Improving physician hand hygiene compliance using behavioural theories: a study protocol

Abstract

BackgroundHealthcare-associated infections affect 10% of patients in Canadian acute-care hospitals and are significant and preventable causes of morbidity and mortality among hospitalized patients. Hand hygiene is among the simplest and most effective preventive measures to reduce these infections. However, compliance with hand hygiene among healthcare workers, specifically among physicians, is consistently suboptimal. We aim to first identify the barriers and enablers to physician hand hygiene compliance, and then to develop and pilot a theory-based knowledge translation intervention to increase physicians’ compliance with best hand hygiene practice.DesignThe study consists of three phases. In Phase 1, we will identify barriers and enablers to hand hygiene compliance by physicians. This will include: key informant interviews with physicians and residents using a structured interview guide, informed by the Theoretical Domains Framework; nonparticipant observation of physician/resident hand hygiene audit sessions; and focus groups with hand hygiene experts. In Phase 2, we will conduct intervention mapping to develop a theory-based knowledge translation intervention to improve physician hand hygiene compliance. Finally, in Phase 3, we will pilot the knowledge translation intervention in four patient care units.DiscussionIn this study, we will use a behavioural theory approach to obtain a better understanding of the barriers and enablers to physician hand hygiene compliance. This will provide a comprehensive framework on which to develop knowledge translation interventions that may be more successful in improving hand hygiene practice. Upon completion of this study, we will refine the piloted knowledge translation intervention so it can be tested in a multi-site cluster randomized controlled trial.

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

“…12 No intervention studies with explicit reference to psychological theories had been published until April 2011, 13 and recent trials have been limited to nurses 14,15 or are still underway. 16,17 Exploratory studies have tended to consider hand hygiene behaviour (HHB) as reasoned actions directly influenced by behavioural intentions. 8,18e20 However, only one study found this effect, and it was limited by a small sample size (N ¼ 104), low response rate (34%) and no differentiation between professional groups.…”

“…18 Also, limitations of theories focusing on attitudes have been pinpointed, arguing that HHB is an acquired habit rather than a reasoned action. 13,16,21,22 There are two sides to this 'habitual quality' coin. First, habits tend to presume stable and supportive environments.…”

A qualitative study of senior hospital managers¿ views on current and innovative strategies to improve hand hygiene

“…Hand hygiene is widely recognised as one of the most successful and cost-effective measures to reduce the incidence of healthcare associated infections (HCAIs) [1][2][3]. Hand hygiene best practice in clinical settings as a key preventive intervention has been endorsed by a number of key organisations including the World Health Organisation, Centers for Disease Control and Prevention, the National Health and Medical Research Council, Australian Commission on Safety and Quality in Health Care and Hand Hygiene Australia.…”

Hand hygiene behavior in a tertiary university hospital: differences between surgical and nonsurgical departments

“…Reasons behind this can lie in limited knowledge of the five moments for HH, a lack of positive role models or simply a lack of interest. So far, barriers to compliance, especially with respect to physician-specific barriers, are poorly understood [11].…”