title: Understanding the determinants of Australian hospital nurses' hand hygiene decisions following the implementation of a national hand hygiene initiative.
abstract: Hand hygiene is the primary measure in hospitals to reduce the spread of infections, with nurses experiencing the greatest frequency of patient contact. The '5 critical moments' of hand hygiene initiative has been implemented in hospitals across Australia, accompanied by awareness-raising, staff training and auditing. The aim of this study was to understand the determinants of nurses' hand hygiene decisions, using an extension of a common health decision-making model, the theory of planned behaviour (TPB), to inform future health education strategies to increase compliance. Nurses from 50 Australian hospitals (n = 2378) completed standard TPB measures (attitude, subjective norm, perceived behavioural control [PBC], intention) and the extended variables of group norm, risk perceptions (susceptibility, severity) and knowledge (subjective, objective) at Time 1, while a sub-sample (n = 797) reported their hand hygiene behaviour 2 weeks later. Regression analyses identified subjective norm, PBC, group norm, subjective knowledge and risk susceptibility as the significant predictors of nurses' hand hygiene intentions, with intention and PBC predicting their compliance behaviour. Rather than targeting attitudes which are already very favourable among nurses, health education strategies should focus on normative influences and perceptions of control and risk in efforts to encourage hand hygiene adherence.
authors.affiliation: School of Psychology and Counselling, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Brisbane 4059, Australia, Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Brisbane 4059, Australia, km.white@qut.edu.au.
authors.forename: Katherine M
authors.initials: KM
authors.lastname: White
authors.affiliation: School of Psychology and Counselling, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Brisbane 4059, Australia.
authors.forename: Louise C
authors.initials: LC
authors.lastname: Starfelt
authors.affiliation: School of Management, Queensland University of Technology, 2 George Street, Brisbane 4000, Australia.
authors.forename: Nerina L
authors.initials: NL
authors.lastname: Jimmieson
authors.affiliation: Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Brisbane 4059, Australia.
authors.forename: Megan
authors.initials: M
authors.lastname: Campbell
authors.affiliation: Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Brisbane 4059, Australia.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Graves
authors.affiliation: Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Brisbane 4059, Australia.
authors.forename: Adrian G
authors.initials: AG
authors.lastname: Barnett
authors.affiliation: School of Psychology and Counselling, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Brisbane 4059, Australia, Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Brisbane 4059, Australia.
authors.forename: Wendell
authors.initials: W
authors.lastname: Cockshaw
authors.affiliation: School of Psychology, The University of Queensland, Sir Fred Schonell Drive, St Lucia, Brisbane, 4072, Australia.
authors.forename: Phillip
authors.initials: P
authors.lastname: Gee
authors.affiliation: Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Brisbane 4059, Australia.
authors.forename: Katie
authors.initials: K
authors.lastname: Page
authors.affiliation: Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Brisbane 4059, Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Martin
authors.affiliation: Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Brisbane 4059, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Brain
authors.affiliation: The University of Queensland Centre for Clinical Research, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Brisbane 4029, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Paterson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001315:Australia; D003657:Decision Making; D003661:Decision Support Techniques; D005260:Female; D063373:Hand Hygiene; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007318:Inservice Training; D033182:Intention; D008297:Male; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000523:psychology*; D010465:Perception; D018570:Risk Assessment; D055815:Young Adult