title: Psychosocial determinants of self-reported hand hygiene behaviour: a survey comparing physicians and nurses in intensive care units.
abstract: BACKGROUND
  Research applying psychological behaviour change theories to hand hygiene compliance is scarce, especially for physicians.
  
  
  OBJECTIVE
  To identify psychosocial determinants of self-reported hand hygiene behaviour (HHB) of physicians and nurses in intensive care units (ICUs).
  
  
  METHODS
  A cross-sectional survey using a self-administered questionnaire that applied concepts from the Health Action Process Approach on hygienic hand disinfection was conducted in 10 ICUs and two haematopoietic stem cell transplantation units at Hannover Medical School, Germany. Self-reported compliance was operationalized as always disinfecting one's hands when given tasks associated with risk of infection. Using seven-point Likert scales, behavioural planning, maintenance self-efficacy and action control were assessed as psychological factors, and personnel and material resources, organizational problems and cooperation on the ward were assessed as perceived environmental factors. Multiple logistic regression analysis was employed.
  
  
  RESULTS
  In total, 307 physicians and 348 nurses participated in this study (response rates 70.9% and 63.4%, respectively). Self-reported compliance did not differ between the groups (72.4% vs 69.4%, P = 0.405). While nurses reported stronger planning, self-efficacy and action control, physicians indicated better personnel resources and cooperation on the ward (P < 0.02). Self-efficacy [odds ratio (OR) 1.4, P = 0.041], action control (OR 1.8, P < 0.001) and cooperation on the ward (OR 1.5, P = 0.036) were positively associated with HHB among physicians, but only action control was positively associated with HHB among nurses (OR 1.6, P < 0.001).
  
  
  CONCLUSIONS
  The associations between action control (self-regulatory strategies where behaviour is evaluated continuously and automatically against guidelines) and compliance indicate that HHB is a habit in need of self-monitoring. The fact that perceived cooperation on the ward was the only environmental correlate of HHB among physicians stresses the importance of team-directed interventions.
authors.affiliation: Medical Psychology Unit, Hannover Medical School, Hannover, Lower Saxony, Germany. Electronic address: lengerke.thomas@mh-hannover.de.
authors.forename: T
authors.initials: T
authors.lastname: von Lengerke
authors.affiliation: Medical Psychology Unit, Hannover Medical School, Hannover, Lower Saxony, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Lutze
authors.affiliation: Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Lower Saxony, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Graf
authors.affiliation: Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Lower Saxony, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Krauth
authors.affiliation: Medical Psychology Unit, Hannover Medical School, Hannover, Lower Saxony, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Lange
authors.affiliation: Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Lower Saxony, Germany.
authors.forename: L
authors.initials: L
authors.lastname: Schwadtke
authors.affiliation: Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Lower Saxony, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Stahmeyer
authors.affiliation: Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Lower Saxony, Germany.
authors.forename: I F
authors.initials: IF
authors.lastname: Chaberny
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D005858:Germany; D019983:Guideline Adherence; D006235:Hand Disinfection / Q000379:methods*; D006761:Hospitals; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009726:Nurses / Q000523:psychology* / Q000706:statistics & numerical data; D010820:Physicians / Q000523:psychology* / Q000706:statistics & numerical data; D057566:Self Report; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Hand hygiene compliance; Intensive care personnel; Nosocomial infection prevention; Self-regulation; Social work environment