title: Developing professional habits of hand hygiene in intensive care settings: An action-research intervention.
abstract: OBJECTIVE
  To explore perceptions and unconscious psychological processes underlying handwashing behaviours of intensive care nurses, to implement organisational innovations for improving hand hygiene in clinical practice.
  
  
  METHODS
  An action-research intervention was performed in 2012 and 2013 in the intensive care unit of a public hospital in Italy, consisting of: structured interviews, semantic analysis, development and validation of a questionnaire, team discussion, project design and implementation. Five general workers, 16 staff nurses and 53 nurse students participated in the various stages.
  
  
  RESULTS
  Social handwashing emerged as a structured and efficient habit, which follows automatically the pattern "cue/behaviour/gratification" when hands are perceived as "dirty". The perception of "dirt" starts unconsciously the process of social washing also in professional settings. Professional handwashing is perceived as goal-directed. The main concern identified is the fact that washing hands requires too much time to be performed in a setting of urgency. These findings addressed participants to develop a professional "habit-directed" hand hygiene procedure, to be implemented at beginning of workshifts.
  
  
  CONCLUSIONS
  Handwashing is a ritualistic behaviour driven by deep and unconscious patterns, and social habits affect professional practice. Creating professional habits of hand hygiene could be a key solution to improve compliance in intensive care settings.
authors.affiliation: Epidemiology and Statistic Unit, Azienda ULSS n.9 "Treviso", Borgo Cavalli 31, 31100 Treviso, Italy. Electronic address: gbattistella@ulss.tv.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Battistella
authors.affiliation: Intensive Care Unit, Azienda ULSS n.9 "Treviso", Via Sant' Ambrogio di Fiera, 37, 31100 Treviso, Italy. Electronic address: gberto@ulss.tv.it.
authors.forename: Giuliana
authors.initials: G
authors.lastname: Berto
authors.affiliation: Health Education and Research consultant, Azienda ULSS n.9 "Treviso", Via Vittoria, 54, 31010 Cimadolmo, Treviso, Italy. Electronic address: stefania.bazzo@gmail.com.
authors.forename: Stefania
authors.initials: S
authors.lastname: Bazzo
mesh_terms: D001521:Behavior Therapy / Q000379:methods; D019983:Guideline Adherence / Q000592:standards; D006184:Habits; D063373:Hand Hygiene / Q000379:methods / Q000592:standards*; D006302:Health Services Research; D006801:Humans; D017053:Infection Control / Q000379:methods / Q000592:standards; D007362:Intensive Care Units / Q000458:organization & administration; D007558:Italy; D009726:Nurses / Q000523:psychology* / Q000592:standards; D011795:Surveys and Questionnaires
keywords: Action research; Hand hygiene; Intensive care unit; Organisational change; Prevention; Unconsciousness