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

Improving the Effectiveness of Anti-COVID Measures in Buildings: Learning from Users’ Perception

The COVID-19 spread abruptly changed the fruition of indoor environments, where necessary adaptive measures have since been implemented. Buildings open to the public were suddenly equipped with physical devices aiming to encourage users’ appropriate behaviors, such as hand sanitizing, social distancing, and temperature monitoring. Through a twofold architectural-psychological perspective, the paper presents a research aiming to understand how users perceive these devices in the Italian context and to identify the design features that could improve their effectiveness in enhancing individuals’ awareness. With an interdisciplinary approach, four methods were adopted: observational field surveys, background and normative framework analysis, survey research through an online questionnaire, and case studies survey research. The results confirm the overall effectiveness of the implemented anti-COVID strategies, their suitability in encouraging individuals’ appropriate behaviors, and the importance of regulating the users’ flow indoors. The research allowed defining the devices (hand-sanitizing devices and temperature-measurement instruments) and wayfinding systems more suited to be included in the prevention strategy and identified their more appropriate design features in relation to the users’ feedback. Operational suggestions are presented as well. The adopted experimental approach can be useful in supporting decision making in managing of the built environment in both the current and future contexts.

The effect of behavioural interventions targeting hand hygiene practices among nurses in high-income hospital settings: a systematic review

BACKGROUND

Hand hygiene is a critical behaviour for infection control but efforts to raise compliance among clinical professionals have been met with mixed success. The aim of this systematic review was to identify the effectiveness of the behaviour change techniques utilised in recent hand hygiene interventions that seek to improve hand hygiene compliance among nurses in hospitals in high-income countries. Nurses are at the frontline of healthcare delivery, and so improving their HH behaviour and thus increasing HHC rates will have a relatively large impact on reducing transmission and preventing healthcare acquired infections.

METHODS

High-quality studies among nurses in high-income countries were surveyed from the scientific literature, following PRISMA guidelines, to identify which kinds of behaviour change mechanisms have been used to effectively increase hand hygiene compliance. Only seven studies met all inclusion criteria. A formal meta-analysis was not conducted due to the heterogeneity of the included studies. Instead, the review analysed studies in line with the Intervention Component Analysis approach to identify which differences in intervention characteristics appear to be important. Analysis proceeded in two steps: first, the Effective Practice and Organization of Care Data Extraction Checklist was used to identify the study design and to describe the intervention, target population, setting, results, outcome measures, and analytic approach. The second step involved inferring the behavioural change techniques used in the complex study interventions. Following coding, logic models were then inferred for each study to identify the Theory of Change behind each intervention. These Theories of Change were then examined for suggestions as to which BCTs were likely to have been responsible for any effectiveness observed.

RESULTS

Goals and planning (to achieve specific ends), comparison of behaviour (to peers or some ideal) and feedback and monitoring (observing and providing feedback about behaviour or outcomes) were the most frequently used behaviour change technique groupings used across studies and within interventions.

CONCLUSION

The complexity of the interventions used and lack of sufficient studies makes assignment of responsibility for behaviour change to specific behaviour change techniques difficult. Delivery channels and activities identified in the study Theories of Change were also highly individualized and so difficult to compare. However, we identified a temporal shift in types of techniques used in these recent studies on HH interventions, as compared with studies from prior to the review period. These newer interventions did not focus on providing access to alcohol-based hand rub or trying to solely encourage administrative support. Instead, they had nurses create goals and plan how to best facilitate HH, compared both individuals' and the group's behaviour to others, and focused on providing feedback.

Acute care nurses' responses and recommendations for improvement of hand hygiene compliance: A cross-sectional factorial survey research study

BACKGROUND

Hand hygiene is promoted as an effective practice to counter health care-acquired infections; however, compliance is less than optimal. Nurses have many patient contact opportunities and therefore are frequent participants in intervention research. The optimal combination of efficient and effective intervention components has not been conclusively identified.

METHODS

A factorial survey research design offers an efficient method to assess multiple factors simultaneously by combining elements into vignettes. This article describes a process, grounded in the framework of Bandura's social cognitive theory, that explored environmental and individual factors that potentially influence nurses' hand hygiene behavior in acute care settings. Survey respondents consisted of nurses employed in patient care; respondents also could address an open response item.

RESULTS

A total of 466 participants scored a total of 3,685 vignettes. Statistically significant parameters included goal, supervisor priority, electronic monitoring, and rewards. The most frequently mentioned open response item was the need to keep hand hygiene product dispensers refilled. Participants also suggested that culture and intrinsic motivation influenced hand hygiene behavior.

CONCLUSIONS

Researchers might consider assessing promising factors, especially use of goal setting, as an intervention rather than as components of an intervention. Further research is indicated to better understand how nurses define and view hand hygiene culture.