Understanding adherence to hand hygiene recommendations: the theory of planned behavior

Process Evaluation of an Acute-Care Nurse-Centred Hand Hygiene Intervention in US Hospitals

This paper describes a process evaluation of a 'wise' intervention that took place in six acute care units in two medical-surgical teaching hospitals in the United States during 2016-2017. 'Wise' interventions are short, inexpensive interventions that depend on triggering specific psychological mechanisms to achieve behaviour change. This study sought to increase the hand hygiene compliance (HHC) rates before entering a patient's room among nurses. The intervention centred on the use of threat to professional identity to prompt improved HHC. Through questionnaires administered to intervention participants and the implementation facilitator, together with independent observation of intervention delivery, we examined whether the steps in the Theory of Change occurred as expected. We found that aspects of the implementation-including mode of delivery, use of incentives, and how nurses were recruited and complied with the intervention-affected reach and likely effectiveness. While components of the intervention's mechanisms of impact-such as the element of surprise-were successful, they ultimately did not translate into performance of the target behaviour. Performance was also not affected by use of an implementation intention as repeated performance of HHC over years of being a nurse has likely already established well-ingrained practices. Context did have an effect; the safety culture of the units, the involvement of the Nurse Managers, the level of accountability for HHC in each unit, and the hospitals themselves all influenced levels of engagement. These conclusions should have implications for those interested in the applicability of 'wise' interventions and those seeking to improve HHC in hospitals.

Examining outpatients' hand hygiene behaviour and its relation to COVID-19 infection prevention measures

BACKGROUND

The increasing demand for outpatient care is associated with a higher risk of infection transmission in these settings. However, there is limited research on infection prevention and control practices in ambulatory clinics, and none focuses on patients.

AIM

To examine outpatients' hand hygiene behaviours, their determinants, and their associations with other infection prevention measures during the COVID-19 pandemic.

METHODS

We observed the hand hygiene behaviour of one cohort of patients in one outpatient clinic and surveyed a separate sample in five clinics about their hand hygiene practice in outpatient facilities. A questionnaire based on the Theoretical Domains Framework (TDF) was used to examine predictors of the behaviour. Moreover, patients indicated their compliance with COVID-19 infection prevention measures, vaccination status, disease risk perception, and vaccine hesitancy.

FINDINGS

Observed hand hygiene rates among 618 patients were low (12.8%), while 67.3% of the 300 surveyed patients indicated sanitizing their hands upon entering the clinic. The TDF domains 'memory, attention, and decision processes' and 'emotions' significantly predicted both current (today's) and general hand hygiene behaviour in outpatient clinics. Hand hygiene behaviour and compliance with COVID-19 infection prevention showed a positive association; however, no significant connection was found with patients' vaccination status, suggesting different behavioural motivators.

CONCLUSION

Hand hygiene among outpatients should be improved through interventions focusing on helping patients remember to clean their hands. More research on infection prevention in outpatient facilities is needed to ensure patient safety.

Attitudes and self-efficacy towards infection prevention and control and antibiotic stewardship among nurses: A mixed-methods study

AIMS

To gain a comprehensive understanding of nurses' infection control practices, antibiotics stewardship attitudes and self-efficacy when caring for patients with multidrug-resistant bacterial infections in a hospital setting.

BACKGROUND

Multidrug-resistant bacteria cause a substantial health burden by complicating infections and prolonging hospital stays. Attitudes and self-efficacy can inform professional behaviour. Nurses' attitudes and self-efficacy concerning multidrug-resistant bacteria, infection prevention and control and antibiotic stewardship are vital in keeping patients safe.

DESIGN

A descriptive and convergent mixed-methods design involving quantitative and qualitative approaches was used.

METHODS

Two hundred and seventeen nurses working in clinical practice at seven different hospital wards (i.e., general medicine, surgical, haematological and oncology) at a Norwegian university hospital were invited to participate. Data were collected in February and March 2020 via two questionnaires: the Multidrug-Resistant Bacteria Attitude Questionnaire and the General Perceived Self-Efficacy Scale (n = 131) and four focus group interviews (n = 22). The data were analysed using descriptive statistics and systematic text condensation.

RESULTS

Most nurses showed moderate knowledge, adequate behavioural intentions towards infection prevention and antibiotic stewardship, and high self-efficacy. However, they reported negative emotions towards their knowledge level and negative emotions towards nursing care. The nurses appeared uncertain about their professional influence and role in antibiotic stewardship practices. Organisational and relational challenges and ambivalent perceptions of nurses' role were potential explanations.

CONCLUSION

Nurses report moderate attitudes and high self-efficacy when caring for patients with multidrug-resistant bacterial infections. This study suggests that nurses experience organisational and relational factors in their work environment that challenge their attitudes towards infection prevention and control and antibiotic stewardship practices. Measures that strengthen their knowledge and emotional response underpin correct infection prevention and control behaviour. A role clarification is needed for antibiotic stewardship. No Patient or Public Contribution.

RELEVANCE TO CLINICAL PRACTICE

Measures to increase attitudes towards infection prevention and control, antibiotic stewardship and multidrug resistance is recommended. Measures should be taken to overcome organisational challenges. A clarification of the nurses' role in antibiotic stewardship is needed.

Investigating the Psychological, Social, Cultural, and Religious Predictors of COVID-19 Vaccine Uptake Intention in Digital Age: A Media Dependency Theory Perspective

Media exposure to health communication contents related to the COVID-19 pandemic alone is inadequate to measure the influence of media on individuals in adopting precautionary behaviors against COVID-19, such as vaccine uptake. Certain individuals may pay attention to and be influenced by communication content. However, literature has suggested other instrumental determinants in developing and adopting health precautionary measures, such as culture or religion, especially regarding vaccination. In times of crisis, such as the COVID-19 pandemic, it is valuable to examine the interrelationships among psychological, sociocultural, and informational factors. This can provide valuable insights for policymakers in developing effective communication strategies. Drawing an analogy between the Media dependency theory (MDT) and the Theory of Planned Behavior (TPB) model, this study unravels the factors underpinning the COVID-19 vaccine uptake intention among Pakistanis. The study utilized a cross-sectional research design and employed a survey method to gather data from a sample of 993 participants. The findings obtained from the PLS-SEM analysis confirmed that individuals relied on both traditional and social media to cope with the COVID-19 pandemic. The findings show that individuals rely more on the informational content disseminated through conventional media channels. The findings also suggest that individuals from Asian countries, such as Pakistan, tend to be more inclined toward collectivism. The findings about the moderating role of religiosity suggest that religious beliefs significantly shape individuals' reliance on traditional media. Hence, this study has uniquely contributed to public health and media management by providing a strategy for managers to address disseminating misinformation related to religion and its impact on vaccination-related health issues. The study has theoretically confirmed the principles of media dependency theory. As a result, it is recommended that various information sources be utilized to cultivate resilience among individuals to manage health crises effectively.

Factors contributing to healthcare professionals' adaptive capacity with hospital standardization: a scoping review

BACKGROUND

Certain factors contribute to healthcare professionals' adaptive capacities towards risks, challenges, and changes such as attitudes, stress, motivation, cognitive capacity, group norms, and teamwork. However, there is limited evidence as to factors that contribute to healthcare professionals' adaptive capacity towards hospital standardization. This scoping review aimed to identify and map the factors contributing to healthcare professionals' adaptive capacity with hospital standardization.

METHODS

Scoping review methodology was used. We searched six academic databases to September 2021 for peer-reviewed articles in English. We also reviewed grey literature sources and the reference lists of included studies. Quantitative and qualitative studies were included if they focused on factors influencing how healthcare professionals adapted towards hospital standardization such as guidelines, procedures, and strategies linked to clinical practice. Two researchers conducted a three-stage screening process and extracted data on study characteristics, hospital standardization practices and factors contributing to healthcare professionals' adaptive capacity. Study quality was not assessed.

RESULTS

A total of 57 studies were included. Factors contributing to healthcare professionals' adaptive capacity were identified in numerous standardization practices ranging from hand hygiene and personal protective equipment to clinical guidelines or protocols on for example asthma, pneumonia, antimicrobial prophylaxis, or cancer. The factors were grouped in eight categories: (1) psychological and emotional, (2) cognitive, (3) motivational, (4) knowledge and experience, (5) professional role, (6) risk management, (7) patient and family, and (8) work relationships. This combination of individual and group/social factors decided whether healthcare professionals complied with or adapted hospital standardization efforts. Contextual factors were identified related to guideline system, cultural norms, leadership support, physical environment, time, and workload.

CONCLUSION

The literature on healthcare professionals' adaptive capacity towards hospital standardization is varied and reflect different reasons for compliance or non-compliance to rules, guidelines, and protocols. The knowledge of individual and group/social factors and the role of contextual factors should be used by hospitals to improve standardization practices through educational efforts, individualised training and motivational support. The influence of patient and family factors on healthcare professionals' adaptive capacity should be investigated.

TRIAL REGISTRATION

Open Science Framework ( https://osf.io/ev7az ) https://doi.org/10.17605/OSF.IO/EV7AZ .

The effect of education based on health belief model on hand hygiene behavior in the staff of Tehran dentistry centers: A quasi-experimental intervention study

Background and Aims

Considering the increasing prevalence of dental services in the community and the impossibility of identifying each infected patient, hand sanitation is the most critical factor in controlling infection in these centers. Therefore, this study aimed to determine the effect of educational intervention on the hand health behavior of the staff of Tehran dentistry clinics based on the health belief model (HBM).

Methods

In this quasi-experimental study in 2017, 128 employees of the health centers were selected through a multistage sampling method and they were placed in two groups of intervention and control (each 64 people). The data was collected using a questionnaire devised by the researcher. The validity and reliability of the questionnaire were determined. The questionnaire consisted of demographics, knowledge, structures of the HBM, and behavior variables. Then, the intervention was administered based on HBM-based education. Data were analyzed by SPSS16 and independent t test, χ ², and repeated measurement analysis of variance.

Results

Before the intervention, the two intervention and control groups did not differ significantly in terms of demographic variables, mean scores of knowledge, constructs of HBM, and hand hygiene behavior (p > 0.05), while the intervention group was scored higher significantly compared to the control one after the intervention (p < 0.001).

Conclusion

According to the findings, the HBM can be used as a framework for designing educational interventions to improve hand hygiene behavior to control infection in health centers.

Predicting behavioral intentions for unsafe off-highway vehicle use

INTRODUCTION

Hundreds of adults are killed or injured each year while operating off-highway vehicles. Four common risk-taking behaviors were identified on off-highway vehicles in the literature and examined intention to engage in such behaviors within the context of the Theory of Planned Behavior.

METHOD

One hundred and sixty-one adults completed measures of experience on off-highway vehicles and injury exposure followed by a self-report created according to the predictive structure of the Theory of Planned Behavior. Behavioral intentions to engage in the four common injury risk behaviors on off-highway vehicles were predicted.

RESULTS

Similar to research on other risk behaviors, perceived behavioral control and attitudes emerged as consistently significant predictors. Subjective norms, the number of vehicles operated, and injury exposure showed varying relationships to the four injury risk behaviors. Results are discussed in the context of similar studies, intrapersonal predictors of injury risk behaviors, and with regard to implications for injury prevention efforts.

Visibility and Accessibility of Hand Hygiene Stations and Fatigue Among Nurses Working in Long-Term Care (LTC) During the COVID-19 Pandemic

OBJECTIVES

Evaluate the relationship between nurses' perception of the long-term care (LTC) environment, specifically having visible and accessible hand hygiene stations (HHS), and nurses' fatigue during the COVID-19 pandemic.

BACKGROUND

LTC nurses experience not only heavy workloads and fatigue but also a high risk of infection during the COVID-19 pandemic. Few studies have evaluated the relationship between safety measures such as having visible and accessible HHS and nurses' fatigue.

METHODS

The cross-sectional COVID-19 Impact on Nurses Study (COINS) was an online survey distributed to members of the American Association of Post-Acute Care Nursing through the REDCap survey platform, between June 1, 2020, and January 31, 2021. Logistic regression modeling was conducted to identify the relationship between nurses' perception of having visible and accessible HHS and fatigue among LTC nurses.

RESULTS

The majority of LTC nurse respondents (78.35%) reported having moderate to very severe fatigue. Nurses who reported not having enough visible and accessible HHS in their work environment have statistically significantly higher odds (odds ratio [OR] = 0.37, 95% confidence interval [CI] [0.20, 0.70], p = .002) of reporting experiencing moderate to very severe fatigue compared to nurses who perceived there was adequate HHS. The logistic regression is significant while controlling for sociodemographic differences, guilt for family and patients, support from work, and confidence in the future of LTC.

CONCLUSIONS

This study reveals the LTC environment that incorporates better considerations of more visible and accessible HHS might mitigate nurses' fatigue during the pandemic. A conceptual framework has been proposed for future studies.

Applying the temporal self-regulation theory to understand sugar-sweetened beverage consumption among Chinese college students

Objective

Worldwide, there is a growing trend that college students are consuming more and more sugar-sweetened beverages (SSBs). In order to develop effective intervention strategies, it is important to explore what social-cognitive factors impact on college students' SSB consumption. Building on the temporal self-regulation theory (TST), the current study aimed to examine the effects of intention, behavioral prepotency, and self-regulatory capacity on SSB consumption among college students.

Design

Data were collected from five hundred Chinese college students online. Participants self-reported their intention, behavioral prepotency (environmental cues and habits), self-regulatory capacity, and behaviors of SSB consumption.

Results

Study findings showed that intention, behavioral prepotency, and self-regulatory capacity accounted for 32.9% of variance in SSB consumption. In terms of the direct effects, intention, behavioral prepotency, and self-regulatory capacity were significantly associated with the SSB consumption among college students. In addition, self-regulatory capacity and habits but not the environmental cues showed significant moderation effects on the intention-SSB consumption path, indicating that individual factors rather than environmental cues influenced the intention-behavior path of SSB consumption among college students.

Conclusion

Findings of the current study demonstrated that the TST can be used to explain and understand the impacts of social-cognitive factors on college students' SSB consumption. Future research can apply TST to develop effective intervention programs targeting the reduction of SSB consumption among college students.

Do task and item difficulty affect overestimation of one's hand hygiene compliance? A cross-sectional survey of physicians and nurses in surgical clinics of six hospitals in Germany

BACKGROUND

One barrier to hand hygiene compliance is overestimation of one's own performance. Overconfidence research shows that overestimation tends to be higher for difficult tasks, which suggests that the magnitude of overestimation also depends on how it is assessed. Thus, we tested the hypothesis that overestimation was stronger for hand hygiene indications with low compliance (i.e., high difficulty), and the hypothesis that self-reported overall compliance based on a single item is higher than based on "5 Moments of Hand Hygiene" (WHO-5) items, since the single item implies an aggregation across indications.

METHODS

In the WACH trial (German Clinical Trials Register [DRKS] ID: DRKS00015502), a questionnaire survey was conducted among physicians and nurses in nine surgical clinics (general/visceral surgery or orthopedics/trauma surgery) of six German hospitals. Self-reported compliance was assessed both by a single item and the WHO-5-items using percentage scales. These were compared with each other and with direct observations. Relative frequencies of the WHO-5 indications used to calculate the WHO-5-based self-reported overall compliance rate were estimated by a systematized review of the literature (see appendix). In analysis, t-tests, Chi²-tests and multiple linear regressions were used.

RESULTS

Ninety-three physicians (response rate: 28.4%) and 225 nurses (30.4%) participated. Significant compliance differences between physicians and nurses were found for direct observations and were in favor of nurses, while no such differences were found for self-reports. Across the WHO-5, overestimation showed inverse correlations with observed compliance (physicians: r = -0.88, p = 0.049; nurses: r = -0.81, p = 0.093). Support for the hypothesis that the self-reported overall compliance based on one item is higher than that based on WHO-5 items was found for physicians (M = 87.2 vs. 84.1%, p = 0.041; nurses: 84.4 vs. 85.5%, p = 0.296). Exploratory analyses showed that this effect was confined to orthopedic/trauma surgeons (89.9 vs. 81.7%, p = 0.006).

CONCLUSION

Among physicians, results indicate stronger hand hygiene overestimation for low-compliance indications, and when measurements are based on a single item versus the five WHO-5 items. For practice, results contribute to infection prevention and control's understanding of overestimation as a psychological mechanism that is relevant to professional hand hygiene.

Impact of Training on Employees' Handwashing Behaviors in School Nutrition Programs

BACKGROUND

School nutrition employee behavior plays an important role in preventing foodborne outbreaks and protecting the almost 30 million children who partake in daily school lunch.

OBJECTIVE

The study aim was to compare the impact of using a food safety training program with or without using a realistic-event video on handwashing behavior modification for school nutrition employees.

DESIGN

A 2-group (control and experimental) pretest with 2 post-tests design was used. The control group received training without the video and the experimental group received the food safety training with a realistic-event video. Measurements used to address the purpose and objectives of this study included questionnaires and direct observations.

PARTICIPANTS/SETTING

The sample consisted of 443 school nutrition employees responsible for food preparation and service affiliated with 21 school districts in 18 states. Approximately half of the sample attended the original unmodified training and the other half attended the modified training. Data were collected in the United States during 2017. A total of 338 employees participated in the observations and 443 participants completed the questionnaires during the 3 phases; 935 questionnaires were used for the analysis.

INTERVENTION

The intervention involved a food safety training program embedded with a realistic-event video related to handwashing. The video used previous research to target antecedents to handwashing behavior among participants.

MAIN OUTCOME MEASURES

Actual behavior was observed across 3 phases-pretraining, post training, and final-for both the control and experimental groups. In addition, indirect and direct measures of behavioral intentions for handwashing were measured.

STATISTICAL ANALYSIS PERFORMED

For the observation data, a 2-way, fixed-effects, mixed-model procedure was used to analyze the data. Simple and multiple linear regression and contingency table analyses looking for differences among phases and treatments were used for questionnaire data analysis.

RESULTS

Most practices were reported as in compliance (51.3% to 80.6%) for both the control and experimental groups during all phases. The experimental group had a higher behavioral intention of properly washing their hands than participants in the control group.

CONCLUSIONS

The results showed that handwashing practices were in compliance most of the time for both the control and experimental groups during all 3 observation periods. Differences among the data collection periods on the theory of planned behavior constructs indicated no statistical effect of the treatment (exposure to the video) between the control and intervention groups.

A controlled before-and-after study of a multi-modal intervention to improve hand hygiene during the peri-natal period in Cambodia

Adequate hand hygiene practices throughout the continuum of care of maternal and newborn health are essential for infection prevention. However, the hand hygiene compliance of facility-based birth attendants, parents and other caregivers along this continuum is low and behavioural-science informed interventions targeting the range of caregivers in both the healthcare facility and home environments are scarce. We assessed the limited efficacy of a novel multimodal behaviour change intervention, delivered at the facility, to improve the hand hygiene practices among midwives and caregivers during childbirth through the return to the home environment. The 6-month intervention was implemented in 4 of 8 purposively selected facilities and included environmental restructuring, hand hygiene infrastructure provision, cues and reminders, and participatory training. In this controlled before-and-after study, the hand hygiene practices of all caregivers present along the care continuum of 99 women and newborns were directly observed. Direct observations took place during three time periods; labour, delivery and immediate aftercare in the facility delivery room, postnatal care in the facility ward and in the home environment within the first 48 h following discharge. Multilevel logistic regression models, adjusted for baseline measures, assessed differences in hand hygiene practices between intervention and control facilities. The intervention was associated with increased odds of improved practice of birth attendants during birth and newborn care in the delivery room (Adjusted odds ratio [AOR] = 4.7; 95% confidence interval [CI] = 2.7, 7.7), and that of parental and non-parental caregivers prior to newborn care in the post-natal care ward (AOR = 9.2; CI = 1.3, 66.2); however, the absolute magnitude of improvements was limited. Intervention effects were not presented for the home environment due COVID-19 related restrictions on observation duration at endline which resulted in too low observation numbers to warrant testing. Our results suggest the potential of a facility-based multimodal behaviour change intervention to improve hand hygiene practices that are critical to maternal and neonatal infection along the continuum of care.

Hand hygiene improvement of individual healthcare workers: results of the multicentre PROHIBIT study

BACKGROUND

Traditionally, hand hygiene (HH) interventions do not identify the observed healthcare workers (HWCs) and therefore, reflect HH compliance only at population level. Intensive care units (ICUs) in seven European hospitals participating in the "Prevention of Hospital Infections by Intervention and Training" (PROHIBIT) study provided individual HH compliance levels. We analysed these to understand the determinants and dynamics of individual change in relation to the overall intervention effect.

METHODS

We included HCWs who contributed at least two observation sessions before and after intervention. Improving, non-changing, and worsening HCWs were defined with a threshold of 20% compliance change. We used multivariable linear regression and spearman's rank correlation to estimate determinants for the individual response to the intervention and correlation to overall change. Swarm graphs visualized ICU-specific patterns.

RESULTS

In total 280 HCWs contributed 17,748 HH opportunities during 2677 observation sessions. Overall, pooled HH compliance increased from 43.1 to 58.7%. The proportion of improving HCWs ranged from 33 to 95% among ICUs. The median HH increase per improving HCW ranged from 16 to 34 percentage points. ICU wide improvement correlated significantly with both the proportion of improving HCWs (ρ = 0.82 [95% CI 0.18-0.97], and their median HH increase (ρ = 0.79 [0.08-0.97]). Multilevel regression demonstrated that individual improvement was significantly associated with nurse profession, lower activity index, higher nurse-to-patient ratio, and lower baseline compliance.

CONCLUSIONS

Both the proportion of improving HCWs and their median individual improvement differed substantially among ICUs but correlated with the ICUs' overall HH improvement. With comparable overall means the range in individual HH varied considerably between some hospitals, implying different transmission risks. Greater insight into improvement dynamics might help to design more effective HH interventions in the future.

Evaluation of the Efficiency of Hand Hygiene Technique with Hydroalcoholic Solution by Image Color Summarize

Background and Objectives: The HH (hand hygiene) technique is relatively simple. Even so, in practice there are still non-conformities regarding this aspect. Lack of knowledge or lack of compliance can be reasons for non-adherence with HH techniques. In this context, the purpose of this study was to follow the realization of the hand-washing technique with hydroalcoholic solution, applied before and after receiving the HH recommendations. Materials and Methods: A descriptive, cross-sectional study was conducted from May 2022 to June 2022. Students from a second year dental medicine class teaching in French 2021/22 “Grigore T. Popa” University of Medicine and Pharmacy in Iasi were included in the study. The approval of the ethics commission was received: No. 184/05.05.2022. The study was conducted in two stages. In the first stage, HH was performed without any recommendation. In the second stage, the antiseptic hand rubbing technique was presented following the WHO recommendations. The fluorescent Fluo-Add solution, Wood lamp for dermatology (4 × 5.5 W ultraviolet tubes with a wavelength of 360 nm), and photo camera were used. Subjects performed their HH movement before and after receiving instructions according to WHO. Images were initially taken from the backhand and palm and were finally analyzed with Image Color Summarizer. The data were analyzed by the Mann–Whitney U Test, t-test paired samples using IBM-SPSS version 26 (IBM, Armonk, NY, USA), and p ≤ 0.05 was considered statistically significant. Results: After analyzing the images, there were 70 subjects, 45.7% (32) female and 54.33% (38) male. Final average covered area of backhand was 60.89% (±17.17), 28.84:86.11, compared to 52.07% (±17.04), 9:85.23. Final average covered area for palm was 69.91% (±13.5), 31.61:93.41 compared to 59.74% (±16.64), 26.13:92.72. No statistical significance was obtained by gender. Conclusions: The study showed an improvement in hand hygiene technique without highlighting gender differences.

Smart Hand Sanitisers in the Workplace: A Survey of Attitudes towards an Internet of Things Technology

An online survey was circulated to employees from a wide range of organisations to gauge attitudes towards the idea of using smart hand sanitisers in the workplace. The sanitisers are capable of real-time monitoring and providing feedback that varies according to the hand hygiene behaviour of users. In certain circumstances, the sanitisers can monitor individuals, making it possible to identify workers whose hand hygiene falls below a certain standard. The survey was circulated between July and August 2021 during the COVID-19 pandemic. Data gathered from 314 respondents indicated support for some features of the technology, but also indicated concern about invasions of privacy and the possibility of coercion. Attitudes towards the possible implementation of the technology varied significantly according to certain characteristics of the sample, but particularly with age. Respondents above the median age were more likely to support the use of data in ways that could facilitate the promotion and enforcement of hand hygiene practices.

Measuring the Self-Efficacy of Health Professionals for Practicing Hand Hygiene and Using Gloves: Development and Validation of an Instrument

Adherence to hand hygiene procedures and the use of gloves is a problem that deserves to be analyzed from an individual and organizational point of view. For this, we aim to develop and validate an instrument for measuring the self-efficacy of health professionals for practicing hand hygiene and using gloves. We evaluated the metric properties of validity and reliability for measuring the self-efficacy of health professionals for practicing hand hygiene and using gloves. Fifteen health and education professionals formed the judges committee to construct the instrument for measuring the self-efficacy of health professionals for practicing hand hygiene and using gloves. Moreover, 362 nursing professionals participated in this study that was carried out from 2017 to 2020. The construct validity by known groups was confirmed by comparing the means of self-efficacy of the self-efficacy of health professionals for practicing hand hygiene and using gloves with the variables sex and unit of activity. The convergent construct validity showed a weak correlation between the scores of the self-efficacy of health professionals for practicing hand hygiene and using gloves instrument, and the perceived general self-efficacy scale. This instrument is easy to apply and can be used in the assessment of behavioral determinants, regarding hand hygiene and the use of gloves, in other health professionals, considering the generalization and scope of the items.

Using the Theory of Planned Behavior to Understand How Crisis Intervention Team (CIT) Training Facilitates Police Officers' Mental Health Referrals

The Theory of Planned Behavior posits that behaviors are predicted by one's intention to perform them; intention is driven by attitude toward the behavior, subjective norm, and perceived behavioral control. We used this theory to predict Crisis Intervention Team (CIT)-trained and non-CIT officers' intention to facilitate referral of persons with suspected mental illnesses to mental health services. CIT-trained (n = 251) and non-CIT (n = 335) officers from six law enforcement agencies participated. CIT-trained officers had significantly greater scores on all constructs. Theory constructs fit the data well, and fit did not differ meaningfully between the two groups. Direct and indirect predictors together accounted for 28% and 21%, respectively, of variance in behavioral intention. Attitude was the strongest predictor. Intentions to facilitate mental health referrals may be driven by the same factors among CIT-trained and non-CIT officers, but CIT officers, even at a median of 22 months after training, have significantly higher scores on those factors.

Compliance of healthcare workers with the infection prevention and control guidance in tertiary care hospitals: quantitative findings from an explanatory sequential mixed-methods study in Bangladesh

OBJECTIVES

To assess healthcare workers' (HCWs) compliance with the infection prevention and control (IPC) practices and identify the factors influencing this compliance using the Health Belief Model as the theoretical framework.

DESIGN

Quantitative data from an explanatory sequential mixed-methods study were employed in this research.

PARTICIPANTS AND SETTINGS

From 17 May to 30 August 2020, 604 physicians and nurses working at six randomly selected tertiary care facilities in Dhaka City in Bangladesh took part in this study.

PRIMARY AND SECONDARY OUTCOME MEASURES

Compliance with the WHO's guidance on IPC measures, as well as the associated factors, was the primary outcome.

RESULTS

A mean compliance score of 0.49 (±0.25) was observed on a 0-1 scale. HCWs were most compliant with the medical mask wearing guidelines (81%) and were least compliant with the high-touch surface decontamination regulations (23%). Compliance with the IPC guidance was significantly associated with increasing age, female sex, working as a nurse, having non-communicable diseases and history of exposure to patients with COVID-19. Perceived benefits (B=0.039, 95% CI 0.001 to 0.076), self-efficacy (B=0.101, 95% CI 0.060 to 0.142) and cues to action (B=0.045, 95% CI 0.002 to 0.088) were positively associated with compliance. Compliance with IPC guidance was 0.061 times greater among participants who reported low perceived barriers compared with those with high perceived barriers.

CONCLUSION

Overall, compliance with IPC guidance among HCWs was unsatisfactory. As self-efficacy exerted the greatest contribution to compliance, it should be emphasised in any endeavour to improve HCWs' IPC adherence. Such interventions should also focus on perceived barriers, including unreliability of the information sources, unsafe working places and unavailability of protective equipment and cues to action, including trust in the administration and availability of adequate IPC guidance.

Health Care Workers' Adherence to Hand Hygiene Guidelines in Emergency Surgical Room of a Tertiary Care Hospital

Background  Out of every 100 hospitalized patients, 7 patients in advanced countries and 10 patients in emerging countries acquire health care-associated infections (HCAIs). Hand hygiene (HH) procedures are the simple and cost-effective solution to significantly reduce HCAI. We wanted to know the compliance rate of HH procedures among health care workers (HCWs) working in emergency surgical room (ESR) of our institute, so that feedback can be given to them and further interventions can be planned.

Methodology  This is a cross-sectional observational study conducted in ESR. Resident doctors and faculties, interns, and nurses were directly observed for all the five moments of HH recommended by World Health Organization (WHO). The data have been recorded with the WHO recommended form for observation and basic compliance calculation for HH.

Results  In total, 1,370 HH opportunities were observed and recorded, of which 690 were for resident doctors and faculties, and 340 each for interns and nurses. The overall total HH compliance rate among all HCWs was 41.3% and resident doctors and faculties had the poorest compliance. Poorest compliance was observed for moment 1, whereas maximum compliance was for moment 3 among all the HCWs.

Conclusion  HCWs' adherence to HH guidelines in ESR of this tertiary care hospital is low and is least in resident doctors and faculties.

Knowledge and perception of hand hygiene: A survey using WHO standardized tools in Tehran, Iran

BACKGROUND

Proper hand hygiene is the most important action in preventing healthcare-associated infections (HCAIs). In this study, the knowledge and perception of hand hygiene assessed among nurses as the most exposed personnel to patients.

METHODS

In this analytical cross-sectional study, the nurses working in different wards of a collegiate tertiary hospital in Tehran were investigated by standardized WHO questionnaires.

RESULTS

Of the 101 participating nurses 89 (88.1%) were females. 81 (80.2%) had received formal related training. The 69 respondents estimated the mean prevalence of HCAI to be 38.91% and 98 (97.1%) considered hand hygiene an effective prevention in this regard. 78 (77.3%) perceived hand hygiene as the center priority; 82, 83 and 79 of participants would think that good hand hygiene matters for their superiors, colleagues and patients, respectively. The practice of hand hygiene was stated to be difficult by 48 (47.5%) respondents. There was no significant difference in self-reporting of hand hygiene practice among nurses in age (P=0.68), the degree of education (P=0.574), work experience (P=0.64), nor their wards (P=0.131). There was a significant reverse relationship with the supposed difficulty level of doing hand hygiene (P=0.049). The mean score of the nurses' knowledge was 66.53 (±9.41) based on the answers to the questions of the knowledge questionnaire.

CONCLUSION

Knowledge and perception of hand hygiene, as this study showed, might not to be satisfactory; therefore, planning to improve these indicators and regular monitoring using standard tools is necessary for all healthcare centers.

The Role of Biosecurity in the Control of Campylobacter: A Qualitative Study of the Attitudes and Perceptions of UK Broiler Farm Workers

Campylobacter is the leading cause of human bacterial diarrhoeal disease worldwide, with poultry meat products contributing to a large proportion of cases. Due to the ubiquitous presence of Campylobacter in the poultry farm environment, biosecurity is the main area for intervention to prevent colonisation of commercial broiler chicken flocks. However, research has repeatedly demonstrated that farmers' uptake of biosecurity recommendations is often poor. This study explored farmers' attitudes towards biosecurity and identified barriers to effective implementation of biosecurity protocols. Semi-structured interviews were conducted with 1–3 members of staff on each of 16 broiler farms; 6 owned by, and 10 contracted to, 3 different UK poultry integrators. In total, 28 interviewees participated, including farm owners, managers, and workers, with a range of industry experience. Thematic analysis of the interviews revealed high levels of recognition amongst broiler farmers of the importance of Campylobacter and the responsibility of the whole farm-to-fork chain within the poultry industry to reduce Campylobacter contamination of chicken meat for the benefit of public health. Participants' self-reported awareness and implementation of biosecurity has improved significantly following the industry-wide focus on Campylobacter control. However, there are frustrations with the industry's approach to tackling Campylobacter and the heavy burden of responsibility that has been put on interventions at the farm-level. There was also scepticism amongst participants as to the effectiveness of current biosecurity measures in the reduction of Campylobacter. Nevertheless, the interviewees' recognition of the benefit of improved biosecurity on broiler health and welfare and other important targets, such as reducing antimicrobial usage, leaves a legacy of which the UK broiler industry can be proud. There is scope for further farmer education about the evidence supporting biosecurity interventions, particularly in the control of Campylobacter, and a need to establish more effective channels of communication. Furthermore, to give all players within the industry agency and investment in industry targets, contributions from all levels should be permitted in the design of future biosecurity interventions. Biosecurity compliance may be improved through collaborative efforts, such as participatory and co-design practises, to facilitate knowledge co-creation and exchange.

Utilization of Kotter's Stages and Statistical Process Control to Implement and Sustain Delirium Screening in PICU

Supplemental Digital Content is available in the text.

Delirium is a preventable cause of ICU morbidity and mortality. Prior unstructured efforts to implement delirium screening in our hospital were unsuccessful. This project aimed to improve the delirium screening compliance from baseline 0% to more than 80% within 12 months (07/2019–06/2020).

Survey of intention among public health nurses in providing solution-focused parenting support

Objective

Parenting support has shifted from a problem‐focused to a strengths‐based solution‐focused approach. This study surveyed public health nurses to explain their intention to provide solution‐focused parenting support in their practice.

Design

The design of this study was cross‐sectional.

Sample

The initial sample included 781 public health nurses who were employed with various youth healthcare organizations in the Netherlands.

Measurements

Based on the Theory of Planned Behavior, a questionnaire was developed and administered to measure (a) behavioral, normative, and control beliefs, (b) attitudes, subjective norm, and perceived behavioral control, and (c) intention. The data were subjected to structural equation modeling.

Results

A total of 449 (57.5%) public health nurses completed questionnaires. Associations as indicated by the Theory of Planned Behavior were confirmed with the exception of that between perceived behavioral control and intention. Statistically significant paths and correlations were added. The final model accounted for 53% of the variance in the intention to perform solution‐focused parenting support.

Conclusions

In this study, public health nurses strongly intended to provide solution‐focused parenting support, thus indicating their acceptance of the approach. Their intention was predominantly associated with subjective norm.

COVID-19 and handwashing: Implications for water use in Sub-Saharan Africa

Because the main modes of transmission of the COVID-19 virus are respiration and contact, WHO recommends frequent washing of hands with soap under running water for at least 20 s. This article investigates how the level of concern about COVID-19 affects the likelihood of washing hands frequently in sub-Saharan Africa. We discuss the implication of the findings for water-scarce environment. The study makes use of a unique survey dataset from 12 sub-Saharan African countries collected in April 2020 (first round) and May 2020 (second round) and employs an extended ordered probit model with endogenous covariate. The results show that the level of concern about the spread of the virus increases the likelihood of washing hands with soap under running water for a minimum of 20 s at least five times a day. The increase in the probability of handwashing due to concern about COVID-19, ranges from 3% for Benin to 6.3% for South Africa. The results also show heterogeneous effects across gender- and age-groups, locality and various water sources. However, in Africa, the sustainability of the handwashing protocol could be threatened by the severe water scarcity that exists in the region. To sustain frequent handwashing, sub-Saharan Africa needs an effective strategy for water management and supply.

Theory of planned behavior as a conceptual framework for the willingness to self-isolate during the COVID-19 pandemic: A regional cross-sectional study

BACKGROUND

Due to an unavailability of a vaccine, one of the efficient methods to prevent the spread of the novel coronavirus (COVID-19) is by applying self-isolation (SI). Hence there is an urgent need to investigate the factors leading to an individuals' willingness to choose to self-isolate.

OBJECTIVES

The current study utilized the Theory of Planned Behavior (TPB) as a conceptual model and aimed to investigate the extent to which subjective norms, personal attitudes and perceived control influences an individual's willingness to self-isolate during COVID-19 risk.

METHOD

A cross-sectional study was performed on 800 Saudi respondents aged≥18 years by using a validated self-administered questionnaire about factors related to willingness to self-isolate during COVID-19 pandemic risk based on the TPB. The effects of different variables on SI were analyzed by using ordinal logistic regression model.

RESULTS

A total of 756 (94.5%) were completed and analyzed. Subjective norms and perceived control over the behavior significantly (p < 0.05) influenced the intention of willingness to self-isolate, while attitude was found to be insignificant. The odds of letting others to know about self COVID status were 2.40 times higher than not telling the neighbors or colleagues. A statistically significant difference (p≤0.001) existed between males and females regarding the willingness to self-isolate. Similarly the odds of willingness to self-isolate with a presence of disabled person in family were 2.88 times higher than the absence of a disability in the family. Few recommendations for the policymakers that are needed to curb the spread of COVID-19 infection are also proposed.

CONCLUSION

The outcomes of study might be considered as an initial understanding of the factors that significantly influences an individual's willingness to SI when facing an unprecedented pandemic risk. Additionally, these factors provide a plan for policymakers to encourage citizens for self-isolation during pandemic infections.

Understanding the predictors of hand hygiene using aspects of the theory of planned behaviour and temporal self-regulation theory

OBJECTIVE

Adherence to proper hand hygiene practice is relatively low and is particularly salient in light of the current COVID-19 pandemic. Having a greater understanding of the psychosocial predictors of engaging in proper hand hygiene is warranted. One way to do this is through the application of a combined theory of planned behaviour and temporal self-regulation theory model.

DESIGN

A prospective two-part study was conducted between May - November 2020, with N = 232 Australians. At time one, variables from both the theory of planned behaviour (attitude, subjective norm, perceived behavioural control, and intention) and temporal self-regulation theory (habit, environmental cues, and planning) were completed.

MAIN OUTCOME MEASURES

One week later, engagement in proper hand hygiene behaviour over the previous week was assessed.

RESULTS

Two hierarchical multiple regressions were conducted, with 47% of variance accounted for in intention, with subjective norm being the strongest predictor, and 38% of variance accounted for in hand hygiene behaviour, with intention being the strongest predictor. Environmental cues also moderated the relationship between intention and behaviour.

CONCLUSIONS

To increase intention, incorporating subjective norm messages in advertisements may be helpful. Incorporating environmental cues in places where hand washing is recommended may assist in increasing hand hygiene.

Self-controlled responses to COVID-19: Self-control and uncertainty predict responses to the COVID-19 pandemic

Two online studies (Total N = 331) tested the hypothesis that individual differences in self-control and responses to uncertainty would predict adherence to Centers for Disease Control and Prevention (CDC, 2020a) guidelines, reported stockpiling, and intentions to engage in hedonic behavior in response to the COVID-19 pandemic. Trait self-control (b = 0.27, p = .015), desire for self-control (Study 1: b = 0.28, p = .001; Study 2: b = 0.27, p = .005), and cognitive uncertainty (b = 0.73, p < .001) predicted more CDC adherence. State self-control (Study 1: b = -0.15, p = .012; Study 2: b = -0.26, p < .001) predicted less stockpiling, whereas emotional uncertainty (b = 0.56, p < .001) and cognitive uncertainty (b = 0.61, p < .001) predicted more stockpiling. State self-control (b = -0.18, p = .003) predicted less hedonic behavior, whereas desire for self-control (b = 0.42, p < .001) and emotional uncertainty (b = 0.26, p = .018) predicted more hedonic behavior. Study 2 (pre-registered) also found that emotional uncertainty predicted more stockpiling and hedonic behavior for participants low in state self-control (stockpiling: b = -0.31, p < .001; hedonic behavior: b = 0.28, p = .025), but not for participants high in state self-control (stockpiling: b = 0.03, p = .795; hedonic behavior: b = -0.24, p = .066). These findings provide evidence that some forms of self-control and uncertainty influenced compliance with behavioral recommendations during the COVID-19 pandemic.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-021-02066-y.

Self-Reported Use of Personal Protective Equipment among Emergency Department Nurses, Physicians and Advanced Practice Providers during the 2020 COVID-19 Pandemic

Background: Emergency departments (EDs) have seen dramatic surges in patients infected with COVID-19 and are high-risk transmission environments. Knowledge, attitudes and practice regarding personal protective equipment (PPE) among ED health care workers (HCWs) during the COVID-19 pandemic have not been studied, thus this study examines this knowledge gap. Methods: This was a cross-sectional survey of 308 HCWs in two urban EDs in Atlanta, Georgia in April and May of 2020. Results: We surveyed 308 HCWs; 137 responded (44% response rate). All HCWs reported adequate knowledge and 96% reported compliance with PPE guidelines. Reported sources of PPE information: 56.7% charge nurse, 67.3% the institutional COVID-19 website. Frequency of training was positively associated with understanding how to protect themselves and patients (OR = 1.7, 95% CI: 1.0–2.9). Conclusions: Few HCWs are willing to care for patients without PPE, and therefore we should aim for resiliency in the PPE supply chain. EDs should consider multiple communication strategies, including a website with concise information and enhanced training for key personnel, particularly the charge nurse. Attention to frequency in HCW training may be key to improve confidence in protecting themselves and patients. Findings can be leveraged by EDs to implement effective PPE training.

Utilizing behavioral theories to explain hospital visitors' observed hand hygiene behavior

BACKGROUND

Hand hygiene is essential for infection prevention. This study aimed to find a suitable theoretical model and identify critical facilitators and barriers to explain hospital visitors' hand hygiene practice.

METHODS

Visitors in 4 hospitals were observed and asked to give explanations for using or not using the hand rub dispenser. The written explanations of N = 838 participants were coded according to three theoretical models: Theory of Planned Behavior, Health Action Process Approach (HAPA), and Theoretical Domains Framework (TDF).

RESULTS

Self-reported hand hygiene behavior differed from observed behavior, with 15.75% wrongly claiming to have cleaned their hands. Critical facilitators for hand hygiene were attitude toward the behavior,subjective norm, outcome expectancies, risk perception, planning, action control, knowledge and skills, motivation and goals, and social influences. Key barriers included perceived behavioral control; barriers and resources; memory, attention, and decision processes; and environmental context and resources.

CONCLUSIONS

Visitors' self-reported hand hygiene behavior is over-reported. Both HAPA and TDF were identified as suitable theoretical models for explaining visitor's hand hygiene practice. Future behavior change interventions should focus on (1) visibility and accessibility of cleaning products; (2) informing laypeople about their role regarding infection prevention; and (3) leveraging social influence processes.

Food safety and evaluation of intention to practice safe eating out measures during COVID-19: Cross sectional study in Indonesia and Malaysia

The COVID-19 pandemic has altered consumers' relationship with food, whether through shopping, increased home cooking, taking pre-cautionary measures during food shopping, food delivery and whilst dining out. This study aims to examine the impact of COVID-19 pandemic on consumers' food safety knowledge, attitude and practices and to identify the predictors of food safety practices during COVID-19. An online survey was conducted and received valid responses from 987 respondents. Data were analysed using descriptive statistics, non-parametric tests, Spearman's rho correlation and multiple regression. The Theory of Planned Behaviour (TPB) model was used to investigate the intention to practice safe eating out measures during COVID-19. The mean food safety knowledge score was 6.37 ± 1.37 (9.00 = highest score) of which 91.3% of total respondents from Indonesia and Malaysia scored ≥5 points. Consumers also demonstrated positive food safety attitude (4.06 ± 0.99) and reported high frequencies in conducting food safety practices (4.03 ± 0.82) during COVID-19. The TPB has provided valuable framework for understanding consumers' intention to practice safe eating out measures during COVID-19. The multiple regression model explained 63% and 73% of the variance in adherence to safe eating out practices in Indonesia and Malaysia and (p < 0.05) respectively. All the TPB antecedents i.e. attitude, subjective norms and perceived behavioural control were identified as significant predictors on consumers' eating out practices. This suggests that consumers with positive food safety attitude and strong family norms were more likely to adhere to safe eating out measures (e.g. selection of clean and less crowded restaurants, practicing hand hygiene, wearing masks and practising social distancing). The findings also suggest that to fully adhere to the safe practices, it is important to have sufficient support from restaurant staff to ensure social distancing and to provide adequate handwashing facilities. This is the first study to provide new empirical findings on consumers' intention to practice safe eating out measures during COVID-19.

How Social Media Exposure to Health Information Influences Chinese People's Health Protective Behavior during Air Pollution: A Theory of Planned Behavior Perspective

Haze has become one of the most life-threatening problems in China and affects over one billion Chinese people's health. Chinese people have become more dependent on receiving health information from social media, especially Weibo and WeChat, which shapes their health perceptions and behaviors. To investigate how Chinese people's exposure to health information on social media influenced their health protective behaviors in response to haze, particularly wearing a PM2.5 anti-haze mask, we conducted a longitudinal web-based survey of mainland Chinese. The results from the structural equation modeling showed that (a) attitude and descriptive norm positively mediated the relationships between using Weibo for health information and behavioral intention while descriptive norm negatively mediated the relationship between using WeChat for health information and intention, and that (b) attitude, descriptive norm, and injunctive norm significantly predicted behavioral intention and wearing mask, but perceived behavior control did not. Theoretical and practical implications are discussed.

Hand Hygiene Knowledge and Self-Reported Hand Washing Behaviors among Restaurant Kitchen Chefs in Jiangsu Province, China

Inadequate hand washing among chefs is a major contributor to outbreaks of foodborne illnesses originating in restaurants. Although many studies have evaluated hand hygiene knowledge (HHK) and self-reported hand washing behaviors (HWBs) in restaurant workers in different countries, little is known about HHK and HWBs in restaurant kitchen chefs, particularly in China. In this study, we interviewed 453 restaurant kitchen chefs in Jiangsu Province in China regarding their HHK and HWBs and used Chi-square tests (Fisher exact tests), pairwise comparisons, and linear regression models to analyze the responses and identify determinants of HHK and HWBs. Results reveal that less frequent hand washing after leaving work temporarily and after touching used cutlery were the main issues among restaurant kitchen chefs in Jiangsu Province. Kitchen hands had lower levels of HHK and engaged less frequently in good HWBs than the other type of chefs. Furthermore, working in a large restaurant and having worked in the restaurant industry for a longer amount of time were correlated with better HHK and HWBs. These findings suggest that close attention should be paid to the HWBs of chefs during food preparation, that kitchen hands are the key group of restaurant kitchen workers who need training in HHK, and that regulatory activities should focus on small-scale restaurants.

Hand(y) hygiene insights: Applying three theoretical models to investigate hospital patients' and visitors' hand hygiene behavior

BACKGROUND

Improving hand hygiene in hospitals is the most efficient method to prevent healthcare-associated infections. The hand hygiene behavior of hospital patients and visitors is not well-researched, although they pose a risk for the transmission of pathogens. Therefore, the present study had three aims: (1) Finding a suitable theoretical model to explain patients' and visitors' hand hygiene practice; (2) Identifying important predictors for their hand hygiene behavior; and (3) Comparing the essential determinants of hand hygiene behavior between healthcare professionals from the literature to our non-professional sample.

METHODS

In total N = 1,605 patients and visitors were surveyed on their hand hygiene practice in hospitals. The employed questionnaires were based on three theoretical models: a) the Theory of Planned Behavior (TPB); b) the Health Action Process Approach (HAPA); and c) the Theoretical Domains Framework (TDF). Structural equation modeling was used to analyze the data. To compare our results to the determinants of healthcare workers' hand hygiene behavior, we searched for studies that used one of the three theoretical models.

RESULTS

Among patients, 52% of the variance in the hand hygiene behavior was accounted for by the TDF domains, 44% by a modified HAPA model, and 40% by the TPB factors. Among visitors, these figures were 59%, 37%, and 55%, respectively. Two clusters of variables surfaced as being essential determinants of behavior: self-regulatory processes and social influence processes. The critical determinants for healthcare professionals' hand hygiene reported in the literature were similar to the findings from our non-professional sample.

CONCLUSIONS

The TDF was identified as the most suitable model to explain patients' and visitors' hand hygiene practices. Patients and visitors should be included in existing behavior change intervention strategies. Newly planned interventions should focus on targeting self-regulatory and social influence processes to improve effectiveness.

A behaviour change package to prevent hand dermatitis in nurses working in health care: the SCIN cluster RCT

BACKGROUND

Although strategies have been developed to minimise the risk of occupational hand dermatitis in nurses, their clinical effectiveness and cost-effectiveness remain unclear.

OBJECTIVES

The Skin Care Intervention in Nurses trial tested the hypothesis that a behaviour change package intervention, coupled with provision of hand moisturisers, could reduce the point prevalence of hand dermatitis when compared with standard care among nurses working in the NHS. The secondary aim was to assess the impact of the intervention on participants' beliefs and behaviour regarding hand care, and the cost-effectiveness of the intervention in comparison with normal care.

DESIGN

Cluster randomised controlled trial.

SETTING

Thirty-five NHS hospital trusts/health boards/universities.

PARTICIPANTS

First-year student nurses with a history of atopic tendency, and full-time intensive care unit nurses.

INTERVENTION

Sites were randomly allocated to be 'intervention plus' or 'intervention light'. Participants at 'intervention plus' sites received access to a bespoke online behaviour change package intervention, coupled with personal supplies of moisturising cream (student nurses) and optimal availability of moisturising cream (intensive care unit nurses). Nurses at 'intervention light' sites received usual care, including a dermatitis prevention leaflet.

MAIN OUTCOME MEASURE

The difference between intervention plus and intervention light sites in the change of point prevalence of visible hand dermatitis was measured from images taken at baseline and at follow-up.

RANDOMISATION

Fourteen sites were randomised to the intervention plus arm, and 21 sites were randomised to the intervention light arm.

BLINDING

The participants, trial statistician, methodologist and the dermatologists interpreting the hand photographs were blinded to intervention assignment.

NUMBERS ANALYSED

An intention-to-treat analysis was conducted on data from 845 student nurses and 1111 intensive care unit nurses.

RESULTS

The intention-to-treat analysis showed no evidence that the risk of developing dermatitis was greater in the intervention light group than in the intervention plus group (student nurses: odds ratio 1.25, 95% confidence interval 0.59 to 2.69; intensive care unit nurses: odds ratio 1.41, 95% confidence interval 0.81 to 2.44). Both groups had high levels of baseline beliefs about the benefits of using hand moisturisers before, during and after work. The frequency of use of hand moisturisers before, during and after shifts was significantly higher in the intensive care unit nurses in the intervention plus arm at follow-up than in the comparator group nurses. For student nurses, the intervention plus group mean costs were £2 lower than those for the comparator and 0.00002 more quality-adjusted life-years were gained. For intensive care unit nurses, costs were £4 higher and 0.0016 fewer quality-adjusted life-years were gained.

HARMS

No adverse events were reported.

LIMITATIONS

Only 44.5% of participants in the intervention plus arm accessed the behaviour change package.

CONCLUSION

The intervention did not result in a statistically significant decrease in the prevalence of hand dermatitis in the intervention plus group.

FUTURE WORK

Participants had a high level of baseline beliefs about the importance of using hand moisturisers before, during and after work. Future research should focus on how workplace culture can be changed in order for that knowledge to be actioned.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN53303171.

FUNDING

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 58. See the NIHR Journals Library website for further project information.

Cleaning and Disinfection Perceptions and Use Practices Among Elastomeric Respirator Users in Health care

BACKGROUND

Reusable elastomeric respirator use in health care may represent one solution to address N95 respirator shortages experienced during infectious disease outbreaks, but cleaning and disinfection requirements may limit their utility. Evidence of respirator cleaning and disinfection behaviors and practices by health care workers may inform guidance on reusable respirator use.

METHODS

Medical system elastomeric respirator users were surveyed about respirator cleaning and disinfection practices and perceptions via an electronic survey. Respondents were subsequently classified based on reported compliance with their assigned respirator use. To explore whether respirator cleaning and disinfection issues affected compliance with assigned device use, responses were compared between user groups and adjusted for covariates.

RESULTS

A total of 432 of 2,024 (21%) eligible elastomeric respirator users completed the survey. Most (>90%) reported that their respirator was clean, but only 52% reported that they always disinfect their respirators after use according to the hospital's expected practice. Only 40 respondents (9%) reported regularly cleaning the respirator with soap and water, in accordance with manufacturer recommendations. Reporting of suboptimal decontamination practice was not associated with assigned device compliance, however, except among providers and respiratory therapists.

CONCLUSION/APPLICATION TO PRACTICE

Although perceptions of cleanliness and adherence to expected decontamination practices during routine use did not appear to influence compliance with assigned respirator use overall, this did predict compliance among providers and respiratory therapists, both of whom have nonfixed workstations. Practical and effective strategies to assure easy access to and availability of clean reusable respiratory protective devices are needed to facilitate their use in health care respiratory protection programs.

Ways in which healthcare interior environments are associated with perceived safety against infectious diseases and coping behaviours

BACKGROUND

Global pandemic outbreaks are a cause of fear. Healthcare workers (HCWs), especially those fighting the pathogens at the front line, are at higher risk of being infected while they treat patients. In addition, various environmental fomites in hospitals, which may carry infectious agents, can increase the risk of acquiring an infectious disease.

AIM

In order to deliver the best healthcare practice, it is critical that HCWs feel safe and protected against infectious diseases. The aim of this study was to improve understanding of HCWs' hand hygiene (HH) behaviours and perceptions of infectious diseases from a psychological perspective.

METHODS

Environmental features were observed in three departments, and questionnaires were used to determine perceived safety against infectious diseases among HCWs and the coping behaviours they used (e.g. avoidance and disinfection).

FINDINGS

This study found that an increase in the number of HH stations at convenient locations would increase HH compliance and perceived safety against infectious diseases among HCWs. In response to the current research gap in psychological aspects associated with HH, this study found that HCWs' coping behaviours can be predicted by their perceived likelihood of contamination and perceived vulnerability.

CONCLUSIONS

The study findings should be interpreted with care, and further studies with more academic rigor are needed.

Hand hygiene knowledge, attitudes, and practices among hospital inpatients: A descriptive study

BACKGROUND

Pathogens may be transmitted in hospitals via patients' own hands, but little is known about the facilitators and barriers of hand hygiene among inpatients. This study aimed to assess the hand hygiene knowledge, attitudes, and practices of adult inpatients at 5 hospitals.

METHODS

The study consisted of a cross-sectional survey distributed followed by structured interviews with randomly selected inpatients. Qualitative data were analyzed independently by 2 researchers using the Theoretical Domains Framework.

RESULTS

A total of 268 surveys were completed, with 66.4% of patients reporting always performing hand hygiene after toileting and 49.2% before eating. The majority of patients (74.6%) stated that they did not want to receive more information about hand hygiene while in the hospital. Key themes identified from 23 interviews include knowledge; environmental context and resources; memory, attention, and decision processes; and social influences.

CONCLUSIONS

Self-reported patient hand hygiene rates are suboptimal and there are knowledge gaps among patients as to when to perform hand hygiene, but patients are not receptive to receiving traditional educational interventions. Future interventions to improve patient hand hygiene should focus on other behavior change domains, including environmental context and resources (eg, access to hand sanitizer at the bedside), memory, attention, and decision processes (eg, posters or other reminders), and social influences (eg, role modeling).

Behavioural Determinants of Hand Washing and Glove Recontamination before Aseptic Procedures at Birth: A Time-and-Motion Study and Survey in Zanzibar Labour Wards

Recent research calls for distinguishing whether the failure to comply with World Health Organisation hand hygiene guidelines is driven by omitting to rub/wash hands, or subsequently recontamination of clean hands or gloves prior to a procedure. This study examined the determinants of these two behaviours. Across the 10 highest-volume labour wards in Zanzibar, we observed 103 birth attendants across 779 hand hygiene opportunities before aseptic procedures (time-and-motion methods). They were then interviewed using a structured cross-sectional survey. We used mixed-effect multivariable logistic regressions to investigate the independent association of candidate determinants with hand rubbing/washing and avoiding glove recontamination. After controlling for confounders, we found that availability of single-use material to dry hands (OR:2.9; CI:1.58–5.14), a higher workload (OR:29.4; CI:12.9–67.0), more knowledge about hand hygiene (OR:1.89; CI:1.02–3.49), and an environment with more reminders from colleagues (OR:1.20; CI:0.98–1.46) were associated with more hand rubbing/washing. Only the length of time elapsed since donning gloves (OR:4.5; CI:2.5–8.0) was associated with avoiding glove recontamination. We identified multiple determinants of hand washing/rubbing. Only time elapsed since washing/rubbing was reliably associated with avoiding glove recontamination. In this setting, these two behaviours require different interventions. Future studies should measure them separately.

Predicting Hand Washing and Sleep Hygiene Behaviors among College Students: Test of an Integrated Social-Cognition Model

Objective: Hand washing and sleep hygiene are two important health behaviors. The purpose of the current study was to identify the motivational and volitional antecedents of college students’ hand washing and sleep hygiene behaviors based on an integrated model of behavior that combined social-cognition constructs from the Theory of Planned Behavior (TPB) and Health Action Process Approach (HAPA). Methods: Using a prospective design, college students (N = 1106) completed a survey assessing the motivational constructs of action self-efficacy, attitudes, subjective norm, perceived behavioral control, intentions, and behaviors of hand washing and sleep hygiene at Time 1. Demographic variables were also collected. One month later, at Time 2, college students (N = 524) self-reported on their volitional factors of maintenance self-efficacy, action planning, coping planning, and behaviors of hand washing and sleep hygiene. A further 2 months later, at Time 3, college students (N = 297) were asked to self-report on their hand washing and sleep hygiene behaviors over the past month. Findings: Data were analyzed using variance-based structural equation modelling. Results showed significant direct effects of attitudes, subjective norm, and perceived behavioral control on intentions; significant direct effects of action self-efficacy on maintenance self-efficacy; and significant direct effects of maintenance self-efficacy on action planning and coping planning. Significant direct effects of intention on action planning (sleep hygiene only), and significant direct effects of intention, maintenance self-efficacy (hand washing only), action and coping planning on behavior were also observed. Action planning also moderated the intention–behavior relationship, but only for hand washing. There were also significant total indirect effects of action self-efficacy on behavior mediated by maintenance self-efficacy, action planning, and coping planning for both behaviors, and significant total indirect effects of subjective norm and perceived behavioral control on behavior mediated by intention for sleep hygiene. When past behavior was included in the integrated model predicting all the psychological variables and behavior, all of the structural relations were attenuated. Discussion: Current findings indicate that college students’ hand washing and sleep hygiene behaviors are a function of both motivational and volitional factors. Findings also indicate that the TPB and HAPA pathways might differ for the two health behaviors. Implications of the current findings for future health interventions aimed at improving college students’ hand washing and sleep hygiene are discussed.

Assessment of correlates of hand hygiene compliance among final year medical students: a cross-sectional study in the Netherlands

OBJECTIVES

To identify the factors that influence the hand hygiene compliance of final year medical students, using a theoretical behavioural framework.

DESIGN

Cross-sectional survey assessing self-reported compliance and its behavioural correlates.

SETTING

Internships of medical students in the Netherlands.

PARTICIPANTS

322 medical students of the Erasmus Medical Center were recruited over a period of 12 months during the Public Health internship, which is the final compulsory internship after an 18-month rotation schedule in all major specialities.

PRIMARY AND SECONDARY OUTCOME MEASURES

Behavioural factors influencing compliance to hand hygiene guidelines were measured by means of a questionnaire based on the Theory of Planned Behaviour and Social Ecological Models. Multiple linear regression analysis was used to identify the effect of including attitudes, social norms, self-efficacy, knowledge, risk perception and habit on hand hygiene compliance.

RESULTS

We included 313 students in the analysis (response rate 97%). The behavioural model explained 40% of the variance in self-reported compliance (adjusted R²=0.40). Hand hygiene compliance was strongly influenced by attitudes (perceived outcomes of preventive actions), self-efficacy (perception of the ability to perform hand hygiene at the clinical ward) and habit, but was not associated with knowledge and risk perception.

CONCLUSIONS

Targeting medical students' behaviour should focus on the empowerment of these juniors and provide them with evidence on the health benefits of prevention, rather than increasing their factual knowledge of procedures. Clinical teaching environments could help them form good patient safety habits during this vital phase of their career.

Hand hygiene beliefs and behaviours about alcohol-based hand rub use: Questionnaire development, piloting and validation

BACKGROUND

Behavioural theories are crucial to the development and success of effective hand hygiene interventions. Research demonstrates that hand hygiene behaviours can also be influenced by religious and cultural beliefs. In this paper we detail the processes undertaken to develop a valid and reliable questionnaire to examine healthcare workers' beliefs and behaviours related to the use of alcoholbased hand rub (ABHR), with particular emphasis on associated religious and cultural factors.

METHODS

Using the Theory of Planned Behaviour, an existing questionnaire was modified and pilot-tested on 35 staff in the Quality Department. Cronbach's alpha values and mean inter-item correlations of the scale items were the main outcome measures. A Pearson correlation was conducted to assess for social desirability response bias.

RESULTS

The questionnaire demonstrated high content and face validity and satisfactory internal consistency in most scales, except for the religious beliefs, cultural beliefs and perceived behavioural control scales, where the inter-item correlations were 0.10, 0.13, and 0.14, respectively. There was a significant correlation between scores on the social desirability scale and the attitude scale. Partial correlation should be used to control the effect of social desirability responding when analysing data from the attitudes scale.

CONCLUSIONS

A validation process allowed the introduction and subsequent modification of religious and cultural belief scales to an existing questionnaire examining behavioural and attitudinal influences on hand hygiene using ABHR. Such processes should be considered for questionnaire development and modification when considering religious and cultural factors as drivers of behaviour.

Effectiveness of hand hygiene promotional program based on the WHO multimodal hand hygiene improvement strategy, in terms of compliance and decontamination efficacy in an indian tertiary level neonatal surgical intensive care unit

Background

The WHO Multimodal Hand Hygiene Improvement Strategy (MHHIS) has been proposed to improve the Hand Hygiene (HH) compliance of the WHO recommendations on HH.Therefore, the current study was planned in our neonatal unit with the objective of evaluating the effectiveness of a Hand Hygiene Promotional Program (HHPP) based on the WHO MHHIS, in terms of compliance and decontamination efficacy among the health-care workers (HCWs) in the unit.

Objective

The objective of the study was to evaluate the effectiveness of the WHO MHHIS on HH compliance and decontamination efficacy.

Methods

The HHPP was carried out in our neonatal surgical intensive care unit from July to August 2013. A pre-intervention phase consisted of assessment of ward infrastructure, HH knowledge and perception, determination of HH compliance and collection of hand rinse samples from the HCWs before and after handwashing. Intervention phase consisted of changing traditional to elbow-operated taps, display of posters and reminders, placement of soaps in water draining trays, autoclaved single-use paper towels for hand drying, availability of hand rubs and training sessions for health-care providers. In the post-intervention phase, all the assessments and observations of pre-intervention phase were repeated.

Results

HHPP resulted in a significant increase in overall HH compliance from 26.6% (95% confidence interval [CI] 23.9-29.3) to 65.3% (95% CI 62.4-68.2) (P < 0.001) and reduction in load of microorganisms (P = 0.013). There was a significant improvement in HH knowledge (P < 0.001), and perception surveys revealed high appreciation of each strategy component by the participants.

Conclusion

To the best of our knowledge, this is the first study about the effect of implementation of the WHO MHHIS from an Indian hospital. HHPP was found to be effective in terms of HH compliance and decontamination efficacy. Its implementation is highly recommended to promote HH in a developing country like India.

Why hand hygiene is not sufficient: modeling hygiene competence of clinical staff as a basis for its development and assessment

Adhering to hygiene standards in daily clinical work is an important characteristic of qualitatively high-value medical care. In this regards, hand hygiene is often focused on in the literature. From the viewpoint of medical education research, we argue that this focus is too narrow to explain how staff who are working clinically with patients implement and adhere to standards of hygiene across a wide variety of tasks of their daily clinical routine. We present basic features of a differentiated concept of hygiene competence, which includes specialized knowledge, corresponding inner attitudes, and action routines that are customized to the needs of specific situations. Building on that, we present a current simulation-based course concept aimed at developing hygiene competence in medical education. Furthermore, we describe a test instrument that is designed according to the principle of a situational judgment test and that appears promising for the assessment of hygiene competence. The course and the measurement instrument are discussed in regards to their fit to the competence model and the related perspectives for research and teaching.

On the Role of Habit in Self-Reported and Observed Hand Hygiene Behavior

BACKGROUND

The present contribution tests the main ideas that (a) hand hygiene behavior is associated with habit, and (b) this association is robust when deliberative constructs (i.e. knowledge and intention) are controlled for, indicating an automatic component in hand hygiene behavior.

METHODS

Two correlational studies using different operationalisations of hand hygiene behavior are reported. In Study 1, hand hygiene was assessed in the context of food preparation; data were measured using the Day Reconstruction Method in a sample of the general population. Study 2 considered hand hygiene compliance of healthcare workers applying video observation by body cameras and additionally self-reported behavior. In both studies, habit was assessed using the Self-Report Behavioral Automaticity Index.

RESULTS

Both studies found the expected positive association between habit and hand hygiene (0.271 < r < 0.570). Habit was further analyzed in combination with knowledge and intention (Study 2), and emerged as a significant predictor of observed hand hygiene, while knowledge and intention were marginally significant. No significant interactions were found.

CONCLUSIONS

The present work provides evidence that hand hygiene behavior is reliably related to habit. The findings speak to the notion that addressing the automatic route to hand hygiene behavior when designing interventions can be fruitful.

Adherence to guideline recommendations for asthma care in community pharmacies: actual and needed performance

Pharmaceutical care guidelines aim to provide recommendations for pharmaceutical care, reduce unwanted pharmacy practice variation and ultimately improve the quality of healthcare. This study evaluated community pharmacists’ adherence to recommendations for the provision of care to asthma patients with first dispensing and follow-up refill encounters in The Netherlands. Data were pharmacists’ self-assessment of adherence to guideline recommendations, independent observations of dispensing encounters and a nationwide questionnaire on pharmacists’ views on the desirable (clinical) necessity of applying guideline recommendations to their patient population. The 21 pharmacists who performed self-assessment judged their adherence concerning inhalation instructions as high. The lowest scores were reported for recommendations to collect additional information on the type of lung disease and for asking patients’ expectations, wishes and concerns. Sixty-eight dispensing encounters were observed. In 83% of the 35 first dispensing observations, inhalation instruction was provided. This percentage was lower (62%) at refill dispensings. During all encounters, pharmacy staff seldom explored patients’ perceptions or responded to patients’ expectations, wishes and concerns. One hundred and four pharmacists completed the feasibility questionnaire. Pharmacists judged that all patients should receive inhalation instruction at first dispensing. They regarded it necessary to check on patients’ expectations, wishes and concerns regarding the treatment for only up to 70% of the patients. More efforts on guideline implementation are needed, especially on follow-up dispensings and on gaining relevant information from patients and other healthcare professionals. Pharmacists still have opportunities to grow in applying a patient-tailored approach and exploring patients’ individual needs, rather than providing practical information.

Evaluating the effectiveness of the "Germ-Free Hands" intervention for improving the hand hygiene practices of public health students

PURPOSE

This quasi-experimental study sought to assess the effectiveness of a multidisciplinary intervention called "Germ-Free Hands" to improve the hand hygiene practices of students attending Thailand's Sirindhorn College of Public Health (SCPH).

METHODS

The intervention was developed and implemented at SCPH and incorporated education, training, a workshop, and performance feedback. The intervention targeted behavioral antecedents specified by the Health Belief Model (HBM) and the Theory of Planned Behavior (TPB). Handwashing determinants (knowledge, beliefs, attitudes, subjective norms, perceived behavioral control, and intentions) and hand hygiene behaviors were assessed at baseline, immediately post-intervention, and 3 months post-intervention for the intervention group at (n=60) at the Suphanburi campus of SCPH and a matched control group (n=60) of students at the Ubonratchathani campus. Data analysis included descriptive statistics, independent samples t-tests, two-way measures of analysis of variance, and a generalized estimating equation to compare handwashing practices by self-reports between two groups.

RESULTS

The "Germ-Free Hands" intervention produced significant improvements in the intervention group's handwashing knowledge, behavioral and control beliefs, subjective norm scores, intentions, and behaviors, as compared to the control group. However, the intervention had no significant impact on normative beliefs, attitudes, or perceived behavioral control. Reported improvements also decreased 3 months post-intervention, and the number of bacterial colonies on students' hands increased over the course of the study.

CONCLUSION

This study adds to the evidence that multidisciplinary interventions can be effective at improving handwashing rates. However, education and training must be continuous, rather than delivered as a one-time program, in order to have sustained results. Participants may also require more in-depth instruction in correct handwashing and drying techniques to remove bacteria effectively and prevent recolonization.

Determinants of hand hygiene behaviour based on the Theory of Interpersonal Behaviour

Background:

Many investigations into the determinants of hand hygiene (HH) behaviour have explored only individual predictors or were designed according to arguably overly simplistic models of behaviour. Consequently, important influences on HH behaviour, including habit and emotion, are sometimes neglected. This study is the first to employ the Theory of Interpersonal Behaviour as a comprehensive model for understanding the determinants of HH behaviour.

Method:

A self-report questionnaire was conducted with staff from two large UK veterinary referral practices. Participants ( n = 75) reported their HH behaviour and responded to statements rating the importance of social norms, self-protection, patient protection, time pressures, access to equipment, habit and disgust, to their HH behaviour.

Results:

Regression analysis showed that, overall, determinants explained 46% of variance ( p < .001) in self-reported HH behaviour, with time constraints being the strongest predictor ( β = −.47, p < .001) followed by difficulty finding equipment ( β = −.21, p = .05).

Discussion:

Time constraints may be the most important influence on HH adherence among the determinants investigated. Future researchers should consider employing theoretical models to aid a more comprehensive understanding of the psychology underlying HH adherence and HH interventions.

Unhygienic Practices of Health Professionals in Brazilian Public Hospital Restaurants: An Alert to Promote New Policies and Hygiene Practices in the Hospitals

This study aimed to evaluate health professionals’ unhygienic practices and the stages of behaviour change in Brazilian public hospital restaurants. We evaluated all medium/large-sized public hospital restaurants (HRs) from the Brazilian Federal District (n = 9); a representative sample of 128 users). We evaluated the HRs’ physical structures, their consumers’ socio-demographic characteristics, their unhygienic practices, as well as the stages of behavioural change concerning unhygienic practices. All the HRs presented their menus for self-service distribution, so customers entered in lines to serve themselves. All the HRs had hand-wash sinks for customers; 77.8% offered antiseptic liquid soap; 33.3% offered alcohol gel; and 77.8% offered storage for professional accessories before serving food. Almost half (46.8%) of the customers did not sanitise their hands (with water and antiseptic soap and/or use of alcohol gel) immediately before serving, and 24.2% wore professional uniforms at HRs. Almost half (43.5%) of the customers spoke with each other in line while serving their plates and arranged the food on their plates with the serving utensils from the distribution counter. The declaration of behavioural change was inversely associated with the hygiene practices. Almost half of the individuals did not sanitize their hands; however, 90.4% declared “changed behaviour” when this contaminant practice was presented to them. We verified a high percentage of hygiene practices inconsistent with most of the customers´ answers about their stage of behaviour change. Based on the observations of this study, it is necessary for an awareness program to be developed that is focused on customers of HRs in order to reduce unhygienic practices. Also, it is important to promote new policies for proper hygiene practices in hospital restaurants.