Perceptions, attitudes, and behavior towards patient hand hygiene

Impact of Work-Related Chronic Low Back Pain on Functional Performance and Physical Capabilities in Women and Men: A Sex-Wise Comparative Study

Purpose

This study is aimed at determining the impact of work-related low back pain (LBP) on functional performance and physical capabilities.

Methods

This cross-sectional study included women (n = 25, mean age, 38.12 ± 4.59) and men (n = 25, mean age, 37.20 ± 5.38) with a history of work-related mechanical chronic LBP who visited our university hospital's outpatient department. All participants were assessed for primary outcomes, including the severity of LBP on rest and on activity, functional performance, and physical capabilities using a numeric pain rating scale (NPRS), Roland-Morris disability questionnaire (RDQ), five-time sit-to-stand test (FTSST), and fifty-foot walk test (FFWT), respectively. Independent t-tests compared the scores of the outcomes between groups while Pearson's correlation coefficient identified the correlation between the outcomes' measures at a significance level of 0.05.

Results

With a response rate of 63.29%, a total of fifty participant's data were obtained for the analysis. A comparison between women and men groups highlighted a significant difference in the scores of the FTSST and FFWT; however, there were insignificant differences in the scores of the NPRS at rest, NPRS on activity, and RDQ. The bivariate correlation revealed a highly significant, positive, and moderate correlation between the scores of NPRS at rest and FTSST, NPRS on activity and FTSST, NPRS at rest and FFWT, NPRS on activity and FFWT, FTSST and RDQ, and FFWT and RDQ in the women group. Similarly, there was a significant, positive, and low correlation between the scores of FTSST and RDQ and FFWT and RDQ in the men group.

Conclusion

Work-related chronic LBP affected the physical capabilities of women more than those of men. However, it equally affected the functional performance of all participants in the study. Furthermore, work-related chronic LBP affected the physical capabilities (FTSST and FFWT) and functional performance (RDQ) of women more than those of men.

Patient, family, and visitor hand hygiene knowledge, attitudes, and practices at pediatric and maternity hospitals: A descriptive study

BACKGROUND

Patient, family, and visitor hand hygiene can prevent health care-associated infections, but little is known about their hand hygiene knowledge, attitudes, and practices. We aimed to assess patient, family, and visitor hand hygiene knowledge, attitudes, and practices at a pediatric and maternity hospital in Vancouver, British Columbia, Canada.

METHODS

Surveys based on the Theoretical Domains Framework were distributed to patients, families, and visitors to provide cross-sectional qualitative and quantitative data. This was supplemented with covert observations by trained medical students to determine patient, family, and visitor hand hygiene rates.

RESULTS

Of 348 survey respondents, there was a clear preference for hand washing with soap and water over use of alcohol-based hand rub. Beliefs about consequences were the main driver for hand hygiene. Self-reported hand hygiene rates were higher than observed rates. The overall hand hygiene rate was observed to be 10.3% (72/701), with soap and water used for 75% of hand hygiene events.

CONCLUSION

There are misconceptions regarding hand hygiene practices and low hand hygiene rates among patients, families, and visitors. Development of interventions to improve hand hygiene should focus on correcting misconceptions and emphasizing consequences of failing to perform hand hygiene in the health care setting.

Exploring determinants of hand hygiene among hospital nurses: a qualitative study

BACKGROUND

The present research is a qualitative one aiming to determine factors affecting hand-hygiene behavior of the nursing staff in Shariati Hospital of Tehran, Iran.

METHODS

This was a qualitative study performed using content analysis approach. Considering the aim of the study, 16 in-depth semi-structured interviews were held with the nursing staff of Shariati Hospital of Tehran University of Medical Sciences. A convenient sampling was performed and continued until data saturation and until no new codes and categories were obtained. Data were analyzed through a qualitative content analysis based on the Graham and landsman method. Directed qualitative content analysis was done in order to analyze the data.

RESULTS

The results of this study revealed 3 main themes in the Theory of Planned Behavior (TPB) (attitude, subjective norms and perceived behavioral control) and 8 main themes in the outside the framework (environment, perceptions, life style, morality, education, organizational culture, salience and personality).

CONCLUSION

Due to the other factors also found in this study, an integration of theories and models for designing of interventions is recommended to increase adherence to hand hygiene behavior.

Active Integration of Patients into Infection Control, as perceived by Health Care Professionals: Results of the AHOI Pilot Study

Objective

Medical professionals have a key role in active patient involvement in infection control and prevention (ICP). ICP of hospital-associated infections is critical for patient safety and requires targeted integration of patients and their relatives. The possibilities of proper involvement are identified, tested and realized in the innovative AHOI project. Its acronym stands for Activation, Help, Open communication and Infection prevention. The project is based on the three dimensions acceptance, empowerment and adherence. The results presented here are from a health-care professional (HCP) focused part of a pilot study to implement AHOI intervention. This section aimed at the HCPs’ evaluation of the intervention material, their perception and acceptance of the adherence and empowerment of patients, as well as the perception of their and colleagues’ own behavior.

Methods

The cross-sectional survey was conducted with a questionnaire at two surgical wards of a third-level hospital for 14 weeks. All HCPs with contact to patients were entitled to voluntarily participate in the study. AHOI instruments such as visual reminder, videos for patients and the AHOI-box were implemented on the wards. Additionally, the ward personnel received a psychological and practical train-the-trainer curriculum.

Results

Sixty-nine questionnaires were handed out and 29 returns were analyzed. The results show a strong identification and acceptance of HCPs with their role in the AHOI project. No additional workload was perceived by implementing AHOI. Teaching of medical professionals and information materials are seen as good supports. HCPs are empowering hygienic behavior in patients and colleagues. HCPs observed increasing adherence of patients.

Conclusion

HCPs positively perceived acceptance, support and identification with the ideas of the AHOI project. Therefore, since HCPs are key for patients and their relatives, AHOI intervention seems to be a feasible instrument and aid in implementing national and international recommendations for hygienic behavior.

Knowledge of psychosocial factors associated with low back pain amongst health science students: a scoping review

Background

Low back pain is a burden worldwide and biological, psychological, and social mechanisms play a role in its development and persistence. Current guidelines support care using the biopsychosocial model. However, biomedical constructs dominate clinician training, and it is unknown the extent to which health science students understand the psychosocial determinates of a patient’s low back pain. Therefore, the aim of this scoping review is to report health science students’ current knowledge of psychosocial factors associated with low back pain.

Methods

A scoping review framework was used to search electronic databases for research examining health science students’ knowledge of psychosocial factors associated with low back pain. The nature and findings of the studies are highlighted using the data charting tool. Each study was analyzed to determine the type of outcome measurement used. Scores were compared to minimum accepted scores, between disciplines, as education advanced, and after educational modules.

Results

Fourteen studies published between 2004 and 2019 were identified. Seven healthcare disciplines were represented.

In total, 12 different measurement tools were utilized. In 9 studies students demonstrated inadequate knowledge of psychosocial factors associated with low back pain. Three tools compared disciplines and nationalities. Three tools were associated with practice behavior. Eight studies showed improvement as students’ education advanced, and 3 studies demonstrated improvements in knowledge after implementation of pain education modules of varied lengths. Of those, two showed significant improvement.

Conclusions

Health science students in these studies had substandard understanding of psychosocial factors associated with low back pain. Dedicated pain education has the potential to improve low back pain understanding, resulting in more guideline appropriate care recommendation.

Multidisciplinary Quality Improvement Intervention to Achieve Sustained Improvement in Hand Hygiene Reliability in a Pediatric Intensive Care Unit

Suboptimal hand hygiene (HH) remains a significant modifiable cause of healthcare-associated infections in the intensive care unit. We report a single-center, quality improvement project aimed at improving adherence to optimal HH among physicians, nurse practitioners, and nursing staff, and to sustain any improvement over time.

The Common Missed Handwashing Instances and Areas after 15 Years of Hand-Hygiene Education

The outbreak of severe acute respiratory syndrome (SARS) claimed the lives of 286 Hong Kong people in 2003. Since then, the Hong Kong government has been promoting the benefits of proper hand hygiene. There are few studies that explore the general quality of handwashing and the hand-hygiene practices of the public of Hong Kong; given this, the aim of this study is to explore this neglected topic. This study is a quantitative study that was conducted in January 2018. The results show that the majority of participants only wash their hands after using the toilet (87%) or handling vomitus or faecal matter (91%). The mean duration of handwashing was 36.54 seconds (SD = 18.57). The areas of the hand most neglected during handwashing were the fingertips (48.1%), medial area (30.5%), and back of the hand (28%). A multiple logistic regression shows that participants who have reached third-level education or higher often tend to be more hand hygienic than those who have not reached third-level education (p ≤ 0.001, B = 1.003). Thus, participants aged 30 and above tend to neglect 5 more areas of the hand than those aged below 30 (p=0.001, B = 4.933).

Knowledge, Perceptions, and Self-reported Performance of Hand Hygiene Among Registered Nurses at Community-based Hospitals in the Republic of Korea: A Cross-sectional Multi-center Study

Objectives

To assess the nurses’ hand hygiene (HH) knowledge, perception, attitude, and self-reported performance in small- and medium-sized hospitals after Middle East Respiratory Syndrome outbreak.

Methods

The structured questionnaire was adapted from the World Health Organization’s survey. Data were collected between June 26 and July 14, 2017.

Results

Nurses showed scores on knowledge (17.6±2.5), perception (69.3±0.8), self-reported HH performance of non-self (86.0±11.0), self-reported performance of self (88.2±11.0), and attitude (50.5±5.5). HH performance rate of non-self was Y₁=36.678+ 0.555X1 (HH performance rate of self) (adjusted R²=0.280, p<0.001). The regression model for performance was Y₄=18.302+0.247X₄₁ (peception)+0.232X₄₂ (attitude)+0.875X₄₂ (role model); coefficients were significant statistically except attitude, and this model significant statistically (adjusted R²=0.191, p<0.001).

Conclusions

Advanced HH education program would be developed and operated continuously. Perception, attitude, role model was found to be a significant predictors of HH performance of self. So these findings could be used in future HH promotion strategies for nurses.

Can improving patient hand hygiene impact Clostridium difficile infection events at an academic medical center?

BACKGROUND

Hand hygiene plays an important role in the prevention of Clostridium difficile (CD) infection (CDI). Patient hand hygiene (PHH) may be a potentially underused preventative measure for CDI. Patient mobility and acuity along with a lack of education present obstacles to PHH for the hospitalized patient. Surveys of patients at our institution showed a need for increased PHH opportunities. The objective of this study was to increase PHH and to examine if PHH affected CDI at our hospital.

METHODS

A biphasic, quasi-experimental study was performed to increase PHH through education for staff and to provide education, assistance, and opportunities to the patient for hand cleaning. PHH practice was assessed by patient surveys and analyzed by χ² test. PHH effect on CDI was determined by following health care facility-onset CD laboratory-identified events data analyzed by National Healthcare Safety Network standardized infection ratios (SIRs).

RESULTS

PHH opportunities improved significantly (P < .0001) after staff and patient education. CD SIRs deceased significantly for 6 months (P ≤ .05) after the PHH intervention.

CONCLUSIONS

PHH opportunities can be increased by providing education and opportunities for patients to clean their hands. PHH should be considered a relevant preventative measure for CDI in hospitalized patients.

Feasibility: An important but neglected issue in patient hand hygiene

BACKGROUND

Patient hand hygiene may be a useful strategy to prevent acquisition of pathogens and to reduce the risk for transmission by colonized patients. Several studies demonstrate that patients and long-term-care facility (LTCF) residents may have difficulty using hand hygiene products that are provided; however, none of them measure feasibility for patients to use different hand hygiene products.

METHODS

A convenience sample of 42 hospitalized patients and 46 LTCF residents was assessed for their ability to use 3 hand sanitizer products (8-oz pushdown pump bottle, 2-oz pocket-sized bottle with a reclosable lid, and alcohol-impregnated hand wipes). The time (seconds) required for accessing each product was compared among acute-care patients and LTCF residents. Participants provided feedback on which product they preferred and found easiest to use.

RESULTS

Of 88 participants, 86 (97.7%) preferred the pushdown pump, 2 (2.3%) preferred the bottle with the reclosable lid, and none preferred the hand wipes. For both hospitalized patients and LTCF residents, the average time required to access the pushdown pump was significantly less than the time required to access the other products (pushdown pump, 0.45 seconds; bottle with reclosable lid, 3.86 seconds; and wipes, 5.66 seconds; P < .001).

CONCLUSIONS

Feasibility and ease of use should be considered in the selection of hand hygiene products for patients and LTCF residents.

Impact of teamwork on missed care in four Australian hospitals

AIMS AND OBJECTIVES

Investigate effects of teamwork on missed nursing care across a healthcare network in Australia.

BACKGROUND

Missed care is universally used as an indicator of quality nursing care, however, little is known about mitigating effects of teamwork on these events.

DESIGN

A descriptive exploratory study.

METHODS

Missed Care and Team Work surveys were completed by 334 nurses. Using Stata software, nursing staff demographic information and components of missed care and teamwork were compared across the healthcare network. Statistical tests were performed to identify predicting factors for missed care.

RESULTS

The most commonly reported components of missed care were as follows: ambulation three times per day (43·3%), turning patient every two hours (29%) and mouth care (27·7%). The commonest reasons mentioned for missed care were as follows: inadequate labour resources (range 69·8-52·7%), followed by material resources (range 59·3-33·3%) and communication (range 39·3-27·2%). There were significant differences in missed care scores across units. Using the mean scores in regression correlation matrix, the negative relationship of missed care and teamwork was supported (r = -0·34, p < 0·001). Controlling for occupation of the staff member and staff characteristics in multiple regression models, teamwork alone accounted for about 9% of missed nursing care.

CONCLUSION

Similar to previous international research findings, our results showed nursing teamwork significantly impacted on missed nursing care. Teamwork may be a mitigating factor to address missed care and future research is needed.

RELEVANCE TO CLINICAL PRACTICE

These results may provide administrators, educators and clinicians with information to develop practices and policies to improve patient care internationally.

Implementation of directly observed patient hand hygiene for hospitalized patients by hand hygiene ambassadors in Hong Kong

BACKGROUND

The importance of compliance with hand hygiene by patients is increasingly recognized to prevent health care-associated infections.

METHODS

This descriptive study observed the effects of an education campaign, targeted to increase patients' self-initiated hand hygiene, and a hand hygiene ambassador-initiated directly observed hand hygiene program on patients' hand hygiene compliance in a university-affiliated hospital.

RESULTS

The overall audited compliance of patients' self-initiated hand hygiene was only 37.5%, with a rate of 26.9% (112/416 episodes) before meals and medications, 27.5% (19/69 episodes) after using a urinal or bedpan, and 89.7% (87/97 episodes) after attending toilet facilities. Patients referred from a residential care home for older adults had significantly lower hand hygiene compliance (P = .007). Comparatively, the overall audited compliance of ambassador-initiated directly observed hand hygiene was 97.3% (428/440 episodes), which was significantly higher than patients' self-initiated hand hygiene via a patient education program (37.5%, 218/582 episodes, P < .001).

CONCLUSIONS

Directly observed hand hygiene can play an important role in improving compliance with hand hygiene by hospitalized patients.

Effectiveness of hand hygiene depends on the patient's health condition and care environment

AIM

The present authors examined how patient hand contamination was associated with underlying disease and treatment environment in order to determine effective hand hygiene methods.

METHODS

Samples were collected from inpatients (45 with hematological malignancies, 48 postoperative), outpatients (48 undergoing hemodialysis, 55 on chemotherapy), and 44 individuals living in nursing homes. All participants provided informed consent for study participation. All subjects performed hand hygiene. Before and after hand hygiene, samples of bacteria were collected from the palm of the hand onto agar media. Bacteria were counted and bacterial strains were identified. The authors then collected smear samples from the contralateral palm and measured adenosine triphosphate (ATP) levels.

RESULTS

Patient hand contamination was the highest in hemodialysis patients, followed by residents of nursing homes, postoperative patients, patients with cancer receiving chemotherapy, and patients of hematological malignancies. Regardless of the underlying disease and treatment environment, patients were able to reduce the number of bacterial colonies and ATP by proper hand hygiene. Compared with wet wipes, hand washing seemed to remove bacteria more effectively. Methicillin-resistant Staphylococcus aureus (MRSA) was detected in 30 subjects, none of whom were patients of hematological malignancies. Of these, 19 tested negative for MRSA after performing proper hand hygiene.

CONCLUSION

Patient hand contamination is affected by underlying disease and care environment, but can be reduced by encouraging proper hand washing. Proper patient hand hygiene can reduce MRSA on patients' hands, and thus may serve as an effective tool for prevention of healthcare-associated infections.

Ni-Vanuatu health-seeking practices for general health and childhood diarrheal illness: results from a qualitative methods study

BACKGROUND

A local perspective on diarrheal illness has been shown to enhance control strategies for diarrheal disease in traditional rural settings. We aimed to assess caregivers' understandings of childhood general and diarrheal illness, in one rural community in Vanuatu, to help formulate control strategies for preventing diarrheal disease.

FINDINGS

This was a descriptive study using qualitative analysis of responses to open-ended questions to provide a fuller understanding of illness. Thematic analysis with categories derived from medical anthropology was used to analyse responses and draw conclusions. Twenty-nine participants were interviewed; 22 were maternal responses, three were traditional practitioners, two were rural health care workers, one was a spiritual healer and one had a caregiver role. Respondents categorised illness as biomedical or traditional. Explanations of illness were enmeshed in and derived from both the traditional and biomedical system as the illness experience in the child under their care unfolded. Diarrheal severity influenced treatment selection and respondents expressed a preference for biomedical assistance. Respondents articulated a preference for biomedicine as the primary help-seeking resort for small children. Exclusive reliance on either traditional or biomedical options was uncommon. Local herbal remedies were the preferred home treatment when illness was known or mild, while oral rehydration therapy was used when accessing biomedical practitioners.

CONCLUSIONS

Belief about diarrheal illness was influenced by traditional medicine and biomedicine. New evidence points to a growing preference for biomedicine as the first choice for severe childhood diarrheal illness. Diarrheal illness could be countered by maternal hand hygiene education at the medical dispensary and rural aid post.

Relationship between knowledge and attitudes of methicillin-resistant Staphylococcus aureus and hand hygiene behavior in Veterans with spinal cord injury and disorder

The objective of this analysis was to understand the relationship between knowledge and attitudes regarding methicillin-resistant Staphylococcus aureus and hand hygiene behavior based on a baseline survey administered to Veterans with spinal cord injuries and disorders. Higher knowledge was associated with higher attitude scores (r = 0.35, P = .003), but knowledge and attitudes were not associated with behavior. Also, those with quadriplegia had higher knowledge scores (P = .03). Knowledge and attitudes, although related, do not appear to fully explain patients' hand hygiene behavior.

Higiene de las manos: conocimientos de los profesionales y áreas de mejora

El objetivo fue analizar los conocimientos sobre la higiene de las manos de los profesionales del Sistema Sanitario Público Andaluz (España). Estudio mediante encuestas en 2011, utilizando el Hand Hygiene Knowledge Questionnaire for Health-Care Workers con la técnica de análisis de clases latentes. La media de respuestas correctas fue de 17,51 ± 3,68. Las preguntas con porcentajes de respuestas correctas más bajos son las referidas a la prevención, mediante la higiene de las manos, de la transmisión de microorganismos después de la exposición al paciente y aquellas relacionadas con la utilización de preparados de base alcohólica. Se obtuvo un modelo de 7 clases latentes. Principales diferencias socio-demográficas: los profesionales con conocimientos más bajos suelen ser hombres, jóvenes y no sanitarios; el haber recibido formación previa no discrimina a los que presentan excelentes conocimientos. Concluimos que la revisión de los programas de formación en higiene de las manos es necesaria para mejorar los conocimientos sobre aspectos conceptuales de la transmisión de microorganismos a través de las manos.

epic3: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England

National evidence-based guidelines for preventing healthcare-associated infections (HCAI) in National Health Service (NHS) hospitals in England were originally commissioned by the Department of Health and developed during 1998-2000 by a nurse-led multi-professional team of researchers and specialist clinicians. Following extensive consultation, they were first published in January 2001(1) and updated in 2007.(2) A cardinal feature of evidence-based guidelines is that they are subject to timely review in order that new research evidence and technological advances can be identified, appraised and, if shown to be effective for the prevention of HCAI, incorporated into amended guidelines. Periodically updating the evidence base and guideline recommendations is essential in order to maintain their validity and authority. The Department of Health commissioned a review of new evidence and we have updated the evidence base for making infection prevention and control recommendations. A critical assessment of the updated evidence indicated that the epic2 guidelines published in 2007 remain robust, relevant and appropriate, but some guideline recommendations required adjustments to enhance clarity and a number of new recommendations were required. These have been clearly identified in the text. In addition, the synopses of evidence underpinning the guideline recommendations have been updated. These guidelines (epic3) provide comprehensive recommendations for preventing HCAI in hospital and other acute care settings based on the best currently available evidence. National evidence-based guidelines are broad principles of best practice that need to be integrated into local practice guidelines and audited to reduce variation in practice and maintain patient safety. Clinically effective infection prevention and control practice is an essential feature of patient protection. By incorporating these guidelines into routine daily clinical practice, patient safety can be enhanced and the risk of patients acquiring an infection during episodes of health care in NHS hospitals in England can be minimised.

Patient hand hygiene practices in surgical patients

BACKGROUND

Little is known about the hand hygiene practices of surgical patients. Most of the research has been directed at the health care worker, and this may discount the role that hand hygiene of the surgical patient might play in surgical site infections.

METHODS

A quasiexperimental, pretest/post-test study was conducted in which patients (n = 72) and nurses (n = 42) were interviewed to examine perceptions and knowledge about patient hand hygiene. Concurrently, observations were conducted to determine whether surgical patients were offered assistance by the nursing staff. Following an initial observation period, nursing staff received an educational session regarding general hand hygiene information and observation results. One month after the education session, patient/nurse dyads were observed for an additional 6 weeks to determine the impact of the educational intervention.

RESULTS

Eighty observations, 72 patient interviews, and 42 nurse interviews were completed preintervention, and 83 observations were completed postintervention. In response to the survey, more than half of patients (n = 41, 55%) reported that they were not offered the opportunity to clean their hands, but a majority of the nursing staff reported (n = 25, 60%) that they offered patients the opportunity to clean their hands. Prior to the educational intervention, nursing staff assisted patients in 14 of 81 hand hygiene opportunities. Following the intervention, nursing staff assisted patients 37 out of 83 opportunities (17.3% vs 44.6%, respectively, [χ(2)1 = 13.008, P = .0003]).

CONCLUSION

This study suggests that efforts to increase hand hygiene should be directed toward patients as well as health care workers.

Patient-centered hand hygiene: the next step in infection prevention

Hand hygiene has been recognized as the most important means of preventing the transmission of infection, and great emphasis has been placed on ways to improve hand hygiene compliance by health care workers (HCWs). Despite increasing evidence that patients' flora and the hospital environment are the primary source of many infections, little effort has been directed toward involving patients in their own hand hygiene. Most previous work involving patients has included patients as monitors or auditors of hand hygiene practices by their HCWs. This article reviews the evidence on the benefits of including patients more directly in hand hygiene initiatives, and uses the framework of patient-centered safety initiatives to provide recommendations for the timing and implementation of patient hand hygiene protocols. It also addresses key areas for further research, practice guideline development, and implications for training of HCWs.

Healthcare workers' and parents' perceptions of measures for improving adherence to hand-hygiene

Background

This study was conducted to evaluate perceptions of healthcare workers (HCW) and parents regarding hand-hygiene and effectiveness of measures for increasing hand-hygiene adherence, in a children's hospital in Italy.

Methods

A cross-sectional study was performed from 5 to 13 July 2010, using two self-administered anonymous questionnaires (one for HCWs and one for parents/caregivers). The questionnaires included information regarding individual perceptions associated with hand hygiene.

Results

We collected 139 questionnaires from HCWs and 236 questionnaires from parents. Alcohol-based handrub was reported to be available at the point of care by 95.0% of the HCWs and in the child's room by 97.0% of the parents. For both HCWs and parents, availability of alcohol-based handrub was perceived as the most useful action for improving adherence to hand hygiene (scores ≥ 6 on a 7-point Likert-type scale: 84.8% [CI95%78.0-90.1] for HCWs and 87.9% [CI95% 83.3-91.7] for parents). Parents' reminding HCWs to perform hand hygiene was perceived as the least useful action (scores ≥ 6: 48.9% [CI95% 40.5-57.3] for HCWs and 55.7% [CI95% 49.2-62.1] for parents). Factors that affected HCWs' perceptions of the effectiveness of actions for improving adherence to hand hygiene included years of practice, type of ward and previous formal training on hand hygiene. For parents, factors affecting perceptions included previous information on hand hygiene and previous hospitalizations for their child.

Conclusions

Investigating HCWs' and parents' perceptions of measures for improving adherence can provide useful information for implementing actions for hand-hygiene promotion in children's hospitals. In this study, HCWs' and parents' perceptions were similar; alcohol-based hand-rub availability was perceived as the most useful tool, confirming its crucial role in multimodal interventions. Poor perception of inviting parents to remind HCWs to perform hand-hygiene has been previously observed, and deserves further investigation. Information and education activities were associated with more positive perceptions regarding various improvement measures. Though the relationship between perceptions and behaviours remains to be fully determined, HCWs should participate in formal training and families should be properly informed, not only to increase knowledge but also to improve perceptions on effectiveness of actions to be implemented.

A realistic approach towards hand hygiene for long-term care residents and health care personnel

The Centers for Disease Control and Prevention and The World Health Organization's hand hygiene recommendations focus on health care personnel in all health care settings. In the long-term care facility (LTCF) environment, where, for many residents, the LTCF is also their home, the recommendations may not be applicable to commonly encountered LTCF situations. The recommendations also do not address the importance of resident hand hygiene program to promote health and prevent infection.