HCWs), especially those fighting the pathogens at the front line, are at higher risk of being infected while they treat patients. In addition, various environmental fomites in hospitals, which may carry infectious agents, can increase the risk of acquiring an infectious disease. AIM In order to deliver the best healthcare practice, it is critical that HCWs feel safe and protected against infectious diseases. The aim of this study was to improve understanding of HCWs' hand hygiene (HH) behaviours and perceptions of infectious diseases from a psychological perspective. METHODS Environmental features were observed in three departments, and questionnaires were used to determine perceived safety against infectious diseases among HCWs and the coping behaviours they used (e.g. avoidance and disinfection). FINDINGS This study found that an increase in the number of HH stations at convenient locations would increase HH compliance and perceived safety against infectious diseases among HCWs. In response to the current research gap in psychological aspects associated with HH, this study found that HCWs' coping behaviours can be predicted by their perceived likelihood of contamination and perceived vulnerability. CONCLUSIONS The study findings should be interpreted with care, and further studies with more academic rigor are needed.
Collapse
|
8
|
Population-Based Study of the Influence of the COVID-19 Pandemic on Hand Hygiene Behaviors—Polish Adolescents’ COVID-19 Experience (PLACE-19) Study. SUSTAINABILITY 2020. [DOI: 10.3390/su12124930] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Due to the COVID-19 pandemic, the World Health Organization and other major authorities recommend frequent hand washing and applying proper hand hygiene procedures as one of the cheapest, easiest, and most important ways to prevent the spread of a virus. For adolescents it is especially important as it should become for them a lifelong habit. The aim of the study was to assess the hand hygiene behaviors during the COVID-19 pandemic in a national Polish sample of secondary school adolescents and to verify the influence of the COVID-19 pandemic on those behaviors. The study was conducted in April 2020 in a national sample of 2323 secondary school students recruited based on secondary school sampling procedure (random quota sampling with quotas for voivodeships). The hand hygiene behaviors that were assessed included: frequency of washing hands, reasons for not washing hands, circumstances of washing hands, and procedure of handwashing. Participants were asked each question twice—for the current period of the COVID-19 pandemic and for the period before the COVID-19 issue. The declared frequency of washing hands during the COVID-19 pandemic was significantly higher than before (p < 0.0001), as the majority of respondents declared doing it 6–15 times a day (58.4%) while before the pandemic, it was 3–10 times a day (68.1%). The share of respondents declaring washing their hands always while it would be needed was significantly higher for the period during the COVID-19 pandemic (54.8%) than it was for the period before (35.6%; p < 0.0001), and there was a lower share of respondents declaring various reasons for not washing hands. For the majority of circumstances of washing hands, including those associated with meals, personal hygiene, leaving home, socializing, health, and household chores, the share of respondents declaring always washing their hands was significantly higher for the period during the COVID-19 pandemic than for the period before (p < 0.0001). For the majority of steps of handwashing procedure, the share of respondents declaring including them always was significantly higher for the period during the COVID-19 pandemic than for the period before (p < 0.0001), but a higher share declared not wearing a watch and bracelet (p = 0.0006), and rings (p = 0.0129). It was concluded that during the COVID-19 pandemic all the assessed hand hygiene behaviors of Polish adolescents were improved, compared with those before, but hand hygiene education is still necessary.
Collapse
|
9
|
Bushuven S, Juenger J, Moeltner A, Dettenkofer M. Overconfidence in infection control proficiency. Am J Infect Control 2019; 47:545-550. [PMID: 30528170 DOI: 10.1016/j.ajic.2018.10.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 10/18/2018] [Accepted: 10/19/2018] [Indexed: 01/29/2023]
Abstract
BACKGROUND Infection control partially depends on hygiene and communication skills. Unfortunately, motivation for continuous training is lower than desired. Many health care providers (HCPs) do not recognize the need for training but express this need for others. This is attributable to heuristic errors, such as the overconfidence effect. The aim of this study was to quantify the flawed self-assessment in infection-control. METHODS In this cross-sectional multicenter study, 255 HCPs of different specialties participated in the 29-item, 5-point Likert scale questionnaire, assessing perceived proficiency in hand hygiene and communication skills for both themselves and others (colleagues, trainees, and supervisors of their own specialty and HCPs of others). RESULTS 222 of 255 surveys could be analyzed. Respondents rated themselves to be better trained in handhygiene (P < .001) than trainees, colleagues, and supervisors; the same was seen for feedback skills (P < .001). HCPs of other specialties were consistently rated worse in all aspects (P < .001). CONCLUSION Results show an overplacement effect in infection prevention skills. The belief of being well educated creates a subjective conviction that no further education in hand hygiene is needed. Thus, HCPs may face motivation barriers that require specialized programs to overcome these beliefs.
Collapse
|
10
|
Jeanes A, Coen PG, Drey NS, Gould DJ. The development of hand hygiene compliance imperatives in an emergency department. Am J Infect Control 2018; 46:441-447. [PMID: 29269167 DOI: 10.1016/j.ajic.2017.10.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 10/25/2017] [Accepted: 10/25/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Monitoring results showing poor hand hygiene compliance in a major, busy emergency department prompted a quality improvement initiative to improve hand hygiene compliance. PURPOSE To identify, remove, and reduce barriers to hand hygiene compliance in an emergency department. METHODS A barrier identification tool was used to identify key barriers and opportunities associated with hand hygiene compliance. Hand hygiene imperatives were developed and agreed on with clinicians, and a framework for monitoring and improving hand hygiene compliance was developed. RESULTS Barriers to compliance were ambiguity about when to clean hands, the pace and urgency of work in some areas of the department, which left little time for hand hygiene and environmental and operational issues. Sore hands were a problem for some staff. Expectations of compliance were agreed on with staff, and changes were made to remove barriers. A monitoring tool was designed to monitor progress. Gradual improvement occurred in all areas, except in emergency situations, which require further improvement work. CONCLUSIONS The context of care and barriers to compliance should be reflected in hand hygiene expectations and monitoring. In the emergency department, the requirement to deliver urgent live-saving care can supersede conventional hand hygiene expectations.
Collapse
|
11
|
Cresswell P, Monrouxe LV. 'And you'll suddenly realise 'I've not washed my hands': medical students', junior doctors' and medical educators' narratives of hygiene behaviours. BMJ Open 2018; 8:e018156. [PMID: 29572392 PMCID: PMC5875678 DOI: 10.1136/bmjopen-2017-018156] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Compliance to hygiene behaviours has long been recognised as important in the prevention and control of healthcare associated infections, but medical doctors still display some of the lowest rates of compliance of all healthcare workers. We aim to understand compliance to hygiene behaviours by analysing medical students', junior doctors' and medical educators' narratives of these behaviours to identify their respective attitudes and beliefs around compliance and how these are learnt during training. Such an understanding can inform future interventions to improve compliance targeted to areas of greatest need. DESIGN A qualitative study, using narrative interviews (nine focus groups and one individual interview). Data were analysed thematically using inductive framework analysis. SETTING Teaching hospitals in the UK. PARTICIPANTS Convenience sample of 25 participants: third-year medical students in their first clinical year (n=13), junior doctors (n=6) and medical educators (n=6). RESULTS We identified four main themes: (1) knowledge, (2) constraints, (3) role models/culture and (4) hygiene as an added extra. Knowledge varied across participant groups and appeared to influence behaviours; medical students relied on what they have been told by seniors, while medical educators relied on their own knowledge and experience. There was a strong belief that evidence for the effectiveness of good hygiene behaviours is lacking. Furthermore, medical educators' behaviour appears to strongly influence others. Finally, hygiene was predominately viewed as an added extra rather than an integral part of the process. CONCLUSIONS Awareness of the evidence around good hygiene needs to be improved at all levels. Medical students and junior doctors should be encouraged to consider why they are asked to perform certain hygiene behaviours in order to improve ownership of those behaviours. Medical educators need to recognise their responsibilities as role models for their junior counterparts, thereby understanding their role in developing the culture of hygiene practices within their clinical domains.
Collapse
Affiliation(s)
- Penelope Cresswell
- NHS East and North Hertfordshire Clinical Commissioning Group, Welwyn Garden City, UK
| | - Lynn V Monrouxe
- Chang Gung Medical Education Research Centre (CG-MERC), Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan (R.O.C.)
| |
Collapse
|
12
|
|
13
|
Schmidtke KA, Aujla N, Marshall T, Hussain A, Hodgkinson GP, Arheart K, Marti J, Birnbach DJ, Vlaev I. Using environmental engineering to increase hand hygiene compliance: a cross-over study protocol. BMJ Open 2017; 7:e017108. [PMID: 28893752 PMCID: PMC5595189 DOI: 10.1136/bmjopen-2017-017108] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Compliance with hand hygiene recommendations in hospital is typically less than 50%. Such low compliance inevitably contributes to hospital-acquired infections that negatively affect patients' well-being and hospitals' finances. The design of the present study is predicated on the assumption that most people who fail to clean their hands are not doing so intentionally, they just forget. The present study will test whether psychological priming can be used to increase the number of people who clean their hands on entering a ward. Here, we present the protocol for this study. METHODS AND ANALYSIS The study will use a randomised cross-over design. During the study, each of four wards will be observed during four conditions: olfactory prime, visual prime, both primes and neither prime. Each condition will be experienced for 42 days followed by a 7-day washout period (total duration of trial=189 days). We will record the number of people who enter each ward and whether they clean their hands during observation sessions, the amount of cleaning material used from the dispensers each week and the number of hospital-acquired infections that occur in each period. The outcomes will be compared using a regression analysis. Following the initial trail, the most effective priming condition will be rolled out for 3 months in all the wards. ETHICS AND DISSEMINATION Research ethics approval was obtained from the South Central-Oxford C Research Ethics Committee (16/SC/0554), the Health Regulatory Authority and the sponsor. TRIAL REGISTRATION NUMBER ISRCTN (15397624); Edge ID 86357.
Collapse
Affiliation(s)
- Kelly Ann Schmidtke
- Behavioural Science Group, Warwick Business School, The University of Warwick, Coventry, UK
| | - Navneet Aujla
- Behavioural Science Group, Warwick Business School, The University of Warwick, Coventry, UK
| | - Tom Marshall
- Behavioural Science Group, Warwick Business School, The University of Warwick, Coventry, UK
- Primary Care Clinical Sciences Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Abid Hussain
- Infection Prevention and Control, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Gerard P Hodgkinson
- Alliance Manchester Business School, The University of Manchester, Manchester, UK
| | - Kristopher Arheart
- Department of Public Health Sciences, Division of Biostatistics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Joachim Marti
- Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, UK
| | - David J Birnbach
- Department of Anesthesiology, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA
| | - Ivo Vlaev
- Behavioural Science Group, Warwick Business School, The University of Warwick, Coventry, UK
| |
Collapse
|
14
|
Wall OM, Smiddy MP. Factors that influence hand hygiene practice amongst occupational therapy students. IRISH JOURNAL OF OCCUPATIONAL THERAPY 2017. [DOI: 10.1108/ijot-02-2017-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
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.
Collapse
|
15
|
Chatfield SL, DeBois K, Nolan R, Crawford H, Hallam JS. Hand hygiene among healthcare workers: A qualitative meta summary using the GRADE-CERQual process. J Infect Prev 2017; 18:104-120. [PMID: 28989515 PMCID: PMC5418899 DOI: 10.1177/1757177416680443] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 10/27/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Hand hygiene is considered an effective and potentially modifiable infection control behaviour among healthcare workers (HCW). Several meta-studies have been published that compare quantitatively expressed findings, but limited efforts have been made to synthesise qualitative research. OBJECTIVES This paper provides the first report of integrated findings from qualitative research reports on hand hygiene compliance among HCW worldwide that employs the GRADE-CERQual process of quality assessment. METHODS We conducted database searches and identified 36 reports in which authors conducted qualitative or mixed methods research on hand hygiene compliance among HCW. We used Dedoose analysis software to facilitate extraction of relevant excerpts. We applied the GRADE-CERQual process to describe relative confidence as high, moderate or low for nine aggregate findings. FINDINGS Highest confidence findings included that HCW believe they have access to adequate training, and that management and resource support are sometimes lacking. Individual, subjective criteria also influence hand hygiene. DISCUSSION These results suggest the need for further investigation into healthcare cultures that are perceived as supportive for infection control. Surveillance processes have potential, especially if information is perceived by HCW as timely and relevant.
Collapse
Affiliation(s)
- Sheryl L. Chatfield
- Department of Social and Behavioral Sciences, College of Public Health, Kent State University, Kent, USA
| | - Kristen DeBois
- Department of Social and Behavioral Sciences, College of Public Health, Kent State University, Kent, USA
| | - Rachael Nolan
- Department of Social and Behavioral Sciences, College of Public Health, Kent State University, Kent, USA
| | - Hannah Crawford
- Department of Social and Behavioral Sciences, College of Public Health, Kent State University, Kent, USA
| | - Jeffrey S. Hallam
- Department of Social and Behavioral Sciences, College of Public Health, Kent State University, Kent, USA
| |
Collapse
|
16
|
Løyland B, Wilmont S, Hessels AJ, Larson E. Staff Knowledge, Awareness, Perceptions, and Beliefs About Infection Prevention in Pediatric Long-term Care Facilities. Nurs Res 2016; 65:132-41. [PMID: 26938362 PMCID: PMC4822544 DOI: 10.1097/nnr.0000000000000136] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The burden of healthcare-associated infection worldwide is considerable, and there is a need to improve surveillance and infection control practices such as hand hygiene. OBJECTIVES The aims of this study were to explore direct care providers' knowledge about infection prevention and hand hygiene, their attitudes regarding their own and others' hand hygiene practices, and their ideas and advice for improving infection prevention efforts. METHODS This exploratory study included interviews with direct care providers in three pediatric long-term care facilities. Two trained nurse interviewers conducted semistructured interviews using an interview guide with open-ended questions. Two other nurse researchers independently transcribed the audio recordings and conducted a thematic analysis using a strategy adapted from the systematic text condensation approach. RESULTS From 31 interviews, four major thematic categories with subthemes emerged from the analysis: (a) hand hygiene products; (b) knowledge, awareness, perceptions, and beliefs; (c) barriers to infection prevention practices; and (d) suggested improvements. There was confusion regarding hand hygiene recommendations, use of soap or sanitizer, and isolation precaution policies. There was a robust "us" and "them" mentality between professionals. DISCUSSION One essential driver of staff behavior change is having expectations that are meaningful to staff, and many staff members stated that they wanted more in-person staff meetings with education and hands-on, practical advice. Workflow patterns and/or the physical environment need to be carefully evaluated to identify systems and methods to minimize cross-contamination. Further studies need to evaluate if personal sized containers of hand sanitizer (e.g., for the pocket, attached to a belt or lanyard) would facilitate improvement of hand hygiene in these facilities.
Collapse
Affiliation(s)
- Borghild Løyland
- Borghild Løyland, PhD, RN, is Associate Professor, Department of Nursing and Health Promotion, Oslo and Akershus University College, Norway. Sibyl Wilmont, BSN, RN, is Research Assistant; and Amanda J. Hessels, PhD, RN, is Postdoctoral Research Fellow, School of Nursing, Columbia University, New York. Elaine Larson, PhD, RN, FAAN, CIC, is Anna C. Maxwell Professor of Nursing Research, Associate Dean for Nursing Research, School of Nursing, and Professor of Epidemiology, the Mailman School of Public Health, Columbia University, New York, and Editor, American Journal of Infection Control
| | | | | | | |
Collapse
|
17
|
Barroso V, Caceres W, Loftus P, Evans KH, Shieh L. Hand hygiene of medical students and resident physicians: predictors of attitudes and behaviour. Postgrad Med J 2016; 92:497-500. [PMID: 26912501 DOI: 10.1136/postgradmedj-2015-133509] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 02/02/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVES We measured medical students' and resident trainees' hand hygiene behaviour, knowledge and attitudes in order to identify important predictors of hand hygiene behaviour in this population. METHODS An anonymous, web-based questionnaire was distributed to medical students and residents at Stanford University School of Medicine in August of 2012. The questionnaire included questions regarding participants' behaviour, knowledge, attitude and experiences about hand hygiene. Behaviour, knowledge and attitude indices were scaled from 0 to 1, with 1 representing superior responses. Using multivariate regression, we identified positive and negative predictors of superior hand hygiene behaviour. We investigated effectiveness of interventions, barriers and comfort reminding others. RESULTS 280 participants (111 students and 169 residents) completed the questionnaire (response rate 27.8%). Residents and medical students reported hand hygiene behaviour compliance of 0.45 and 0.55, respectively (p=0.02). Resident and medical student knowledge was 0.80 and 0.73, respectively (p=0.001). The attitude index for residents was 0.56 and 0.55 for medical students. Regression analysis identified experiences as predictors of hand hygiene behaviour (both positive and negative influence). Knowledge was not a significant predictor of behaviour, but a working gel dispenser and observing attending physicians with good hand hygiene practices were reported by both groups as the most effective strategy in influencing trainees. CONCLUSIONS Medical students and residents have similar attitudes about hand hygiene, but differ in their level of knowledge and compliance. Concerns about hierarchy may have a significant negative impact on hand hygiene advocacy.
Collapse
Affiliation(s)
- Violeta Barroso
- Department of Family Medicine, Kaiser, Vallejo Medical Center, Vallejo, California, USA
| | - Wendy Caceres
- Department of Medicine, Stanford University, Stanford, California, USA
| | - Pooja Loftus
- Department of Medicine, Stanford University, Stanford, California, USA
| | - Kambria H Evans
- Department of Medicine, Stanford University, Stanford, California, USA
| | - Lisa Shieh
- Department of Medicine, Stanford University, Stanford, California, USA
| |
Collapse
|
18
|
Herepath A, Kitchener M, Waring J. A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multisite case study. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03400] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BackgroundHospital patient safety is a major social problem. In the UK, policy responses focus on the introduction of improvement programmes that seek to implement evidence-based clinical practices using the Model for Improvement, Plan-Do-Study-Act cycle. Empirical evidence that the outcomes of such programmes vary across hospitals demonstrates that the context of their implementation matters. However, the relationships between features of context and the implementation of safety programmes are both undertheorised and poorly understood in empirical terms.ObjectivesThis study is designed to address gaps in conceptual, methodological and empirical knowledge about the influence of context on the local implementation of patient safety programmes.DesignWe used concepts from critical realism and institutional analysis to conduct a qualitative comparative-intensive case study involving 21 hospitals across all seven Welsh health boards. We focused on the local implementation of three focal interventions from the 1000 Lives+patient safety programme: Improving Leadership for Quality Improvement, Reducing Surgical Complications and Reducing Health-care Associated Infection. Our main sources of data were 160 semistructured interviews, observation and 1700 health policy and organisational documents. These data were analysed using the realist approaches of abstraction, abduction and retroduction.SettingWelsh Government and NHS Wales.ParticipantsInterviews were conducted with 160 participants including government policy leads, health managers and professionals, partner agencies with strategic oversight of patient safety, advocacy groups and academics with expertise in patient safety.Main outcome measuresIdentification of the contextual factors pertinent to the local implementation of the 1000 Lives+patient safety programme in Welsh NHS hospitals.ResultsAn innovative conceptual framework harnessing realist social theory and institutional theory was produced to address challenges identified within previous applications of realist inquiry in patient safety research. This involved the development and use of an explanatory intervention–context–mechanism–agency–outcome (I-CMAO) configuration to illustrate the processes behind implementation of a change programme. Our findings, illustrated by multiple nested I-CMAO configurations, show how local implementation of patient safety interventions are impacted and modified by particular aspects of context: specifically, isomorphism, by which an intervention becomes adapted to the environment in which it is implemented; institutional logics, the beliefs and values underpinning the intervention and its source, and their perceived legitimacy among different groups of health-care professionals; and the relational structure and power dynamics of the functional group, that is, those tasked with implementing the initiative. This dynamic interplay shapes and guides actions leading to the normalisation or the rejection of the patient safety programme.ConclusionsHeightened awareness of the influence of context on the local implementation of patient safety programmes is required to inform the design of such interventions and to ensure their effective implementation and operationalisation in the day-to-day practice of health-care teams. Future work is required to elaborate our conceptual model and findings in similar settings where different interventions are introduced, and in different settings where similar innovations are implemented.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
Collapse
Affiliation(s)
- Andrea Herepath
- Sir Roland Smith Centre for Strategic Management, Department of Entrepreneurship, Strategy and Innovation, Lancaster University Management School, Lancaster University, Lancaster, UK
- Cardiff Business School, Cardiff University, Cardiff, UK
| | | | - Justin Waring
- Nottingham University Business School, University of Nottingham, Nottingham, UK
| |
Collapse
|
19
|
Botene DZDA, Pedro ENR. [Health professionals and hand hygiene: a question of pediatric patient safety]. ACTA ACUST UNITED AC 2015; 35:124-9. [PMID: 25474851 DOI: 10.1590/1983-1447.2014.03.44306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This paper is a qualitative descriptive study, which aims to analyze how the academic education concerning hand hygiene contributes to the pediatric patient safety. This research was developed in an university hospital in Southern Brazil, in the pediatric unit, during the period of August to December, 2012. Sixteen healthcare professionals participated (doctors, nurses and physical therapists). A semi-structured interview was used to gather information. Data was organized by the software QSR Nvivo and analyzed using the content analysis technique. The results allowed us to list two thematic categories:"Hand hygiene and healthcare professionals' academic education"; and "Hand hygiene and professional life". The first thematic category will be presented in this paper. It was identified that the academic education contributes in an ineffective way to the creation of a patient safety culture. According to the professionals, there are gaps during the educational process regarding hand hygiene. The topic is treated in an ineffective and not very significant way to the learning and adhesion of hand hygiene in the professional life. It is recommended that, for the internalization of the practice by future professionals, a transversal, continuous and systematical approach is adopted during the professional's training, evaluations concerning the hand hygiene are done throughout the academic life as well as healthcare professors bethink the topic.
Collapse
|
20
|
Smiddy MP, O' Connell R, Creedon SA. Systematic qualitative literature review of health care workers' compliance with hand hygiene guidelines. Am J Infect Control 2015; 43:269-74. [PMID: 25728153 DOI: 10.1016/j.ajic.2014.11.007] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 11/07/2014] [Accepted: 11/13/2014] [Indexed: 10/23/2022]
Abstract
BACKGROUND Acquisition of a health care-associated infection is a substantial risk to patient safety. When health care workers comply with hand hygiene guidelines, it reduces this risk. Despite a growing body of qualitative research in this area, a review of the qualitative literature has not been published. METHODS A systematic review of the qualitative literature. RESULTS The results were themed by the factors that health care workers identified as contributing to their compliance with hand hygiene guidelines. Contributing factors were conceptualized using a theoretical background. This review of the qualitative literature enabled the researchers to take an inductive approach allowing for all factors affecting the phenomenon of interest to be explored. Two core concepts seem to influence health care workers' compliance with hand hygiene guidelines. These are motivational factors and perceptions of the work environment. Motivational factors are grounded in behaviorism, and the way in which employees perceive their work environment relates to structural empowerment. CONCLUSION Noncompliance with hand hygiene guidelines remains a collective challenge that requires researchers to adopt a consistent and standardized approach. Theoretical models should be used intentionally to better explain the complexities of hand hygiene.
Collapse
|