title: Focus group study of hand hygiene practice among healthcare workers in a teaching hospital in Toronto, Canada.
abstract: OBJECTIVE
  To understand the behavioral determinants of hand hygiene in our hospital.
  
  
  METHODS
  Qualitative study based on 17 focus groups.
  
  
  METHODS
  Mount Sinai Hospital, an acute care tertiary hospital affiliated with the University of Toronto.
  
  
  METHODS
  We recruited 153 healthcare workers (HCWs) representing all major patient care job categories.
  
  
  METHODS
  Focus group discussions were transcribed verbatim. Thematic analysis was independently conducted by 3 investigators.
  
  
  RESULTS
  Participants reported that the realities of their workload (eg, urgent care and interruptions) make complete adherence to hand hygiene impossible. The guidelines were described as overly conservative, and participants expressed that their judgement is adequate to determine when to perform hand hygiene. Discussions revealed gaps in knowledge among participants; most participants expressed interest in more information and education. Participants reported self-protection as the primary reason for the performance of hand hygiene, and many admitted to prolonged glove use because it gave them a sense of protection. Limited access to hand hygiene products was a source of frustration, as was confusion related to hospital equipment as potential vehicles for transmission of infection. Participants said that they noticed other HCWs' adherence and reported that others HCWs' hygiene practices influenced their own attitudes and practices. In particular, HCWs perceive physicians as role models; physicians, however, do not see themselves as such.
  
  
  CONCLUSIONS
  Our results confirm previous findings that hand hygiene is practiced for personal protection, that limited access to supplies is a barrier, and that role models and a sense of team effort encourage hand hygiene. Educating HCWs on how to manage workload with guideline adherence and addressing contaminated hospital equipment may improve compliance.
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Ontario, Canada.
authors.forename: Ji-Hyun
authors.initials: JH
authors.lastname: Jang
authors.forename: Samantha
authors.initials: S
authors.lastname: Wu
authors.forename: Debra
authors.initials: D
authors.lastname: Kirzner
authors.forename: Christine
authors.initials: C
authors.lastname: Moore
authors.forename: Gomana
authors.initials: G
authors.lastname: Youssef
authors.forename: Agnes
authors.initials: A
authors.lastname: Tong
authors.forename: Jenny
authors.initials: J
authors.lastname: Lourenco
authors.forename: Robyn B
authors.initials: RB
authors.lastname: Stewart
authors.forename: Liz J
authors.initials: LJ
authors.lastname: McCreight
authors.forename: Karen
authors.initials: K
authors.lastname: Green
authors.forename: Allison
authors.initials: A
authors.lastname: McGeer
mesh_terms: D002170:Canada; D003428:Cross Infection / Q000517:prevention & control; D017144:Focus Groups / Q000379:methods*; D019983:Guideline Adherence; D006235:Hand Disinfection / Q000379:methods / Q000592:standards; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006784:Hospitals, Teaching; D006801:Humans; D006920:Hygiene / Q000592:standards*; D017053:Infection Control / Q000379:methods / Q000592:standards