Psychometric Evaluation of a Measure of Factors Influencing Hand Hygiene Behaviour to Inform Intervention Background. Although the hand hygiene (HH) procedure is simple, the related behaviour is complex and is not readily understood, explained, or changed. There is a need for practical tools to provide data that can guide healthcare managers and practitioners not only on the 'what' (the standards that must be met), but also the 'how' (guidance on how to achieve the standards). Aim. To develop a valid questionnaire to evaluate attitudes to the factors that influence engagement in HH behaviour that can be readily completed, administered, and analysed by healthcare professionals to identify appropriate intervention strategies. Construct validity was assessed using confirmatory factor analysis, predictive validity through comparison with selfreported HH behaviour, and convergent validity through direct unit-level observation of HH behaviour. Methods. The Capability, Opportunity, Motivation-Behaviour (COM-B) model was used to design a 25-item questionnaire that was distributed to Intensive Care Unit (ICU) personnel in Ireland. Direct observation of HH behaviour was carried out at two ICUs. Findings. A total of 292 responses to the survey (response rate 41.0%) were included in the analysis. Confirmatory factor analysis resulted in a 17-item questionnaire. Multiple regression revealed that a model including Capability, Opportunity, and Motivation, was a significant predictor of self-reported Behavioural intention (F(3,209) =22.58, p<0.001). However, the Opportunity factor was not found to make a significant contribution to the regression model. Conclusion. The COMB HH questionnaire is reliable and valid and provides data to support the development, and evaluation, of HH interventions that meet the needs of specific healthcare units.

Background: Although appropriate hand hygiene (HH) practices are recognised as the most effective preventative strategy for infection, adherence is suboptimal. Previous studies in intensive care units (ICUs) have found differences in HH compliance between those moments that protect the patient, and those that protect the healthcare provider. However, such studies did not control for other variables known to impact HH compliance. Aim: To examine HH among healthcare workers (HCWs) in ICU settings, and identify whether there is a statistical difference in HH compliance between patient-protective and self-protective moments, while controlling for other variables known to influence HH compliance (i.e. professional role, unit and shift time). Methods: A cross-sectional observational study was conducted in four ICUs across three Irish hospitals. Compliance was assessed according to the WHO’s ‘five moments for hand hygiene’. HCW professional role, total number of ‘opportunities’ for HH and whether compliance was achieved were recorded. Results: A total of 712 HH opportunities were recorded, with an overall compliance rate of 56.9%. Logistic regression analysis revealed that physicians, allied healthcare professionals and auxiliary staff were less likely than nurses to engage in HH. HCWs were more likely to comply during night shifts compared to morning shifts, and with self-protective as compared to patient-protective HH moments. Conclusion: The information provided in this study provides a data-driven approach that ICUs can use to tailor HH interventions to where, when and for whom they are most required.

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