title: Improving physician hand hygiene compliance using behavioural theories: a study protocol.
abstract: BACKGROUND
  Healthcare-associated infections affect 10% of patients in Canadian acute-care hospitals and are significant and preventable causes of morbidity and mortality among hospitalized patients. Hand hygiene is among the simplest and most effective preventive measures to reduce these infections. However, compliance with hand hygiene among healthcare workers, specifically among physicians, is consistently suboptimal. We aim to first identify the barriers and enablers to physician hand hygiene compliance, and then to develop and pilot a theory-based knowledge translation intervention to increase physicians' compliance with best hand hygiene practice.
  
  
  METHODS
  The study consists of three phases. In Phase 1, we will identify barriers and enablers to hand hygiene compliance by physicians. This will include: key informant interviews with physicians and residents using a structured interview guide, informed by the Theoretical Domains Framework; nonparticipant observation of physician/resident hand hygiene audit sessions; and focus groups with hand hygiene experts. In Phase 2, we will conduct intervention mapping to develop a theory-based knowledge translation intervention to improve physician hand hygiene compliance. Finally, in Phase 3, we will pilot the knowledge translation intervention in four patient care units.
  
  
  CONCLUSIONS
  In this study, we will use a behavioural theory approach to obtain a better understanding of the barriers and enablers to physician hand hygiene compliance. This will provide a comprehensive framework on which to develop knowledge translation interventions that may be more successful in improving hand hygiene practice. Upon completion of this study, we will refine the piloted knowledge translation intervention so it can be tested in a multi-site cluster randomized controlled trial.
authors: Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada. jasquires@ohri.ca
authors: Janet E
authors: JE
authors: Squires
authors: Kathryn N
authors: KN
authors: Suh
authors: Stefanie
authors: S
authors: Linklater
authors: Natalie
authors: N
authors: Bruce
authors: Kathleen
authors: K
authors: Gartke
authors: Ian D
authors: ID
authors: Graham
authors: Alan
authors: A
authors: Karovitch
authors: Joanne
authors: J
authors: Read
authors: Virginia
authors: V
authors: Roth
authors: Karen
authors: K
authors: Stockton
authors: Emma
authors: E
authors: Tibbo
authors: Kent
authors: K
authors: Woodhall
authors: Jim
authors: J
authors: Worthington
authors: Jeremy M
authors: JM
authors: Grimshaw
mesh_terms: D001291:Attitude of Health Personnel; D003428:Cross Infection / Q000517:prevention & control*; D006235:Hand Disinfection / Q000592:standards; D063373:Hand Hygiene / Q000592:standards*; D015438:Health Behavior; D006293:Health Promotion; D006801:Humans; D017053:Infection Control / Q000379:methods / Q000592:standards; D017757:Infectious Disease Transmission, Professional-to-Patient / Q000517:prevention & control*; D007396:Internship and Residency; D008505:Medical Staff, Hospital; D010865:Pilot Projects; D011792:Quebec; D057170:Translational Research, Biomedical
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