Behavioral Determinants of Hand Hygiene Compliance in Intensive Care Units

Abstract

Background Although hand hygiene is the most effective measure for preventing cross-infection, overall compliance is poor among health care workers. Objectives To identify and describe predictors and determinants of noncompliance with hand hygiene prescriptions in intensive care unit nurses by means of a questionnaire. Methods 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. Results 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 (β = .379; P = .001). After exclusion of this variable, a negative attitude toward time-related barriers was associated with noncompliance (β = -.147; P < .001). Conclusions 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. (American Journal of Critical Care. 2010;19:230-240) BEHAVIORAL DETERMINANTS OF HAND HYGIENE COMPLIANCE IN INTENSIVE CARE UNITS C E 1.0 Hour Notice to CE enrollees:A closed-book, multiple-choice examination following this article tests your under standing of the following objectives:1. Recognize the impact of behavioral determinants on compliance with hand hygiene recommendations. 2. Describe determinants of noncompliance with hand hygiene prescriptions among nurses in a general intensive care unit. 3. Understand how a low self-efficacy and a negative attitude toward time-related barriers are predictors of poor compliance with hand hygiene recommendations. In accordance with the attitude-social influenceself-efficacy model, 12 which combines Fishbein and Ajzen's theory of reasoned action 13 and Bandura's social learning theory, 14 attitude, social influence, and self-efficacy are valid concepts in predicting one's intention to change one's behavior or even one's actual change in behavior. 15,16 Attitude is primordially based on earlier experiences: behavior that has led to success will be reinforced and vice versa. Although one's general attitude toward a certain behavior is often the result of success and failure (or perceived advantage and disadvantage), not all attitudes are based on reason and logical sense. Some attitudes can be very rigid and based on highly ...

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