Hand hygiene practices: nursing students' perceptions

Impact of and strategies to address negative role models and adherence of nursing students to standard precautions: An integrative review

BACKGROUND

Negative role models can significantly impact nursing students' adherence to standard infection control precautions (SP) but there has been limited research on impacts and relevant strategies.

PURPOSE

This review examined the impact of negative role models on nursing students' adherence to SP and explored strategies that nursing instructors could use to help students effectively manage the influence of negative role models.

METHODS

An integrative review was conducted, guided by Whittemore and Knafl's methodology (2005). PubMed, CINAHL, and Scopus were searched for articles from 2008-2023. Research studies were critically appraised using appropriate tools.

RESULTS

Fourteen articles met the inclusion criteria and were included in this review. The literature indicates that nursing students frequently encounter negative role models during their clinical placements and that such negative encounters detrimentally impact their adherence to SP. Five strategies to potentially mitigate the impact of negative role models were identified.

CONCLUSION

To address the issue of negative role models, nursing instructors can help students learn specific strategies to manage encounters with negative role models, promote discussion of role modeling with students and clinical staff, and act as role models themselves. Further research is needed to inform specific strategies.

Determinants of hand hygiene compliance among healthcare workers in intensive care units: a qualitative study

BACKGROUND

Practicing hand hygiene is a cost-effective method to decrease the occurrence of Healthcare-Associated Infections (HAIs). However, despite their simplicity, adhering to hand hygiene methods among healthcare workers (HCWs) can be highly challenging. We aim to examine the factors influencing hand hygiene compliance as perceived by HCWs working in the intensive care units (ICUs) at several major hospitals in Riyadh, Saudi Arabia.

METHOD

This qualitative study was conducted by adopting a content analysis to examine the interviews of HCWs who are currently working in the ICUs of various major hospitals located in the capital city of Riyadh, Saudi Arabia.

RESULTS

We interviewed 49 HCWs working in ICUs, with an average age of 38 and 8 years of experience. The HCWs comprised doctors (n = 12), anesthesiologists (n = 6), and nurses (n = 31). There were 34 females and 15 males among the participants. Our analysis revealed several factors that impact hand hygiene compliance, including individual, work/environment, team, task, patient, organizational, and management concerns. Several obstacles and possibilities for enhancement have been identified.

CONCLUSION

The results of this study would enhance our comprehension of hand hygiene practices and serve as a foundation for creating future strategies and assessment methods to enhance compliance with hand hygiene protocols in ICUs.

Exploring determinants of hand hygiene among nursing students: A theory of planned behavior approach

BACKGROUND

This study aims to assess the hand hygiene behavior of nursing students and identify the factors influencing this behavior through the "Scale for Assessment Hand Washing Behavior in the Frame of Theory of Planned Behaviour (SAHBTPB)".

METHODS

This descriptive and cross-sectional study was undertaken at the nursing departments of the university's faculty of health sciences in İzmir, Turkey between 2021 and 2022. A total of 240 nursing students were recruited as participants for this study. Data were collected with the SAHBTPB. The data was analyzed using descriptive statistics, the Chi-square test, and correlation analysis in the SPSS 21.0 program (p < .05).

RESULTS

Participation rate was 74.76%. The mean age of the students was 20.59 ± 1.59 years and 69.9% were woman. The nursing students' total mean score of SAHBTPB was 147.5 ± 14.0 (min = 94; max = 176). There was a positively significant association between the total score and students' gender, graduate level, and hand hygiene education status. There was no significant difference in scale total score mean based on the existence of dermatological problems on the students' hands or their frequency of hand hygiene (p > .05).

CONCLUSION

The mean scores of nursing students on the SAHBTPB were found to be at a good level. The sub-dimension "intention" was identified as an effective factor in predicting the hand hygiene behavior of the students. The findings have the potential to positively impact nursing education by increasing awareness among students and offering valuable insights for nurses and educators.

Healthcare workers' experiences of caring for patients colonized with carbapenemase-producing Enterobacterales (CPE) in an acute hospital setting - a scoping review

Carbapenemase-producing Enterobacterales (CPE) is an increasing public health concern; these bacteria are highly transmissible in hospital environments and the number of patients with these multidrug-resistant bacteria is rising. Healthcare workers caring for patients colonized with CPE offer insight into care delivery and processes in the hospital setting. The aim of this review was to explore healthcare workers' experiences of caring for patients colonized with CPE. A scoping review method was employed and seven electronic databases (CINAHL, Academic Search Complete, Cochrane, Embase, Medline, Web of Science and Scopus) and four grey literature databases (Open Grey, Grey Literature Report, Clinical trials. gov and WHO International Clinical Trials Registry Platform) were searched using specific search terms and inclusion/exclusion criteria. A PRISMA flow diagram was used to illustrate the process of article selection and thematic analysis used to form themes. Three studies met the criteria to be included in this review. Two main themes were identified from analysing the articles: 'Safeguarding' and 'Power of Knowledge'. The desire to protect themselves, their families and patients was evident from the studies. Healthcare workers were aware of the importance on infection prevention and control measures such as hand hygiene, in preventing the transmission of CPE, however barriers to these were identified, such as time constraints. In conclusion, healthcare workers have negative associations when it comes to caring for patients with CPE. Very little research has been conducted in the area and there is an opportunity to further explore the experience of healthcare workers caring for patients with CPE to identify opportunities for improvement and support of staff.

Teaching health care students hand hygiene theory and skills: a systematic review

Hand hygiene is the cornerstone of infection prevention but is poorly undertaken and under-appreciated by medical, nursing, and other health care students. This systematic review aimed to identify and describe strategies used to teach the theory and practice of hand hygiene, determine impact on knowledge and practice, and identify need for future education and research. Ten studies met the criteria for review. Health care students' theoretical knowledge of hand hygiene and their ability to practise are suboptimal and should be improved before they have contact with vulnerable patients. Educational input can increase knowledge and practice but the methodological heterogeneity of the studies and lack of rigour make it impossible to determine which interventions are most likely to be successful. The literature provides little evidence upon which to base educational practice in this area. There is a need for multi-centred longitudinal studies to measure effectiveness of teaching methods over time.

Knowledge, Perception, and Performance of Hand Hygiene and Their Correlation among Nursing Students in Republic of Korea

Recently, various outbreaks of newly emerging or reemerging diseases are expected more frequently and regularly. The importance of hand hygiene (HH) competency of nursing students (NS) is further required as a crucial learning objective of nursing education in universities. Purpose: This study aimed to investigate knowledge, perception, and performance of HH among NS and analyze their correlation. Methods: A cross-sectional questionnaire (modified from a World Health Organization questionnaire) was conducted from 23 November to 22 December 2019; 233 responses were used for the final analysis. Results: The average scores (mean ± standard deviation (range)) for knowledge, perception, and performance of HH were 17.82 ± 2.15 (0–25), 77.24 ± 10.78 (15–96), and 67.42 ± 23.10 (0–100), respectively. No significant variables were discovered to the knowledge of HH. Grade, university-affiliated hospitals, and the most recent healthcare institute of clinical practice nursing course significantly affected perceptions of HH (p < 0.039, p = 044, p < 0.001). Knowledge of HH was positively correlated with performance of HH (p = 0.002). The perception and the performance of HH of NS were positively correlated with HH performance of healthcare workers (HCWs); p < 0.001, p = 0.002. Conclusion: HH education for NS is crucial for improving the performance and the knowledge of HH. Good HH performance of healthcare workers (HCWs) can contribute to increased perception and performance of HH among NS. The cooperation of nursing education in a university and clinical practice with competent HCWs in healthcare institutions may create an effective education program for good HH performance of NS, who will be nurses during unpredictable pandemics.

Hand Hygiene Compliance at Critical Points of Care

BACKGROUND

Most articles on hand hygiene report either overall compliance or compliance with specific hand hygiene moments. These moments vary in the level of risk to patients if healthcare workers (HCWs) are noncompliant. We assessed how task type affected HCWs' hand hygiene compliance.

METHODS

We linked consecutive tasks individual HCWs performed during the Strategies to Reduce Transmission of Antimicrobial Resistant Bacteria in Intensive Care Units (STAR*ICU) study into care sequences and identified task pairs-2 consecutive tasks and the intervening hand hygiene opportunity. We defined tasks as critical and/or contaminating. We determined the odds of critical and contaminating tasks occurring, and the odds of hand hygiene compliance using logistic regression for transition with a random effect adjusting for isolation precautions, glove use, HCW type, and compliance at prior opportunities.

RESULTS

Healthcare workers were less likely to do hand hygiene before critical tasks than before other tasks (adjusted odds ratio [aOR], 0.97 [95% confidence interval {CI}, .95-.98]) and more likely to do hand hygiene after contaminating tasks than after other tasks (aOR, 1.12 [95% CI, 1.10-1.13]). Nurses were more likely to perform both critical and contaminating tasks, but nurses' hand hygiene compliance was better than physicians' (aOR, 0.94 [95% CI, .91-.97]) and other HCWs' compliance (aOR, 0.87 [95% CI, .87-.94]).

CONCLUSIONS

Healthcare workers were more likely to do hand hygiene after contaminating tasks than before critical tasks, suggesting that habits and a feeling of disgust may influence hand hygiene compliance. This information could be incorporated into interventions to improve hand hygiene practices, particularly before critical tasks and after contaminating tasks.

Hand Areas Which Are Commonly Missed during Hand Disinfection by Nursing Students Who Completed a Basic Educational Course in Hand Hygiene

BACKGROUND

Teaching nursing students how to correctly perform hand hygiene procedures may guarantee a reduction in transmitting pathogens through direct contact and, thus, it may lead to a decrease in the number of hospital infections. The aim of the study, which was conducted in low fidelity simulation conditions, was to assess the performance and the efficiency of a hand-rubbing disinfection technique among nursing students on the last day of their course.

MATERIALS AND METHODS

The study was conducted in a group of 190 nursing students studying at the Jagiellonian University and it focused on the performed hand-rubbing disinfection procedure. The accuracy of the task performance was assessed by measuring the percentage of the amount of Fluo-Rub (B. Braun) fluorescent alcohol-based gel remaining on students' hands after disinfection. The gel was rubbed into particular hand parts including four surfaces (left palm, right palm, left back and right back) divided into thirteen areas (I-XIII) and each surface was examined separately. The results were then dichotomized based on the cut-off point of 10% and two categories: "clean" and "dirty" were established. Additionally, the range of negligence in the disinfection procedure was assessed by counting the total number of the areas classified as "dirty". The comparison of continuous and categorical variables was conducted by means of Friedman's and Cochrane's tests, respectively.

RESULTS

It was found out that the palm surfaces that were commonly missed during hand disinfection included the whole thumb (I and VI), the fingertip of the little finger (V) and the midpalm (XIII), whereas in the case of back surfaces (on both right and left hand) the most commonly missed areas were the fingertips and the whole thumb I-VI. Only 30 students (13%) had all 52 areas of both hands completely clean, whereas more than one third-66 students (33%)-failed to disinfect properly more than 10 areas out of all assessed ones on the surfaces of both hands.

CONCLUSIONS

In the examined group of nursing students, a significant lack of compliance with hand disinfection procedures was observed and it was related mainly to thumbs and back parts of both hands. Therefore, it is essential to conduct systematic training sessions and assessment of hand hygiene procedures for nursing students at the end of every educational stage as it can lead to their developing these skills properly.

Perceptions of Nigerian healthcare workers towards hand hygiene: a qualitative study

Introduction

hand hygiene (HH) is an effective measure to reduce healthcare-associated infections and the growing burden of antimicrobial resistance. There is a need to understand the perceptions of healthcare workers towards its practice and the use of alcohol-based hand rubs (ABHR) to make recommendations to promote HH. Our study aimed to explore the perceptions of Nigerian healthcare workers towards HH and the use and availability of ABHR to suggest potential interventions to improve its practice as qualitative evidence in this field is limited in Nigeria.

Methods

a qualitative study design was utilized to understand the perceptions of healthcare workers towards HH and the use of ABHR at Adeoyo Maternity Hospital, Ibadan, Nigeria. Purposive sampling was used to recruit nineteen healthcare workers who were interviewed. Thematic content analysis was used to analyze the data generated.

Results

five themes emerged including discrepancies in what constitutes HH practice as participants, motivation for HH practice, a good knowledge of timing as regards practice, barriers to good practice and evidence of poor practice.

Conclusion

while many healthcare workers know about HH and self-reported compliance towards it seems to be high, knowledge gaps, lack of resources, absence of regulations and poor working conditions were impediments to the successful implementation of HH practices. We recommend that hospitals institute well-articulated HH regulations, continuous education and training of healthcare workers. Hospitals should also ensure adequate provision of resources for hand hygiene and institute a continuous monitoring and feedback program to evaluate compliance with regulations.

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.

Nurses' Attitudes and Perceptions towards Hand Hygiene in Mental Health and Medical Inpatient Settings: Comparative, Cross-Sectional Study

Poor hand hygiene is a major contributor to hospital acquired infection. In this study, a comparison of the related attitudes of psychiatric and non-psychiatric nurses was made using a cross-sectional survey design. N = 79 nurses who work in psychiatric or non-psychiatric hospital wards completed questionnaires regarding intended compliance with hand-washing protocols and potential cognitive predictors of compliance. Perceived ease of compliance and behavioural norms, and working in a non-psychiatric ward, predicted superlative intended compliance. Working in psychiatry did not in itself predict outgroup membership suggesting that psychiatric ward-related factors, rather than psychiatric nurse-related factors are most relevant in determining between-group differences. Consideration of factors unique to psychiatry wards during service design could improve compliance.

Factors influencing hand hygiene practice of nursing students: A descriptive, mixed-methods study

Developing nursing students' knowledge and practice of infection prevention and control (IPC) is fundamental to safe healthcare. A two-phase descriptive, mixed-method study conducted within a Bachelor of Nursing program at an Australian university aimed to explore: (i) theoretical knowledge of IPC, highlighting hand hygiene, of nursing students and; (ii) nursing students' and clinical facilitators' perceptions of factors influencing these practices during clinical placement. Phase One utilised an anonymous validated questionnaire assessing students' knowledge; identifying variables influencing students' IPC practices, subjected to descriptive and inferential analysis. Phase Two were semi-structured interviews exploring clinical facilitators' experiences/perceptions of students during clinical placement, analysed thematically. Students' demonstrated satisfactory knowledge of IPC in their second and third year, but clinical facilitators perceived that. students lacked awareness of the importance of these practices. Five themes arose from the interviews: (i) understanding workplace culture; (ii) students' modelling local behaviour; (iii) enhancing and consolidating knowledge for practice; (iv) adjusting to practice reality and; (v) accessing additional hand hygiene resources. Factors specific to workplace setting and culture were perceived to influence nursing students' socialisation. Future practice/education strategies could address these factors by ensuring students receive adequate supervision during clinical placement, and having strong advocates/role models present in the workplace.

Physiotherapy students as a partner for the prevention of healthcare associated infections

Background: Hand hygiene compliances of healthcare students have been examined extensively. However, there has been no study in this area for the students of the department of physiotherapy and rehabilitation. The aim was to evaluate hand hygiene compliance of the department of physiotherapy and rehabilitation students after a briefing on hand hygiene. Methods: Before the summer practice, the students were briefed on hand hygiene. Then their hand hygiene compliance were assessed. Their sociodemographic characteristics, clinical summer practice data, and hand hygiene compliance based on the recommendations commented in the Centers for Disease Control and Prevention Guideline for Hand Hygiene in Health Care Settings were assessed with a questionnaire prepared by the researchers. Results: Of 53 students, 52 met inclusion criteria. The average correct answer rate was 82.69%. Students had inadequacies in selecting suitable hand hygiene techniques and in complying with hand hygiene indications in some situations related to their profession. Moreover, the students suggested that there was a great need for education (n = 24; 39.34%) and improvements in physical conditions (n = 21; 34.43%). Conclusions: As a conclusion, department of physiotherapy and rehabilitation students were aware of the importance of hand hygiene in terms of prevention of healthcare-associated infections. However, for department of physiotherapy and rehabilitation students, educational programs about hand hygiene is needed in order to gain optimal competence and to be able to protect and improve health care workers and patients safety.

Moving beyond hand hygiene monitoring as a marker of infection prevention performance: Development of a tailored infection control continuous quality improvement tool

BACKGROUND

Infection control practice compliance is commonly monitored by measuring hand hygiene compliance. The limitations of this approach were recognized in 1 acute health care organization that led to the development of an Infection Control Continuous Quality Improvement tool.

METHODS

The Pronovost cycle, Barriers and Mitigation tool, and Hexagon framework were used to review the existing monitoring system and develop a quality improvement data collection tool that considered the context of care delivery.

RESULTS

Barriers and opportunities for improvement including ambiguity, consistency and feasibility of expectations, the environment, knowledge, and education were combined in a monitoring tool that was piloted and modified in response to feedback. Local adaptations enabled staff to prioritize and monitor issues important in their own workplace. The tool replaced the previous system and was positively evaluated by auditors. Challenges included ensuring staff had time to train in use of the tool, time to collect the audit, and the reporting of low scores that conflicted with a target-based performance system.

CONCLUSIONS

Hand hygiene compliance monitoring alone misses other important aspects of infection control compliance. A continuous quality improvement tool was developed reflecting specific organizational needs that could be transferred or adapted to other organizations.

Inclusion of Real-Time Hand Hygiene Observation and Feedback in a Multimodal Hand Hygiene Improvement Strategy in Low-Resource Settings

Importance

Hand hygiene adherence monitoring and feedback can reduce health care-acquired infections in hospitals. Few low-cost hand hygiene adherence monitoring tools exist in low-resource settings.

Objective

To pilot an open-source application for mobile devices and an interactive analytical dashboard for the collection and visualization of health care workers' hand hygiene adherence data.

Design, Setting, and Participants

This prospective multicenter quality improvement study evaluated preintervention and postintervention adherence with the 5 Moments for Hand Hygiene, as suggested by the World Health Organization, among health care workers from April 23 to May 25, 2018. A novel data collection form, the Hand Hygiene Observation Tool, was developed in open-source software and used to measure adherence with hand hygiene guidelines among health care workers in the inpatient therapeutic feeding center and pediatric ward of Anka General Hospital, Anka, Nigeria, and the postoperative ward of Noma Children's Hospital, Sokoto, Nigeria. Qualitative data were analyzed throughout data collection and used for immediate feedback to staff. A more formal analysis of the data was conducted during October 2018.

Exposures

Multimodal hand hygiene improvement strategy with increased availability and accessibility of alcohol-based hand sanitizer, staff training and education, and evaluation and feedback in near real-time.

Main Outcomes and Measures

Hand hygiene adherence before and after the intervention in 3 hospital wards, stratified by health care worker role, ward, and moment of hand hygiene.

Results

A total of 686 preintervention adherence observations and 673 postintervention adherence observations were conducted. After the intervention, overall hand hygiene adherence increased from 32.4% to 57.4%. Adherence increased in both wards in Anka General Hospital (inpatient therapeutic feeding center, 24.3% [54 of 222 moments] to 63.7% [163 of 256 moments]; P < .001; pediatric ward, 50.9% [132 of 259 moments] to 68.8% [135 of 196 moments]; P < .001). Adherence among nurses in Anka General Hospital also increased in both wards (inpatient therapeutic feeding center, 17.7% [28 of 158 moments] to 71.2% [79 of 111 moments]; P < .001; pediatric ward, 45.9% [68 of 148 moments] to 68.4% [78 of 114 moments]; P < .001). In Noma Children's Hospital, the overall adherence increased from 17.6% (36 of 205 moments) to 39.8% (88 of 221 moments) (P < .001). Adherence among nurses in Noma Children's Hospital increased from 11.5% (14 of 122 moments) to 61.4% (78 of 126 moments) (P < .001). Adherence among Noma Children's Hospital physicians decreased from 34.2% (13 of 38 moments) to 8.6% (7 of 81 moments). Lowest overall adherence after the intervention occurred before patient contact (53.1% [85 of 160 moments]), before aseptic procedure (58.3% [21 of 36 moments]), and after touching a patient's surroundings (47.1% [124 of 263 moments]).

Conclusions and Relevance

This study suggests that tools for the collection and rapid visualization of hand hygiene adherence data are feasible in low-resource settings. The novel tool used in this study may contribute to comprehensive infection prevention and control strategies and strengthening of hand hygiene behavior among all health care workers in health care facilities in humanitarian and low-resource settings.

Barriers to hand hygiene practices among health care workers in sub-Saharan African countries: A narrative review

BACKGROUND

Hand hygiene (HH) is the primary measure in the prevention of health care-associated infections; however, from published studies, compliance of health care workers (HCWs) to HH guidelines is low. There is currently no review on HH compliance rates in developing countries, specifically sub-Saharan Africa (SSA), or the barriers to compliance. We therefore, through a narrative review, sought to identify the compliance with and the barriers to HH in SSA.

METHODS

From 3 databases, we performed a search of peer-reviewed studies from SSA, conducted among HCWs, published in the English language between 2005 and 2017. Only studies that reported HH compliance and/or barriers were included.

RESULTS

A total of 278 articles were identified, and the final sample of 27 articles was analyzed in full length. Overall, the HH compliance rate was estimated to be 21.1%, and doctors had better compliance irrespective of the type of patient contact. The main barriers identified were heavy workload, infrastructural deficit (eg, lack of water, soap, hand sanitizers, and blocked/leaking sinks), and poorly positioned facilities.

CONCLUSIONS

HH compliance is poor among SSA HCWs. There is a need for more reports of HH compliance in SSA, and emphasis needs to be placed on surgical wards in which surgical site infections-the most common form of health care-associated infections in SSA-are most likely to occur. Barriers identified in this review are consistent with the findings of studies conducted elsewhere; however, it appears that heavy workload, infrastructural deficit, and poorly positioned facilities are more likely in developing countries.

Hand hygiene expectations in radiography: A critical evaluation of the opportunities for and barriers to compliance

Introduction:

Good hand hygiene practices reduce the risk of transmission of infection in healthcare. In common with other areas of healthcare, infection control knowledge and practice in radiography has potential for improvement. Regular hand hygiene compliance (HHC) monitoring indicated poor compliance in radiology which did not accurately reflect practice in one organisation. Using a quality improvement cycle, the process and context of work undertaken in radiology were examined in order to improve the validity and utility of HHC monitoring data collection process in the department.

Methods:

Following examination of the evidence base and with agreement from the radiology team, the chest X-ray process was observed and actions notated. This was then scored using the organisation and the World Health Organization five moments of hand hygiene tool. An alternative risk-based scoring system was developed.

Results:

The HHC score of 22% was obtained using standard measurements. Achievement of 100% compliance would require the radiographer to clean their hands nine times for each X-ray. The sequence of taking a chest X-ray was examined and two points in the process were identified as key points at which hand cleaning should take place to reduce the risk of transmission of infection.

Conclusions:

Cleaning hands frequently to achieve compliance expectations in this short low-risk process is neither feasible nor beneficial. A pragmatic risk-based approach to hand hygiene expectations in predictable procedures such as taking a chest X-ray reduces ambiguity and potentially increases compliance.

Increasing nursing students' knowledge of evidence-based hand-hygiene: A quasi-experimental study

Aim of study was to evaluate the effects of a multi-component intervention on nursing students' knowledge of evidence-based hand-hygiene. A quasi-experimental design was used. Nursing students (N = 146) from two universities of applied sciences (experimental group n = 107, control group n = 39) completed an instrument based on international clinical guidelines related to hand hygiene that consisted of 17 Likert-scale items. Data were collected at three time points (baseline, after university-based training and after clinical training) between autumn 2014 and spring 2016. Group differences were examined using chi-squared or Fisher Exact tests, the Mann-Whitney and U test. Within-group differences were assessed with the McNemar test for paired nominal data. At the first and second time points the experimental group had better hand hygiene knowledge than the controls. There were no group differences in responses to items concerning the appropriate length of hand disinfection. The experimental group showed improvements in the practice of washing hands with soap and water, but not in the other statements concerning hand disinfection. Theoretical recap and training at school seemed to influence students' hand hygiene knowledge, but reinforcement during clinical training may be required to ensure that learning practical evidence-based skills, such as hand-hygiene, may be established.

How to make hand hygiene interventions more attractive to nurses: A discrete choice experiment

Background

Better understanding of the characteristics of interventions which are attractive to nurses is required in order to implement effective hand hygiene interventions.

Methods

The intervention characteristics were derived from diffusion of innovation theory (DIT): relative advantage, compatibility, simplicity, trialability, and observability. To identify nurses’ preferences for the five characteristics, a discrete choice experiment (DCE) was conducted. Participants were nurses working at Taiwanese tertiary care hospitals selected through stratified sampling. In addition, the hand hygiene moment (before or after patient contact) was taken into consideration in the DCE to investigate whether nurses’ preferences for the intervention characteristics were the same at different hand hygiene moments.

Results

This survey was conducted between 1 October and 31 December 2014. Among 200 nurses from three Taiwanese tertiary care hospitals, significant preferences for the five intervention characteristics were observed. That is, when an intervention makes the hand hygiene activity more convenient (p<0.001), when nurses participate in the design of the intervention (p<0.001), when an intervention is explained well to nurses before implementing it (p<0.001), when the evidence of hand hygiene is provided at a trial stage to show its effectiveness (p<0.001), and when nurses’ hand hygiene performance is observable to their peers (p<0.001), nurses are more willing to wash their hands with high compliance. In addition, nurses preferred for providing evidence at a trial stage most, and well explanation about the intervention to increase simplicity was least. The rankings of the preference for the five intervention characteristics were the same at different hand hygiene moments (p = 0.453)

Conclusions

The findings suggest policy directions for decision makers aiming to improve overall hand hygiene compliance in healthcare facilities.

Factors influencing nursing students' intention to comply with infection control practices

The purpose of this study was to examine how nursing students' intention to comply with infection control practices (ICPs) is affected by their awareness of ICPs and by their observations of staff nurses' noncompliance with ICPs. The subjects were 350 nursing students from 8 universities in Korea. Hierarchical multiple linear regression analysis was used to determine the predictive factors of compliance intention with ICPs. We found that nursing students' awareness of ICPs was the most significant influencing factor affecting their compliance with ICPs. Students' observation of staff nurses' noncompliance with ICPs was the second most significant influencing factor.

Shortening the Application Time of Alcohol-Based Hand Rubs to 15 Seconds May Improve the Frequency of Hand Antisepsis Actions in a Neonatal Intensive Care Unit

BACKGROUND For alcohol-based hand rubs, the currently recommended application time of 30 seconds is longer than the actual time spent in clinical practice. We investigated whether a shorter application time of 15 seconds is microbiologically safe in neonatal intensive care and may positively influence compliance with the frequency of hand antisepsis actions. METHODS We conducted in vitro experiments to determine the antimicrobial efficacy of hand rubs within 15 seconds, followed by clinical observations to assess the effect of a shortened hand antisepsis procedure under clinical conditions in a neonatal intensive care unit (NICU). An independent observer monitored the frequency of hand antisepsis actions during shifts. RESULTS All tested hand rubs fulfilled the requirement of equal or even significantly higher efficacy within 15 seconds when compared to a reference alcohol propan-2-ol 60% (v/v) within 30 seconds. Microbiologically, reducing the application time to 15 seconds had a similar effect when compared to 30-second hand rubbing, but it resulted in significantly increased frequency of hand antisepsis actions (7.9±4.3 per hour vs 5.8±2.9 per hour; P=.05). CONCLUSION Time pressure and workload are recognized barriers to compliance. Therefore, reducing the recommended time for hand antisepsis actions, using tested and well-evaluated hand rub formulations, may improve hand hygiene compliance in clinical practice. Infect Control Hosp Epidemiol 2017;38:1430-1434.

A systematic review on hand hygiene knowledge and compliance in student nurses

BACKGROUND

Hand hygiene competence is one of the critical outcomes in nursing education. Ensuring nursing students recognize the what, when and how of hand hygiene is critical in the light of the increasing rates of healthcare-associated infections.

AIM

To systematically appraise and synthesize articles on hand hygiene knowledge and compliance among nursing students.

METHODS

This is a systematic review of scientific articles published from 2006 to 2016. The primary databases used were as follows: PubMed, Embase, Cumulative Index to Nursing & Allied Health Literature, Proquest and PsychINFO. Key search terms utilized were as follows: 'handwashing', 'hand hygiene', 'compliance', 'knowledge', 'practice' and 'nursing students'.

FINDINGS

Nineteen studies met the review criteria. The findings revealed a low-to-moderate knowledge of and compliance with hand hygiene among nursing students. In addition, there were significantly higher rates of hand hygiene compliance in nursing students when compared to medical students. Relatively few studies attempted to identify predictors of hand hygiene knowledge and compliance.

CONCLUSION

This review demonstrated suboptimal knowledge and compliance to hand hygiene among student nurses. In addition, this review also highlighted the paucity of studies that examined individual and organizational factors, which influence nursing students hand hygiene knowledge and compliance.

IMPLICATIONS FOR NURSING AND POLICY

The findings of this review emphasized the role of nurse educators in enhancing hand hygiene competence in nursing students. Implementation of empirically tested strategies such as utilizing multidimensional interventions, scenario-based hand hygiene simulation activities and hand hygiene education programmes that would enhance nursing students' hand hygiene knowledge and compliance is an asset. Hospital and nursing administrators should ensure continuous support and monitoring to guarantee that hand hygiene programmes are institutionalized in every healthcare setting by every healthcare worker.

Views on Exercise

INTRODUCTION

There is a large prevalence of asthma, particularly among Hispanic children. Although physical activity is a good way to manage asthma, more Hispanic children with asthma lack activity than their healthy classmates. Given this, the purpose of this study was to explore the development of exercise perceptions in Hispanic children with asthma and to further develop an existing explanatory theory.

METHOD

Grounded theory was the approach for the study. Grounded theory illuminated components of exercise perceptions from participants. Participants included Hispanic children with asthma, their families, and professionals who work with Hispanic children with asthma ( n = 29).

RESULTS

Findings from this study supported the previously identified grounded theory called The Process of Creating Perceptions of Exercise. In addition, two new concepts ( cultural and peer influences) were identified that further explain the category of exercise influences.

CONCLUSION

The revised theory can be used to assist in developing nursing interventions aimed at increasing exercise participation among Hispanic children with asthma.

Hand hygiene among healthcare workers: A qualitative meta summary using the GRADE-CERQual process

BACKGROUND

Hand hygiene is considered an effective and potentially modifiable infection control behaviour among healthcare workers (HCW). Several meta-studies have been published that compare quantitatively expressed findings, but limited efforts have been made to synthesise qualitative research.

OBJECTIVES

This paper provides the first report of integrated findings from qualitative research reports on hand hygiene compliance among HCW worldwide that employs the GRADE-CERQual process of quality assessment.

METHODS

We conducted database searches and identified 36 reports in which authors conducted qualitative or mixed methods research on hand hygiene compliance among HCW. We used Dedoose analysis software to facilitate extraction of relevant excerpts. We applied the GRADE-CERQual process to describe relative confidence as high, moderate or low for nine aggregate findings.

FINDINGS

Highest confidence findings included that HCW believe they have access to adequate training, and that management and resource support are sometimes lacking. Individual, subjective criteria also influence hand hygiene.

DISCUSSION

These results suggest the need for further investigation into healthcare cultures that are perceived as supportive for infection control. Surveillance processes have potential, especially if information is perceived by HCW as timely and relevant.

A Systematic Review on the Effectiveness of Interventions to Improve Hand Hygiene Compliance of Nurses in the Hospital Setting

PURPOSE

The purpose of the present systematic review is to identify the interventions that improve hand hygiene compliance (HHC) specifically among nurses.

METHODS

A systematic review was performed guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses to evaluate the short and long-term effects of interventions to promote hand hygiene practices among nurses in the hospital setting. A search of the Cumulative Index to Nursing and Allied Health Literature, Medline Global Health, and Embase was conducted in addition to studies identified by the most recent systematic review. Six studies met inclusion criteria: three randomized controlled trials (RCTs), one controlled before and after studies (CBAs), and two interrupted times series (ITS).

FINDINGS

One RCT reported effectiveness and 6-month sustainability of the effect related to multimodal-directed and multimodal with team leadership-directed strategies. The other two RCTs found positive effect of education and feedback on compliance; however, compliance rates declined after 1 month. Education was also found to improve HHC up to 3 months postintervention. An electronic reminder and feedback system evaluated by an ITS improved HHC and detected variation in HHC through the day.

CONCLUSIONS

This review showed that single and combined interventions do improve hand hygiene practices among nurses; however, there is a need for more methodologically robust studies to define the most effective and sustainable interventions.

CLINICAL RELEVANCE

Although hand hygiene is the most effective measure to prevent healthcare-associated infections, compliance with hand hygiene remains low. Nurses are among the healthcare providers who spend the most time in direct patient contact. Therefore, there is a need for research to identify the interventions that improve HHC in this group.

Public perceptions of the use of gloves by healthcare workers and comparison with perceptions of student nurses

INTRODUCTION

There is evidence that non-sterile clinical gloves (NSCG) are over-used by healthcare workers (HCWs) and are associated with cross-contamination. This study aimed to determine attitudes of student nurses and members of the public to the use of NSCG.

METHODS

Third-year student nurses completed a questionnaire indicating tasks for which they would wear NSCG and influences on their decision. Correlations between tasks were identified using exploratory factor analysis. An online survey of the public was conducted using snowball sampling method.

RESULTS

Sixty-seven students completed the questionnaire; they indicated use of NSCG for low-risk tasks and reported their own judgement as the main influence on their decision to wear them. Correlated tasks included 'perceived to be risky' or 'definitive indication for gloves/no gloves' and 'related to personal hygiene'. A total of 142 respondents completed the public survey. They reported being uncomfortable with HCW wearing gloves for some personal tasks, e.g. assisting to toilet and dressing, but 94% preferred their use for washing 'private parts'; 29% had observed inappropriate glove use by HCWs during recent contact with healthcare.

CONCLUSION

Student nurses reported using NSCG routinely for tasks for which they are neither required nor recommended. The public observe inappropriate glove use and are uncomfortable with their use for some personal tasks.

Experiences of hand hygiene among acute care nurses: An interpretative phenomenological analysis

Objective:

Occurrences of healthcare-associated infections are associated with substantial direct and indirect costs. Improvement in hand hygiene among acute care nurses has potential to reduce incidence of healthcare-associated infections. Findings from reviews of intervention research have not conclusively identified components that are more or less efficient or effective. Much prior qualitative research has focused on descriptive analysis of policies and practices rather than providing interpretive explorations of how individuals’ perceptions of hygiene might drive practices.

Methods:

We conducted qualitative interview research with eight nurses in the United States who were employed in various patient-care roles. We analyzed the data using an interpretative phenomenological analysis methodology to explore how nurses described their perceptions of, and experiences with, hygiene. We developed themes that explored individual, workplace, and management influences on perception of hygiene.

Results:

Developed themes include practical hygiene, risky business, and hygiene on trial; the latter theme described the conflict between how nurses perceived their own hygiene practices and how they felt hospital management perceived these practices. Other findings included that participants distinguished between policy-mandated use of sanitizer and a personal sense of cleanliness; the latter was more likely to be associated with scrubbing or removal of contaminants than with use of protectants.

Conclusion:

While participants asserted support for facility hand hygiene policies, their behavior in certain instances might be mediated by broadly defined emergent situations and a belief that it is not currently possible to establish a causal link between an healthcare-associated infections and a specific individual or occurrence. Researchers and infection prevention practitioners might consider soliciting greater input from nurses in planning hand hygiene improvement interventions, to encourage ownership, and emphasizing detailed cases as training content to take advantage of individuals’ sensory responses to hygiene.

'Sometimes your safety goes a bit by the wayside' … exploring occupational health and safety (OHS) with student nurses

Because nursing is a high risk profession in terms of occupational health and safety (OHS), the topic of OHS is an important component of student nurse education and practice. Seeking ways to enhance curricular content and foster student health, safety and wellbeing is an ongoing pursuit. This pilot study explored nursing student perspectives about OHS in the clinical setting to develop an understanding of student views that could enlighten teaching about this topic within the undergraduate nursing course. Focus groups were held with pre-registration student nurses in two discrete cohort levels (first and third year). Themes were identified from the focus group discussion about trust, knowledge and responsibility. The students demonstrated a sound grasp of clinical hazards and associated administrative controls. Strengthening student awareness of higher order controls and their evaluation would augment their knowledge of legislative requirements. Students may benefit from learning about a risk management approach to OHS which would provide them with a structured basis for problem solving. This may assist them with clinical reasoning about health and safety issues and empower them in aspects of self-care.

Knowledge, Attitude, and Performance of Nurses toward Hand Hygiene in Hospitals

INTRODUCTION

The proper hand hygiene is one of the foremost techniques to reduce Nosocomial infections. The hand hygiene is deemed as the simplest method for control of Nosocomial infections if it is done properly it may prevent from a lot of costs and fatalities. Due to constant relationship with patients, nurses play paramount role in proper execution of hand hygiene among clinical personnel. The current study was carried out in order to analyze knowledge, attitude, and performance of nurses regarding hand hygiene.

MATERIALS & METHODOLOGY

A cross-sectional study was conducted on 200 (of 240) nurses from three hospitals in Kerman city at east of Iran in 2015. The standardized questionnaire was the tool for data collection. These data entered in SPSS (V.22). The frequency and percentage of frequency in descriptive statistics was employed for data analysis. The confidence interval was considered as 95%.

RESULTS

The results showed that the majority of participants were male173 (86.5%), had BA degree 161 (80.5%) and were married 155 (70.5%). Most of nurses 77 (38.5%) had working experience (5-10years). The majority of nurses had good knowledge 149 (74.5%), positive attitude 141 (70.5%) and good performance 175 (87.5%).

DISCUSSION & CONCLUSION

The nurses are good level in terms of knowledge, attitude, and performance but improvement of their knowledge and knowledge seems to be more necessary by holding educational classes and courses in cases where they have less knowledge.

Influencing factors on hand hygiene behavior of nursing students based on theory of planned behavior: A descriptive survey study

BACKGROUND

Hand hygiene is the single most important measure to prevent transmission of infection, but the compliance rate of healthcare workers is relatively low.

OBJECTIVES

This study was conducted to identify the knowledge, beliefs, behavior, and affecting factors about hand hygiene among nursing students.

DESIGN

A descriptive survey study.

SETTINGS

The study was carried out in two South Korean nursing schools.

PARTICIPANTS

A total 208 nursing students participated in this study.

METHODS

Questionnaires were used to collect data.

RESULTS

The percentage of correct answers in the survey section concerning hand hygiene knowledge was 68.1%. No significant difference in the knowledge, behavioral beliefs, normative beliefs, or control beliefs data was found related to general characteristics. Behavioral beliefs correlated with normative beliefs (r=.25, p<.001) and hand hygiene behavior (r=.17, p=.017), and control beliefs correlated with hand hygiene behavior (r=.18, p=.010).

CONCLUSION

The results suggest that knowledge is not enough to change the beliefs related to hand hygiene; positive behavioral beliefs and strong control beliefs are also needed to increase hand hygiene compliance.

Self-perceived hand hygiene practices among undergraduate nursing students

Abstract Limited research has investigated the hand hygiene practices of undergraduate nursing students. A descriptive self-report survey explored the predictors of self-perceived hand hygiene compliance using a convenience sample of 306 undergraduate nursing students enrolled at a southwestern Ontario university. Compliance was defined as the performance of hand hygiene at least 90% of the time in the moments both before and after direct patient contact. The self-reported compliance rate among study participants was 74.8%. Logistic regression analysis revealed that the independent predictors of hand hygiene compliance included concern about reprimand or discipline (odds ratio (OR) 4.324; 95% confidence interval (CI) 1.465–12.758); motivation to protect patients from infection (OR 2.418; 95% CI 1.001–5.838); number of clinical placements (OR 0.815; 95% CI 0.702–0.947) and role modelling by the clinical instructor (OR 2.227; 95% CI 1.009–4.915). Other independent predictors were the perceived barriers of busyness (OR 0.231; 95% CI 0.126–0.423), forgetfulness (OR 0.356; 95% CI 0.186–0.678) and perceptions of alcohol rub-related skin damage (OR 0.163; 95% CI 0.070–0.380). The findings of this study provide research-based evidence that could be used by educators to understand better hand hygiene practices among undergraduate nursing students.

Predictors for compliance of standard precautions among nursing students

BACKGROUND

We aimed to investigate the frequency of standard precautions (SPs) compliance and the factors affecting the compliance among nursing students (NSs).

METHODS

A cross-sectional survey study guided by the health belief model was conducted in 2009. The study questionnaire is valid (content validity index, 0.81) and reliable (Cronbach α range, 0.65-0.94).

RESULTS

There were 678 questionnaires analyzed, with a response rate of 68.9%. The mean frequency score of SPs compliance was 4.38 ± 0.40 out of 5. Tukey honest significant difference post hoc test indicated that year 2 and year 4 students had better SPs compliance than year 3 students. Further analysis using a univariate general linear model identified an interaction effect of perceived influence of nursing staff and year of study (F1,593 = 3.72; P < .05). The 5 following predictors for SPs compliance were identified: knowledge of SPs, perceived barriers, adequacy of training, management support, and influence of nursing staff.

CONCLUSION

Although the SPs compliance among NSs was high, the compliance varied by year of study and was affected by the nursing staff. Furthermore, SPs compliance among NSs can be enhanced by increasing SPs knowledge, providing more SPs training, promoting management support, reducing identified SPs barriers, and improving nursing staff compliance to SPs.

Systematic qualitative literature review of health care workers' compliance with hand hygiene guidelines

BACKGROUND

Acquisition of a health care-associated infection is a substantial risk to patient safety. When health care workers comply with hand hygiene guidelines, it reduces this risk. Despite a growing body of qualitative research in this area, a review of the qualitative literature has not been published.

METHODS

A systematic review of the qualitative literature.

RESULTS

The results were themed by the factors that health care workers identified as contributing to their compliance with hand hygiene guidelines. Contributing factors were conceptualized using a theoretical background. This review of the qualitative literature enabled the researchers to take an inductive approach allowing for all factors affecting the phenomenon of interest to be explored. Two core concepts seem to influence health care workers' compliance with hand hygiene guidelines. These are motivational factors and perceptions of the work environment. Motivational factors are grounded in behaviorism, and the way in which employees perceive their work environment relates to structural empowerment.

CONCLUSION

Noncompliance with hand hygiene guidelines remains a collective challenge that requires researchers to adopt a consistent and standardized approach. Theoretical models should be used intentionally to better explain the complexities of hand hygiene.

Systematic Review of Studies on Compliance with Hand Hygiene Guidelines in Hospital Care

Objectives.

To assess the prevalence and correlates of compliance and noncompliance with hand hygiene guidelines in hospital care.

Design.

A systematic review of studies published before January 1, 2009, on observed or self-reported compliance rates.

Methods.

Articles on empirical studies written in English and conducted on general patient populations in industrialized countries were included. The results were grouped by type of healthcare worker before and after patient contact. Correlates contributing to compliance were grouped and listed.

Results.

We included 96 empirical studies, the majority (n= 65) in intensive care units. In general, the study methods were not very robust and often ill reported. We found an overall median compliance rate of 40%. Unadjusted compliance rates were lower in intensive care units (30%–40%) than in other settings (50%–60%), lower among physicians (32%) than among nurses (48%), and before (21%) rather than after (47%) patient contact. The majority of the time, the situations that were associated with a lower compliance rate were those with a high activity level and/or those in which a physician was involved. The majority of the time, the situations that were associated with a higher compliance rate were those having to do with dirty tasks, the introduction of alcohol-based hand rub or gel, performance feedback, and accessibility of materials. A minority of studies (n= 12) have investigated the behavioral determinants of hand hygiene, of which only 7 report the use of a theoretical framework with inconclusive results.

Conclusions.

Noncompliance with hand hygiene guidelines is a universal problem, which calls for standardized measures for research and monitoring. Theoretical models from the behavioral sciences should be used internationally and should be adapted to better explain the complexities of hand hygiene.

Iranian healthcare workers' perspective on hand hygiene: a qualitative study

BACKGROUND

Hand hygiene (HH) has been identified as one of the simplest, but most important, methods to prevent cross-infection in healthcare facilities. In spite of this fact, the HH compliance rate remains low among healthcare workers (HCWs). Several factors may affect HH behavior. In this study, we aimed to assess various aspects of HH from the perspective of HCWs.

METHOD

This qualitative study was conducted in two hospital settings in Shiraz, Iran. Eight focus group discussions (FGDs) and six in-depth interview sessions were held with ICU and surgical ward nurses, attending physicians, medical and nursing students and supporting staff. Each FGD and interview was transcribed verbatim, open codes were extracted, and thematic analysis was conducted.

RESULTS

Three themes emerged from the thematic analysis including: "the relationship between personal factors and HH compliance," "the relationship between environmental factors and HH compliance" and "the impact of the health system on HH adherence, including the role of adequate health systems, administrative obligations and the effect of surveillance systems."

CONCLUSION

Several factors played a significant role in improving HCWs HH compliance, such as the regular adherence to health system tenets. HH compliance may be improved through application of realistic policies and better supervision. In addition, appropriate education may positively affect HH behavior and attitudes.

How do university education and clinical experience influence pre-registration nursing students' infection control practice? A descriptive, cross sectional survey

AIMS

This study aims to explore nursing students' knowledge of infection control and investigate how university education and clinical experience influence their infection control practice.

BACKGROUND

In order to prevent and control healthcare associated infections all healthcare staff must be knowledgeable about infection control. However, knowledge and practice of infection control are often sub-optimal. Education has had variable results in improving the infection control knowledge of healthcare professionals yet, there have been few studies examining this issue in relation to pre-registration nursing students in the United Kingdom.

METHODS

This descriptive cross-sectional survey employed a questionnaire composed of predominantly closed questions for data collection. A non-probability, purposive sample of 354/444 (79.7%) nursing students from one university participated in the study.

FINDINGS

Knowledge was generally adequate in questions related to pathogen transmission, hand hygiene principles, glove use, immediate action following sharps' injuries, and risk reduction in relation to sharps and waste management. Topics that received less positive results related to the chain of infection, the use of alcohol gel and Clostridium difficile and the definition of inoculation injury. University education was the main influence on knowledge and practice (340/353, 96.3%), but mentors (322/354, 91.2%), nurses (316/353, 89.3%), doctors (175/353, 49.4%) and other members of the multi-disciplinary team (213/352, 60.2%) were also deemed influential. Workload, time, and availability of facilities and equipment also contributed to the adoption of infection control precautions. The findings illustrated the importance of both theoretical and practical knowledge, supported by competent role models.

CONCLUSION

The study identified the complexities of knowledge acquisition and application in a practice based discipline. The support of a competent role model to assist in applying theory to practice is vital. The study has identified that there are many variables that affect IPC practice, both positively and negatively.

Student nurses' experiences of infection prevention and control during clinical placements

BACKGROUND

Little is known about nursing students' experiences of infection control in the clinical setting despite its importance protecting patients and reducing risks of occupational exposure.

METHODS

We conducted an online survey involving a fixed choice Likert-type scale with 19 items and an open question to solicit more detailed information with a national sample of student nurses in the United Kingdom.

RESULTS

Four hundred eighty-eight student nurses completed questionnaires. All participants reported lack of compliance for every item on the Likert scale, most frequently from community settings and long-term care facilities for older people. Incidents most commonly witnessed were failure to comply with hand hygiene protocols, failure to comply with isolation precautions, poor standards of cleaning in the patient environment, not changing personal protective clothing between patients, and poor management of sharp instruments. Qualified nurses did not provide good role models. Medical staff were the occupational group most heavily criticized for poor compliance.

CONCLUSION

Students demonstrated sound understanding of infection control and were able to identify lack of compliance on the basis of preclinical classroom instruction. The study findings indicate that ensuring safe infection control practice remains a challenge in the United Kingdom despite its high priority.

A novel approach to improve hand hygiene compliance of student nurses

Background

The National University Hospital, Singapore routinely undertakes standardized Hand Hygiene auditing with results produced by ward and by staff type. In 2010 concern was raised over consistently low compliance by nursing students averaging 45% (95% CI 42%–48%) prompting us to explore novel approaches to educating our next generation of nurses to improve their hand hygiene practice.

We introduced an experiential learning assignment to final year student nurses on attachment to NUH inclusive of hand hygiene auditor training followed by a period of hand hygiene observation. The training was based on the World Health Organisation (WHO) “My 5 moments for hand hygiene” approach. Upon completion students completed an anonymous questionnaire to evaluate their learning experience.

Findings

By 2012, nursing students were 40% (RR: 1.4, 95% CI 1.3–1.5, p<0.001) more likely to comply with hand hygiene practices. 97.5% (359/368) of nursing students felt that the experience would enhance their own hand hygiene practice and would recommend participating in audits as a learning instrument.

Conclusions

With consideration of all stakeholders a sustainable, flexible, programme was implemented. Experiential learning of hand hygiene was a highly valued educational tool and in our project was directly associated with improved hand hygiene compliance. Feedback demonstrated popularity amongst participants and success in achieving its program objectives. While this does not guarantee long term behavioural change it is intuitive that instilling good habits and messages at the early stages of a career will potentially have significant long-term impact.

The barriers and motivators to learning infection control in clinical placements: interviews with midwifery students

AIM

To investigate the barriers to and motivators for learning infection prevention and control as identified by midwifery students.

METHODS

Semi-structured interviews were undertaken with 15 undergraduate midwifery students within one large university. Data were analysed using Framework Analysis.

RESULTS

Barriers to good clinical practice were identified by students which were concordant with previous literature related to reasons for non-compliance with infection control precautions. Issues such as competing demands specific to midwifery were also identified. Factors which act as barriers to learning good practice in placements included conflicting information and practices from different staff and placement areas and staff attitudes towards students who tried to comply with precautions. Motivators to good practice included the perceived vulnerability of infants to infection, the role modelling of good practice to new mothers and the monitoring of practice.

CONCLUSIONS

This study demonstrated that midwifery students perceive barriers and motivators to learning infection prevention and control in their clinical placements. Many of the barriers identified are related to the attitudes and practices of qualified staff. Some of the motivators are related specifically to midwifery practice. Midwives need to be aware of the effects of what is observed in practice on midwifery students and how their practices and attitudes can influence learning both positively and negatively. As healthcare-associated infection and poor compliance with precautions are a global problem, this research should be of benefit to midwives and midwifery educators worldwide in terms of addressing barriers and ensuring better clinical education.