Psychosocial determinants of self-reported hand hygiene behaviour: a survey comparing physicians and nurses in intensive care units.

BACKGROUND: Research applying psychological behaviour change theories to hand hygiene compliance is scarce, especially for physicians. AIM: To identify psychosocial determinants of self-reported hand hygiene behaviour (HHB) of physicians and nurses in intensive care units (ICUs). METHODS: A cross-sectional survey using a self-administered questionnaire that applied concepts from the Health Action Process Approach on hygienic hand disinfection was conducted in 10 ICUs and two haematopoietic stem cell transplantation units at Hannover Medical School, Germany. Self-reported compliance was operationalized as always disinfecting one's hands when given tasks associated with risk of infection. Using seven-point Likert scales, behavioural planning, maintenance self-efficacy and action control were assessed as psychological factors, and personnel and material resources, organizational problems and cooperation on the ward were assessed as perceived environmental factors. Multiple logistic regression analysis was employed. FINDINGS: In total, 307 physicians and 348 nurses participated in this study (response rates 70.9% and 63.4%, respectively). Self-reported compliance did not differ between the groups (72.4% vs 69.4%, P = 0.405). While nurses reported stronger planning, self-efficacy and action control, physicians indicated better personnel resources and cooperation on the ward (P < 0.02). Self-efficacy [odds ratio (OR) 1.4, P = 0.041], action control (OR 1.8, P < 0.001) and cooperation on the ward (OR 1.5, P = 0.036) were positively associated with HHB among physicians, but only action control was positively associated with HHB among nurses (OR 1.6, P < 0.001). CONCLUSION: The associations between action control (self-regulatory strategies where behaviour is evaluated continuously and automatically against guidelines) and compliance indicate that HHB is a habit in need of self-monitoring. The fact that perceived cooperation on the ward was the only environmental correlate of HHB among physicians stresses the importance of team-directed interventions.

[Compliance with hand hygiene guidelines on intensive care units at a university medical centre with surgical focus]. / Hygienische Händedesinfektion - Leitlinien-Compliance auf Intensivstationen eines Universitätsklinikums mit chirurgischem Schwerpunkt.

BACKGROUND AND AIM: Hand hygiene practice is one of the most effective measures to prevent healthcare-associated infections. This study examines the trends of hand hygiene compliance among physicians and nurses on the intensive care units (ICU) and hematopoetic stem cell transplantation units (HSCTU) at Hannover Medical School. An observational study via repeated cross-sectional assessments was conducted during the first 6 years of the "AKTION Saubere Hände" (ASH), i.e. the German adaptation of WHO's "Clean Care is Safer Care" campaign. METHODS: Compliance rates were directly observed in accordance with WHO definitions on the 10 ICU and two HSCTU. Overall, 13,175 hand hygiene opportunities were observed between 2008 and 2013. RESULTS: In 2008, compliance rates of physicians and nurses did not differ significantly in statistical terms (53% vs. 57%, p=0.085). Physicians' compliance improved to 64% in 2011, but declined again to 48.4% in 2013 (p < 0.001). In contrast, hand hygiene compliance among nurses had increased to 71.3% as soon as 2009 /10 (p < 0.001). Their compliance dropped to 55.8% in 2013 and thus to baseline level (p=0.444), while remaining higher than that of physicians (p=0.003). Similar trends pertained to the surgical ICU. CONCLUSIONS: These results indicate that during the ASH-campaign hand hygiene compliance increased initially both among physicians and nurses, albeit so far not in a sustainable fashion. This implies an increased demand for interventions which not only promote motivation, but also its translation into stable and sustained behavior in accordance with guidelines.