The Influence of Emotions and Behavioral Theories behind Hand Hygiene in COVID-19 Pandemic

Abstract

Background: Hand hygiene (HH) is essential in preventing healthcare-associated infections, especially during the COVID-19 pandemic, where SARS-CoV2 has shown the ability to survive on surfaces for days. In this study, we explore HH compliance rate and the factors associated with its increase during COVID-19 pandemic. Methods: HH compliance was assessed amongst doctors in Anesthesia and Surgical Intensive Care Unit by direct observation between 2018 and 2021. An anonymous survey was then sent to the doctors to understand factors influencing the observed improvement in HH compliance during the pandemic. Results: Compliance towards the five moments of HH has shown a statistically significant rising trend from a median HH compliance of 60% in 2018, to 70% in 2019 to 94% in 2020. However, HH compliance subsequently declined in the first quarter of 2021 to median of 87%. The follow-up survey had a response rate of 96% (n = 53). 90% of survey participants responded that their HH frequency had increased during the COVID-19 pandemic with 47% stating they were performing HH 11 -20 times/day. 64% responded that this increased frequency had affected their skin condition. 62% responded that this increased frequency was sustainable even after the pandemic ends. Participants ranked considerations influencing HH compliance. "Prevent transmitting the infection to vulnerable patients" was ranked highest followed by "High infection rate", "Fear of contracting COVID-19" and lastly, "Public health guidelines". Conclusions: Despite the absence of new campaigns, HH compliance reached an all-time high. The pandemic has provided opportunity for behavioral change through "reflective" drivers of behavior such as emotions ("Fear") and knowledge ("High infection rate"). Understanding the motivations behind current increased HH compliance and riding on the increased initial uptake of behavior may help convert HH into a habitual action and not just a reaction to the pandemic.

Social Contacts and Transmission of COVID-19 in British Columbia, Canada

“…For instance, during the 2014 Ebola outbreak in Sierra Leone, self-reported prevention practices such as avoidance of contacts with corpses, were found to have increased with rising disease prevalence ( 39 ). During the early stages of the COVID-19 pandemic, the practice of cautious social contacts by the Singaporean population, increased with rising rates of infection due to behavioral drivers such as fear and perceived risk of infection ( 40 ). Similarly, the decline of close contacts in Hong Kong during the first quarter of 2020 is thought to have resulted from increasing messaging and spread of information about the prevalence of COVID-19 ( 41 ).…”

Interventions to improve knowledge or compliance to hand hygiene in nursing students: A scoping review

“…All the studies included in this review only applied quantitative methods. Hand hygiene is a complex behavior with a myriad of motivators and barriers (Kiew et al, 2021); therefore, improving adherence to this procedure is a challenging task. In this respect, it is valuable to complement quantitative studies with qualitative research to provide more depth in understanding of interventions that promote hand hygiene compliance in nursing students.…”

Barriers to hand hygiene compliance in intensive care units during the COVID-19 pandemic: A qualitative study

“…While this may be true, the pandemic allowed to change behavior through reactive stimuli such as fear and knowledge (increased infection rates), which led to greater compliance with hand hygiene practices ( 17 ); little information is available regarding hand hygiene compliance rates during the COVID-19 pandemic ( 17 ). Consequently, most studies have only been quantitative and have examined compliance with hand hygiene practices ( 9 , 10 ).…”