title: [Factors predisposing, enabling and reinforcing hand hygiene in hospitals].
abstract: OBJECTIVE
  To identify the predisposing, enabling and reinforcing factors of hand hygiene behaviour of healthcare staff, and to determine the prevalence of hand washing in hospitals.
  
  
  METHODS
  Using the PRECEDE methodology and techniques of non-participant observation and questionnaires, a behavioural diagnosis was made of the factors that favour and hinder the practice of hand hygiene. In addition, a cross-sectional prevalence study was performed to determine the rate of compliance. The study subjects were healthcare staff and managers.
  
  
  RESULTS
  Various predisposing variables were identified: instruction, valuing the effectiveness of hygiene, the perception that infections may be acquired from patients, etc. The enabling variables were the availability of alcohol-based cleansers, the understanding that hand hygiene is effortless, the absence of pressure of work, etc. The enhancing variables were the presence of hierarchical superiors stressing the importance of hand hygiene, the wish to imitate positive behaviour, etc. Compliance with hand washing recommendations was 26.8%.
  
  
  CONCLUSIONS
  Access to instruments for hand hygiene, healthcarers' attitudes regarding self-protection, modesty, scepticism and conditioning or reinforcing models are all factors that influence hand washing practices. Cognitive-behavioural models should be considered when policies aimed at modifying and assimilating hand washing behaviour are being developed.
authors.affiliation: Unidad de Medicina Preventiva y Salud Pública, Agencia Sanitaria Costa del Sol, Hospital Costa del Sol, Marbella, España. vfgomez@hcs.es
authors.forename: V
authors.initials: V
authors.lastname: Fuentes-Gómez
authors.forename: E
authors.initials: E
authors.lastname: Crespillo-García
authors.forename: M
authors.initials: M
authors.lastname: Enríquez de Luna-Rodríguez
authors.forename: F
authors.initials: F
authors.lastname: Fontalba-Díaz
authors.forename: P
authors.initials: P
authors.lastname: Gavira-Albiach
authors.forename: F
authors.initials: F
authors.lastname: Rivas-Ruiz
authors.forename: S
authors.initials: S
authors.lastname: Soler-Méndez
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D063373:Hand Hygiene; D006740:Hospital Administrators / Q000523:psychology; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D019370:Observation; D010564:Personnel, Hospital / Q000193:education / Q000523:psychology*; D036301:Qualitative Research; D011787:Quality of Health Care; D012054:Reinforcement, Psychology; D013030:Spain; D011795:Surveys and Questionnaires