Advertisement

Use of hand-held computers to determine the relative contribution of different cognitive, attitudinal, social, and organizational factors on health care workers' decision to decontaminate hands

      Background

      Observational and survey methods have limitations in measuring hand hygiene behavior. The ability of a personal digital assistant to anonymously gather data at the point of decision making could potentially address these.

      Methods

      Participants were provided with a personal digital assistant to be used for three 2-hour periods and asked to rate influential factors of the Health Belief Model (HBM). Participants were also required to enter what they thought they should do and what they actually did.

      Results

      A total of 741 hand hygiene opportunities was recorded. All HBM constructs were higher for hand hygiene opportunities where there was compliance versus noncompliance, with a significant difference for patient pressure, my risk, perceived benefits, perceived seriousness, and availability of good facilities. Only 20% of doctors, 28% of nurses, and 66% of physiotherapists always did what they thought they should. There was no correlation between self-reported and actual compliance.

      Conclusion

      The HBM appeared to be a useful theoretical framework. Surprisingly, participants rated their compliance as high despite having recorded instances where they did not do what they thought they should do. This suggests that staff may have a different definition of compliance than strict observation of the guidelines.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Infection Control
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Pratt R.J.
        • Pellowe C.M.
        • Wilson J.A.
        • Loveday H.P.
        • Harper P.J.
        • Jones S.R.L.J.
        • et al.
        Epic2: national evidence-based guidelines for preventing health care-associated infections in NHS hospitals in England.
        J Hosp Infect. 2007; 65: S1-64
        • Gould D.J.
        • Hewitt-Taylor J.
        • Drey N.S.
        • Gammon J.
        • Chudleigh J.
        • Weinberg J.R.
        The Clean Your Hands Campaign: critiquing policy and evidence base.
        J Hosp Infect. 2007; 65: 95-101
        • Pittet D.
        The Lowbury lecture: behaviour in infection control.
        J Hosp Infect. 2004; 58: 1-13
        • Centers for Disease Control and Prevention
        Guideline for hand hygiene in healthcare settings.
        MMWR. 2002; 51: 1-44
        • Whitby M.
        • Pessoa-Silva C.L.
        • McLaws M.-L.
        • Allegranzi B.
        • Sax H.
        • Larson E.
        • et al.
        Behavioural considerations for hand hygiene practices: the basic building blocks.
        J Hosp Infect. 2007; 65: 1-8
        • Michie S.
        • Johnston M.
        • Abraham C.
        • Lawton R.
        • Parker D.
        • Walker A.
        Making psychological theory useful for implementing evidence based practice: a consensus approach.
        Qual Saf Health Care. 2005; 14: 26-33
        • Pessoa-Silva C.L.
        • Posfay-Barbe K.
        • Pfister R.
        • Touveneau S.
        • Perneger T.V.
        • Pittet D.
        Attitudes and perceptions toward hand hygiene among healthcare workers caring for critically ill neonates.
        Infect Control Hosp Epidemiol. 2005; 26: 305-311
        • Kretzer E.K.
        • Larson E.L.
        Behavioral interventions to improve infection control practices.
        Am J Infect Control. 1998; 26: 245-253
        • Rosenstock I.M.
        • Strecher V.J.
        • Becker M.H.
        Social Learning Theory and the Health Belief Model.
        Health Educ Behav. 1988; 15: 175-183
        • Ritchie K.
        • Iqbal K.
        • Macpherson K.
        • Riches E.
        • Stout A.
        The provision of alcohol-based products to improve compliance with hand hygiene.
        Quality Improvement Scotland, Edinburgh2005
        • O'Boyle C.A.
        • Henly S.J.
        • Larson E.
        Understanding adherence to hand hygiene recommendations: the theory of planned behaviour.
        Am J Infect Control. 2001; 29: 352-360
        • Johnston D.W.
        • Beedie A.
        • Jones M.C.
        Using computerized ambulatory diaries for the assessment of job characteristics and work-related stress in nurses.
        Work Stress. 2006; 20: 163-172
        • Bartzokas C.A.
        • Williams E.E.
        • Slade P.D.
        A psychological approach to hospital-acquired infections. Studies in health and human sciences.
        Edward Mellen, London1995
        • Watson P.W.B.
        • Myers L.B.
        Which cognitive factors predict clinical glove use amongst nurse?.
        Psychol Health Med. 2001; 6: 399-409
        • Freestone L.
        • Bolsin M.C.
        • Patrick A.
        • Creati B.
        Voluntary incident reporting by anaesthetic trainees in an Australian hospital.
        Int J Qual Health Care. 2006; 18: 452-457
        • Shiffman S.
        • Stone A.A.
        • Hufford M.R.
        Ecological momentary assessment.
        Annu Rev Clin Psychol. 2008; 4: 1-32
        • Piasecki T.M.
        • Hufford M.R.
        • Solhan S.
        • Trull T.J.
        Assessing clients in their natural environments with electronic diaries: rationale, benefits, limitations and barriers.
        Psychol Assess. 2007; 19: 25-43
        • Lee K.
        • Themesslhuber M.
        • Davidson P.
        Research or audit? The benefits and limitations of structured observation of the hand hygiene practice of named staff.
        Br J Infect Control. 2008; 9: 12-17
      1. Morrison K, Ricketts IW, Jones MC, Johnston DW, Pitts NB, Sullivan FM. A secure electronic diary and data collection tool, in 3rd International Conference on Pervasive Computing Technologies for Healthcare, London, UK, 2009.

        • Brady R.R.W.
        • Verran J.
        • Damani N.N.
        • Gibb A.P.
        Review of mobile communication devices as potential reservoirs of nosocomial pathogens.
        J Hosp Infect. 2009; 71: 295-300
        • Sax H.
        • Allegranzi B.
        • Uckay I.
        • Larson E.
        • Boyce J.
        • Pittet D.
        My five moments for hand hygiene: a user-centred design approach to understand, train, monitor and report hand hygiene.
        J Hosp Infect. 2007; 67: 9-21
        • Harris A.D.
        • Samore M.H.
        • Nafziger R.
        • DiRosario K.
        • Roghmann M.C.
        • Carmeli Y.
        A survey on handwashing practices and opinions of healthcare workers.
        J Hosp Infect. 2000; 45: 318-321
      2. Meyers G, Henderson E, Moralejo D, Louie T, Dalby T, Duregon K. To wash or not to wash: understanding hand washing behaviour. Canadian Association for Clinical Microbiology and Infectious Diseases Annual Conference, Victoria, 2001.

        • O'Boyle C.A.
        • Henly S.J.
        • Duckett L.J.
        Nurses' motivation to wash their hands: a standardised measurement approach.
        Appl Nurs Res. 2001; 14: 136-145
        • Jenner E.A.
        • Fletcher B.C.
        • Watson P.
        • Jones F.A.
        • Miller L.
        • Scott G.
        Discrepancy between self-reported and observed hand hygiene behaviour in healthcare professionals.
        J Hosp Infect. 2006; 63: 418-422