Discrepancy between self-reported and observed hand hygiene behaviour in healthcare professionals

Abstract

Ms number: JHI-D-05-00521Discrepancy between self-reported and observed hand hygiene behaviour in health care professionals. Self reported and observed hand hygiene 3Professor Ben (C) Fletcher, November 2005. SummaryHand hygiene behaviour in 71 healthcare professionals was observed on hospital wards for a total of 132 hours and 1,284 hand hygiene opportunities. Questionnaires completed by the participants were used to compare actual behaviours with self-reports of behaviour, as well as intentions and attitudes towards hand hygiene. Observed practice showed very poor rates of adherence to guidelines and indicated that staff failed to take account of risk, even with patients colonised with MRSA. Observed practice was unrelated to carers" intentions and self-reports of behaviour. The results suggest that hand-hygiene interventions that target changes in attitudes, intentions or self-reported practice are likely to fail in terms of changing behaviour and consideration is given to how this could be remedied. (118 words) IntroductionThe U.K. Health Department guidelines state that hands should be washed "before and after contact with each patient" 1 . This study examines practitioners" adherence to this guideline, particularly taking note of practice when working with patients colonised with methicillinresistant Staphylococcus aureus (MRSA) patients. It also examines whether observed hand hygiene behaviour on wards is consistent with health professionals" self-reports of their actions.Research suggests that healthcare professionals clean their hands much less often than they say they do 2 . Understanding the link between self-reported and observed behaviours is of major importance in hand hygiene, but previous research has not concentrated on this. If there is no association, then interventions designed to improve intentions or self-reported MethodObservations were made on wards over a total period of 132 hours during which 1,284 opportunities for hand hygiene occurred. An opportunity for hand hygiene was defined as any occasion when a participant performed any activity which required hand hygiene, including contact with the patient, equipment, medication, food or prior to carers going on their break. Observations were made by two experienced observers: an infection control professional and a psychologist. Inter-rater reliability was established through both observers making the same observations for two days on four wards (kappa = 0.9, range 0.75-1.00).Seventy-one health care professionals (doctors, qualified nurses including "permanent" agency/bank nurses, therapists and healthcare assistants) were observed. In order to minimise effects of observational error, 51 of the health care professionals (72%) were observed on at least four occasions. Sampling of care activities and participants was Trust. All participants gave written consent prior to participating. ResultsThe percentage of opportunities when hands were washed both before and after contact with the patient, washing only before, or only after contact for di...

Quicker, Easier, and Cheaper? The Promise of Automated Hand Hygiene Monitoring

“…Yet we are notoriously poor at estimating our own performance, thus mandating the use of an alternate method. 7 In our experience, HCWs want access to their own hand hygiene performance results. Although this may vary between countries and institutions, they dislike being observed without feedback.…”

Monitoração da adesão à higienização das mãos: uma revisão de literatura

“…Vale destacar que alguns estudos (14,20,26) , realizaram uma comparação entre dois ou mais métodos. Além disso, como, trata-se de um problema de preocupação mundial, verificou-se que os estudos foram conduzidos em todos os continentes.…”

“…Os confrontos entre a adesão às oportunidades de HM autorreportadas e aquelas obtidas por meio de observadores evidenciam que a estratégia autorreportada não compreende a real taxa de adesão, tende a ser superestimada, reafirmando que os profissionais supervalorizam suas adesões (14) .…”

“…Estudos que utilizaram estes questionários, encontraram taxas de adesão entre 18% e 93,6%, dependendo da situação analisada, e a menor taxa foi verificada para intenção de HM, antes do contato com a pele intacta do paciente e a maior taxa após contato com fluidos corporais (5)(6)(12)(13)(14)(15) .…”

“…Estudos realizados com base nesta técnica encontraram taxas de adesão entre 7,6% -91,3% (2)(3)(4)(7)(8)(9)14,(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) . Vale lembrar ainda que mesmo se tratando de estudos observacionais os critérios utilizados em cada estudo variaram consideravelmente, sendo que, em alguns trabalhos, foram observadas as lavagens das mãos apenas antes do contato com o paciente; enquanto outros estudos foram além, observando a adesão durante a assistência inclusive de um mesmo paciente, diferenciando atenção nas áreas mais contaminadas para áreas menos contaminadas do corpo.…”