Challenges of Hand Hygiene in Healthcare: The Development of a Tool Kit to Create Supportive Processes and Environments

Abstract

Hand hygiene compliance by healthcare providers has been difficult to achieve due to diverse environments, work culture, processes and task requirements. Because of this complexity, hand hygiene lends itself well to a human factors analysis in order to design a system that matches human cognitive and physical strengths and makes allowances for human limitations.

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

“…Studies investigating HCWs generally have reported a range of barriers, including environmental barriers ( e.g ., lack of access to sinks, difficulty of locating products, empty dispensers, dispensers and time constraints) and personal barriers ( e.g ., attitudinal beliefs, skin irritation from repeated hand washing) [23,24]. Using a behavioural theory approach, Boscart and colleagues explored nurses’ perceived barriers and enablers to hand hygiene practice [25].…”

Understanding Practice: Factors That Influence Physician Hand Hygiene Compliance

“…Studies investigating healthcare workers generally (which sometimes include a small sample of physicians) have reported a range of barriers, including environmental (eg, lack of access to sinks, difficulty of locating products, empty or broken dispensers, and time constraints) and personal (eg, attitudinal beliefs, skin irritation from repeated hand washing) barriers. 10,11 Additional barriers specific to physicians identified or postulated include educational gaps in infection control training, [12][13][14] a perception that their compliance is better than it actually is, 15,16 a more cavalier attitude toward infection control with experience, 17,18 a lack of positive physician role models, [18][19][20] and the local (eg, unit, hospital) culture of patient safety. 21 We located only 1 study that explicitly used behavioral theory to study hand hygiene compliance among physicians.…”

A successful multifaceted strategy to improve hand hygiene compliance rates

“…For example, increasing the availability of hand dispensers and moving them to areas where provider traffic was higher and placement of red flags on gel dispensers signaling that the dispenser was empty was a visual cue to accelerate the replacement of the gel, awarding trophies to HCWs at institutional meetings, and sending letters to noncompliant HCWs were ideas that stemmed from the monthly meetings. [9][10][11] The success as measured by the increased compliance rate with HH is the result of many reasons. First, the multidisciplinary task force could be classified as a highly functional natural-group setting according to the classic classification by Tuckman.…”

“…15 The members of the multidisciplinary team were engaged, and the team exhibited many of the characteristics that have been associated with great team performance, such as the capacity of the members to talk and listen in equal measure, engagement in energetic conversation with the team leader and with one another, continuing conversation after the formal meetings and exploring for new options and new measures outside the team, and bringing back to the multidisciplinary team potentially useful information that could be implemented. 16 Second, multimodal strategies were used, 3,[9][10][11][12][13] including increasing the number of dispensers and changing dispenser placement to increase accessibility, using covert observers to measure compliance, making providers accountable by asking the chief medical officer and chief nursing officer to send a letter to HCWs who were noncompliant, and making it clear to HCWs that by being noncomplaint they were putting the life of the patients in danger. The noncompliant HCWs had to review a slide presentation about HH and needed confirmation by the chair of the department that the review was completed.…”

“…The interventions that were implemented (Table 1) included education and training; promotion; use of visual cues on the gel dispensers to indicate malfunction or empty and placement of dispensers in high-traffic areas; visual cues in examining room reminding providers, patients, and families about the importance of HH; covert direct observation of HH by peers; rewards to the teams with highest compliance presented in hospital-wide meetings; alerts to the immediate supervisor via letters when health care provider did not comply; and regular reports to leadership, including the chief medical officer, chief nursing officer, chair caucus (all of the chairs of the different clinical departments), and board of trustees. [10][11][12][13] The monthly summary report of HHCRs was distributed to all providers within the institution for transparency in HHCRs. Monthly meetings were held with the members of the task force to review all evidence-based guidelines in HH and to discuss the necessary changes that needed to be made.…”