Behavioral determinants of hand hygiene compliance in intensive care units.
BACKGROUND
Although hand hygiene is the most effective measure for preventing cross-infection, overall compliance is poor among health care workers.


OBJECTIVE
To identify and describe predictors and determinants of noncompliance with hand hygiene prescriptions in intensive care unit nurses by means of a questionnaire.


METHODS
A questionnaire based on a behavioral theory model was filled out by 148 nurses working on a 40-bed intensive care unit in a university hospital. Subjects were asked to fill out the 56-item questionnaire twice within a 2- to 6-week period. During this period, no interventions to enforce hand hygiene occurred on the unit.


RESULTS
Response rate for the test was 73% (108/148); response rate for the retest was 53% (57/108). The mean self-reported compliance rate was 84%. Factor analysis revealed 8 elementary factors potentially associated with compliance. Internal consistency of the scales was acceptable. Intraclass correlation was low (<0.60) for 2 subscales but acceptable (>0.60) for 6 subscales. A low self-efficacy was independently associated with noncompliance (beta = .379; P = .001). After exclusion of this variable, a negative attitude toward time-related barriers was associated with noncompliance (beta = -.147; P < .001).


CONCLUSIONS
Neither having good theoretical knowledge of hand hygiene guidelines nor social influence or moral perceptions had any predictive value relative to hand hygiene practice. A valid questionnaire to identify predictors and determinants of noncompliance with hand hygiene has been designed. Nurses reporting a poor self-efficacy or a poor attitude toward time-related barriers appear to be less compliant.
De Wandel
David
D
Faculty of Health Care, University College Ghent, Ghent, Belgium. david.dewandel@hogent.be
Maes
Lea
L
Labeau
Sonia
S
Vereecken
Carine
C
Blot
Stijn
S
D001291:Attitude of Health Personnel; D001530:Belgium; D003428:Cross Infection / Q000517:prevention & control; D005163:Factor Analysis, Statistical; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006235:Hand Disinfection / Q000379:methods / Q000592:standards*; D015438:Health Behavior; D019538:Health Care Surveys / Q000706:statistics & numerical data; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000706:statistics & numerical data; D006801:Humans; D017053:Infection Control / Q000706:statistics & numerical data; D017757:Infectious Disease Transmission, Professional-to-Patient / Q000706:statistics & numerical data; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D010564:Personnel, Hospital / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D017592:Skin Care / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires