Healthcare workers’ attitudes toward hand hygiene practices: Results of a multicentre qualitative study in Quebec

Abstract

Background: Hand hygiene (HH) is one of the most effective practices to reduce healthcare-associated infection (HAI) transmission, though compliance remains inadequate among hospital personnel. The aim of this study was to explore perceived barriers and enablers of HH compliance in hospital care and healthcare workers’ (HCW) HAI risk and severity perceptions. Methods: Qualitative study using semi-structured interviews and observations. Interview recordings were transcribed verbatim and supplemented with transcribed observations and field notes. Data was aggregated and coded thematically using a qualitative data analysis software. Results: 65 interviews and 18 observations with HCWs were conducted in nine hospital centres in Quebec, Canada. Data analysis revealed several factors that may influence HCWs’ compliance with HH recommendations. These included clinical environment factors (e.g., lack of sinks), organizational factors (e.g., inadequate staffing, demanding workloads), and communication factors (e.g., dissemination of infection prevention and control [IPAC] information, feedback, and interpersonal professional relationships). At the individual level, knowledge of IPAC and HAI risk perceptions were associated with the adoption of HH. Conclusion: Understanding the determinants of HH adoption is crucial for improving current practices and reducing HAI rates in hospital care. Our findings suggest that environmental strategies (e.g., additional sinks and HH stations) and organizational and communication strategies (e.g., continuing education and training sessions, support from hospital management, positive feedback) could help raise HCWs’ awareness of HAI prevention and adoption of HH guidelines.

Barriers to Hand Hygiene Compliance in Intensive Care Units From the Perspective of Healthcare Workers: A Qualitative Study

“…In the present study, improper management and planning, and improper design of the physical space of the ward were mentioned as some of the obstacles to hand hygiene practice. Atif et al (2019) considered high workload, lack of obvious contamination on the hands, substitute of gloves for hand hygiene, limited hospital space and unavailability of sinks as barriers to hand hygiene practice, which were consistent with our study. This study provided suggestions such as holding training sessions, positive feedback, managerial support and proper organization of the environment to promote hand hygiene practice [33].…”

“…Atif et al (2019) considered high workload, lack of obvious contamination on the hands, substitute of gloves for hand hygiene, limited hospital space and unavailability of sinks as barriers to hand hygiene practice, which were consistent with our study. This study provided suggestions such as holding training sessions, positive feedback, managerial support and proper organization of the environment to promote hand hygiene practice [33]. Mclaws et al (2015) believed that hospital authorities were responsible for good hand hygiene practice and should have more control over barriers to remove them [1].…”

“…In the present study, barriers related to the healthcare workers were identi ed as one of the most important barriers to hand hygiene practice. Numerous studies have identi ed workload as one of the barriers to healthcare workers' compliance with hand hygiene [32,33]. Obviously, healthcare workers do not have enough time to practice hand hygiene due to the high workload, which along with environmental and social problems will lead to job burnout, lack of hand hygiene practice, and cross-transmission of the infection.…”

“…Joshi et al (2012) demonstrated that the staff had su cient knowledge and readiness to comply with hand hygiene, but they were not able to practice hand hygiene protocols according to the recommended guidelines due to lack of appropriate equipment and facilities [38]. Therefore, providing appropriate equipment and facilities, holding regular training sessions to increase staff's awareness and knowledge, and providing support and positive feedback can play important roles in implementing hand hygiene guidelines and preventing nosocomial infections [33].…”

La déviance positive : faire autrement pour améliorer l’hygiène des mains des infirmières Positive deviance: Doing things differently to improve hand hygiene of nurses

“…Ces résultats sont semblables à ceux de Caris et al [7] où les participants sur des unités où les taux d'adhésion à l'hygiène des mains sont élevés reconnaissent l'importance de l'hygiène des mains pour protéger les patients des infections. Le manque de connaissances et de formation sur l'hygiène des mains a d'ailleurs été mentionné comme une barrière à cette pratique par les infirmières qui ont participé à l'étude d'Atif et al [8]. Selon Gould et Drey [9], il faudrait s'attarder aux besoins et caractéristiques de chaque groupe de professionnels de la santé afin de personnaliser les formations et demander leurs opinions quant au contenu de ces formations [10].…”