Determinants of hand hygiene compliance in Egypt: building blocks for a communication strategy

Abstract

Hand hygiene of health-care staff is one of the most important interventions in reducing transmission of nosocomial infections. This qualitative study aimed to understand the behavioural determinants of hand hygiene in order to develop sustainable interventions to promote hand hygiene in hospitals. Fourteen focus group discussions were conducted with nurses in 2 university hospitals in Egypt. The interviews were tape recorded and transcribed. Thematic analysis was conducted by 2 independent investigators. The findings highlighted that nurses did not perceive the benefits of hand hygiene, and that they linked the need to wash hands to a sense of dirtiness. Knowledge of hand hygiene and related products was limited and preference for water and soap was obvious. Environmental constraints, lack of role models and social control were identified as barriers for compliance with hand hygiene. A multi-faceted hand hygiene strategy was developed based on existing cultural concepts valued by the hospital staff. RÉSUMÉ L'hygiène des mains du personnel de santé est l'une des interventions les plus importantes pour réduire la transmission des infections nosocomiales. Une étude qualitative visait à comprendre les déterminants comportementaux de l'hygiène des mains afin d'établir des interventions durables pour la promotion de ce type d'hygiène dans les hôpitaux. Quatorze discussions thématiques en groupes ont été organisées avec le personnel infirmier dans deux hôpitaux universitaires en Égypte. Les entretiens ont été enregistrés puis retranscrits. Une analyse thématique a été menée par deux chercheurs indépendants. Les résultats ont mis en évidence le fait que le personnel infirmier ne percevait pas les avantages de l'hygiène des mains, et qu'il reliait le besoin de se laver les mains à une sensation de saleté. Les connaissances en matière d'hygiène des mains et des produits à utiliser étaient limitées et la préférence pour l'eau et le savon était marquée. Les contraintes environnementales, l'absence de modèles à suivre et de contrôle social ont été identifiés comme des obstacles au respect de l'hygiène des mains. Une stratégie d'hygiène des mains multidimensionelle a été mise au point à partir des concepts culturels existants qui étaient importants pour le personnel hospitalier. ‫للتواصل‬ ‫اسرتاتيجية‬ ‫وضع‬ ‫أجل‬ ‫من‬ ‫أساسية‬ ‫نات‬

Implementation science in low-resource settings: using the interactive systems framework to improve hand hygiene in a tertiary hospital in Ghana

“…Dixon-Woods [32] identified 10 challenges to the successful implementation of QI projects, including convincing workers there is a problem, overcoming the burden of data collection, improving the organizational leadership and lack of staff engagement. Studies have also shown that two limitations to complying with hand hygiene protocol include lack of resources to properly dry hands with clean towels [33] and a failure to associate poor hand hygiene with unseen bacteria instead of a feeling of ‘dirtiness’ [34]. Use of implementation frameworks such as the ISF allow for the identification of local determinants affecting implementation and for the creation of locally acceptable implementation strategies.…”

Electronic Monitoring Systems for Hand Hygiene in Hospitals: Relationship to Practice and Exploration of Clinical Perceptions

“…Borg et al (2009) found self-reported compliance to hand hygiene to be higher following direct patient contact, or when hands were visibly dirty. The sense that a patient was unclean due to having open wounds or body odour has also been found to be a prompt for hand cleansing, with this feeling extending to patient unfriendliness or erratic behaviour (Lohiniva et al, 2015). The inherent need to clean one's hands drives the majority of hand hygiene behaviour and stems from the emotion of disgust and feelings of self-protection (Curtis and Biran, 2001;World Health Organization, 2009).…”