Behavioral Determinants of Hand Hygiene Compliance in Intensive Care Units

• Published in: American journal of critical care Vol. 19; no. 3; pp. 230 - 239
• Main Authors: De Wandel, D., Maes, L., Labeau, S., Vereecken, C., Blot, S.
• Format: Journal Article
• Language: English
• Published: United States 01.05.2010
• Subjects: Attitude of Health Personnel; Belgium; Cross Infection - prevention & control; Factor Analysis, Statistical; Female; Guideline Adherence - statistics & numerical data; Hand Disinfection - methods; Hand Disinfection - standards; Health Behavior; Health Care Surveys - statistics & numerical data; Health Knowledge, Attitudes, Practice; Health Personnel - statistics & numerical data; Humans; Infection Control - statistics & numerical data; Infectious Disease Transmission, Professional-to-Patient - statistics & numerical data; Intensive Care Units - statistics & numerical data; Male; Personnel, Hospital - statistics & numerical data; Reproducibility of Results; Skin Care - statistics & numerical data; Surveys and Questionnaires; Belgium
• ISSN: 1062-3264; 1937-710X; 1937-710X
• DOI: 10.4037/ajcc2010892

Although hand hygiene is the most effective measure for preventing cross-infection, overall compliance is poor among health care workers. To identify and describe predictors and determinants of noncompliance with hand hygiene prescriptions in intensive care unit nurses by means of a questionnaire. A questionnaire based on a behavioral theory model was filled out by 148 nurses working on a 40-bed intensive care unit in a university hospital. Subjects were asked to fill out the 56-item questionnaire twice within a 2- to 6-week period. During this period, no interventions to enforce hand hygiene occurred on the unit. Response rate for the test was 73% (108/148); response rate for the retest was 53% (57/108). The mean self-reported compliance rate was 84%. Factor analysis revealed 8 elementary factors potentially associated with compliance. Internal consistency of the scales was acceptable. Intraclass correlation was low (<0.60) for 2 subscales but acceptable (>0.60) for 6 subscales. A low self-efficacy was independently associated with noncompliance (beta = .379; P = .001). After exclusion of this variable, a negative attitude toward time-related barriers was associated with noncompliance (beta = -.147; P < .001). Neither having good theoretical knowledge of hand hygiene guidelines nor social influence or moral perceptions had any predictive value relative to hand hygiene practice. A valid questionnaire to identify predictors and determinants of noncompliance with hand hygiene has been designed. Nurses reporting a poor self-efficacy or a poor attitude toward time-related barriers appear to be less compliant.