title: Qualitative findings from focus group discussions on hand hygiene compliance among health care workers in Vietnam.
abstract: BACKGROUND
  It is accepted by hospital clinical governance that every clinician's "duty of care" includes hand hygiene, yet globally, health care workers (HCWs) continue to struggle with compliance. Focus group discussions were conducted to explore HCWs' barriers to hand hygiene in Vietnam.
  
  
  METHODS
  Twelve focus group discussions were conducted with HCWs from 6 public hospitals across Hanoi, Vietnam. Discussions included participants' experiences with and perceptions concerning hand hygiene. Tape recordings were transcribed verbatim and then translated into English. Thematic analysis was conducted by 2 investigators.
  
  
  RESULTS
  Expressed frustration with high workload, limited access to hand hygiene solutions, and complicated guidelines that are difficult to interpret in overcrowded settings were considered by participants to be bona fide reasons for noncompliance. No participant acknowledged hand hygiene as a duty of care practice for her or his patients. Justification for noncompliance was the observation that visitors did not perform hand hygiene. HCWs did acknowledge a personal duty of care when hand hygiene was perceived to benefit her or his own health, and then neither workload or environmental challenges influenced compliance.
  
  
  CONCLUSIONS
  Limited resources in Vietnam are amplified by overcrowded conditions and dual bed occupancy. Yet without a systematic systemic duty of care to patient safety, changes to guidelines and resources might not immediately improve compliance. Thus, introducing routine hand hygiene must start with education programs focusing on duty of care.
authors.affiliation: School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, Australia.
authors.forename: Sharon
authors.initials: S
authors.lastname: Salmon
authors.affiliation: School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, Australia. Electronic address: m.mclaws@unsw.edu.au.
authors.forename: Mary-Louise
authors.initials: ML
authors.lastname: McLaws
mesh_terms: D001291:Attitude of Health Personnel; D017144:Focus Groups; D019983:Guideline Adherence; D063373:Hand Hygiene / Q000379:methods*; D006282:Health Personnel; D006779:Hospitals, Public; D006801:Humans; D017053:Infection Control / Q000379:methods*; D014744:Vietnam
keywords: Hand hygiene; Hand hygiene compliance; Healthcare worker; Vietnam