title: Using a theory of planned behaviour framework to explore hand hygiene beliefs at the '5 critical moments' among Australian hospital-based nurses.
abstract: BACKGROUND
  Improving hand hygiene among health care workers (HCWs) is the single most effective intervention to reduce health care associated infections in hospitals. Understanding the cognitive determinants of hand hygiene decisions for HCWs with the greatest patient contact (nurses) is essential to improve compliance. The aim of this study was to explore hospital-based nurses' beliefs associated with performing hand hygiene guided by the World Health Organization's (WHO) 5 critical moments. Using the belief-base framework of the Theory of Planned Behaviour, we examined attitudinal, normative, and control beliefs underpinning nurses' decisions to perform hand hygiene according to the recently implemented national guidelines.
  
  
  METHODS
  Thematic content analysis of qualitative data from focus group discussions with hospital-based registered nurses from 5 wards across 3 hospitals in Queensland, Australia.
  
  
  RESULTS
  Important advantages (protection of patient and self), disadvantages (time, hand damage), referents (supportive: patients, colleagues; unsupportive: some doctors), barriers (being too busy, emergency situations), and facilitators (accessibility of sinks/products, training, reminders) were identified. There was some equivocation regarding the relative importance of hand washing following contact with patient surroundings.
  
  
  CONCLUSIONS
  The belief base of the theory of planned behaviour provided a useful framework to explore systematically the underlying beliefs of nurses' hand hygiene decisions according to the 5 critical moments, allowing comparisons with previous belief studies. A commitment to improve nurses' hand hygiene practice across the 5 moments should focus on individual strategies to combat distraction from other duties, peer-based initiatives to foster a sense of shared responsibility, and management-driven solutions to tackle staffing and resource issues. Hand hygiene following touching a patient's surroundings continues to be reported as the most neglected opportunity for compliance.
authors.affiliation: School of Psychology and Counselling, Queensland University of Technology, Victoria Park Road, 4059, Kelvin Grove, Australia. km.white@qut.edu.au.|Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, 4059, Kelvin Grove, Australia. km.white@qut.edu.au.
authors.forename: Katherine M
authors.initials: KM
authors.lastname: White
authors.affiliation: School of Management, Queensland University of Technology, 2 George Street, 4000, Brisbane, Australia. n.jimmieson@qut.edu.au.
authors.forename: Nerina L
authors.initials: NL
authors.lastname: Jimmieson
authors.affiliation: School of Psychology and Counselling, Queensland University of Technology, Victoria Park Road, 4059, Kelvin Grove, Australia. p.obst@qut.edu.au.|Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, 4059, Kelvin Grove, Australia. p.obst@qut.edu.au.
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Obst
authors.affiliation: Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, 4059, Kelvin Grove, Australia. n.graves@qut.edu.au.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Graves
authors.affiliation: Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, 4059, Kelvin Grove, Australia. a.barnett@qut.edu.au.
authors.forename: Adrian
authors.initials: A
authors.lastname: Barnett
authors.affiliation: School of Psychology and Counselling, Queensland University of Technology, Victoria Park Road, 4059, Kelvin Grove, Australia. w.cockshaw@qut.edu.au.|Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, 4059, Kelvin Grove, Australia. w.cockshaw@qut.edu.au.
authors.forename: Wendell
authors.initials: W
authors.lastname: Cockshaw
authors.affiliation: School of Psychology, The University of Queensland, 4072, St Lucia, Australia. p.gee@psy.uq.edu.au.
authors.forename: Phillip
authors.initials: P
authors.lastname: Gee
authors.affiliation: School of Psychology, The University of Queensland, 4072, St Lucia, Australia. lara.haneman@uqconnect.edu.au.
authors.forename: Lara
authors.initials: L
authors.lastname: Haneman
authors.affiliation: Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, 4059, Kelvin Grove, Australia. katie.page@qut.edu.au.
authors.forename: Katie
authors.initials: K
authors.lastname: Page
authors.affiliation: Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, 4059, Kelvin Grove, Australia. megan.campbell@qut.edu.au.
authors.forename: Megan
authors.initials: M
authors.lastname: Campbell
authors.affiliation: Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, 4059, Kelvin Grove, Australia. elizabethkate.martin@qut.edu.au.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Martin
authors.affiliation: The University of Queensland Centre for Clinical Research, Royal Brisbane and Women's Hospital, 4029, Herston, Australia. d.paterson1@uq.edu.au.
authors.forename: David
authors.initials: D
authors.lastname: Paterson
mesh_terms: D000328:Adult; D003428:Cross Infection / Q000517:prevention & control; D017144:Focus Groups; D019983:Guideline Adherence; D006235:Hand Disinfection; D063373:Hand Hygiene; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008505:Medical Staff, Hospital / Q000523:psychology*; D008875:Middle Aged; D010349:Patient Compliance; D011793:Queensland