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Acquisition of a health care-associated infection is a substantial risk to patient safety. When health care workers comply with hand hygiene guidelines, it reduces this risk. Despite a growing body of qualitative research in this area, a review of the qualitative literature has not been published.
A systematic review of the qualitative literature....
Citations
... The desire to protect patients and coworkers was cited less frequently [19]. In similar studies, self-protection is a frequently cited motivator for HHA [30]. This may explain why HHA was highest when the risk to the HCW was elevated, including early in the pandemic when COVID-19 mortality was high (Fig 1), during invasive contacts, after patient contact, and when gloves are not used. ...
Hand hygiene (HH) can reduce transmission of healthcare-associated infections (HAIs) in healthcare facilities and is especially important in low- and middle-income countries where HH infrastructure may be insufficient and the burden of HAIs is highest. At baseline, we assessed HH infrastructure and practices among healthcare workers (HCWs) at two large hospitals in the Dominican Republic during the COVID-19 pandemic. HCWs were observed for HH adherence (HHA) (defined as the use of alcohol-based hand rub (ABHR) or handwashing with soap and water) before and after patient contact and donning new gloves before patient contact. The baseline assessment was repeated following implementation of local production and distribution of ABHR and a HH promotion campaign. Descriptive analyses and regression models evaluated predictors of HHA and glove use. Cumulative HHA was 18.9%. While patient-care areas with a functional HH resource increased from 47% at baseline to 92% after the intervention, HHA declined from 23.0% to 16.7%. HHA was higher after patient contact (aOR = 5.88; 95% CI = 4.17–8.33), during a period of increased COVID-19 risk (aOR = 1.69; 95% CI = 1.05–2.77), during invasive patient contacts (aOR = 1.64; 95% CI = 1.23–2.17) and when gloves were not used (aOR = 1.25; 95% CI = 1.01–1.56). The negative association between glove use and HHA diminished when access to HH resources increased. New gloves were donned before 39.6% of patient contacts. Glove use was higher among nurses (aOR = 7.12; 95% CI = 3.02–16.79) and during invasive contacts (aOR = 4.76; 95% CI = 2.27–10.0). While access to HH resources increased after the interventions, HHA did not increase. HHA was lower when COVID-19 risk was lower. Findings from this study may guide future efforts to increase HHA among HCWs.
... A study of self-reported HH behaviours in hospitals in Ireland found that motivation was a predictor for HH compliance [20]. A systematic review of qualitative studies on HH adherence conducted among hospital staff in high-income countries (HICs) similarly found that motivation was one of two main factors impacting workers' HH adherence [21]. ...
Background
Proper hand hygiene (HH), which includes sanitizing with alcohol-based hand rub (ABHR) (or handwashing with soap and water if ABHR is unavailable), is key for preventing healthcare-associated infections (HCAI), including COVID-19. Understanding drivers of HH is key to improving adherence.
Aim
This study aims to explore drivers and barriers to HH practice at two hospitals in the Dominican Republic in the context of the COVID-19 pandemic to inform development of HH behaviour change interventions.
Methods
We conducted in-depth interviews with 20 hospital staff during September 2021. We used the COM-B (capability, opportunity, motivation, behaviour) model to explore HH experiences and preferences. Interviews were recorded, transcribed, coded, and analysed using a thematic approach.
Results
A total of 11 parent codes and 27 sub-codes were identified, and 1145 coded segments were analysed. Use of handwashing with soap and water and/or sanitizing with ABHR was reported by all participants; handwashing was generally preferred. Participants expressed knowledge of proper HH methods (capability), but inconsistent supplies and lack of time presented HH challenges (opportunity). Interviewees described practicing HH to protect themselves and their families from COVID-19 and other infections (reflective motivation) or out of habit (automatic motivation).
Discussion
By understanding and addressing underlying factors affecting HH, hospitals can decrease the risk of HCAIs. Our findings suggest that interventions implemented to improve HH in these hospitals should target motivation and opportunity. These findings informed a multimodal intervention to increase ABHR access and implement message-tested communications campaigns; end-point assessments will provide insights into the intervention's impact.
... Hence, organizational culture plays a crucial role in facilitating the exchange of hand hygiene feedback without instilling fear of criticism or retaliation. [57][58][59][60] Furthermore, several research has demonstrated that a lack of a liation with the ICU team and limited social cohesion mostly hindered these participants from properly addressing the problem. 61,62 Work and environmental circumstances have the potential to impact HCWs adherence to appropriate hand hygiene protocols. ...
Background
Practicing hand hygiene is a cost-effective method to decrease the occurrence of Healthcare-Associated Infections (HAIs). However, despite their simplicity, adhering to hand hygiene methods among healthcare workers (HCWs) can be highly challenging. We aim to examine the factors influencing hand hygiene compliance as perceived by HCWs working in the intensive care units (ICUs) at several major hospitals in Riyadh, Saudi Arabia
Method
This qualitative study was conducted by adopting a content analysis to examine the interviews of HCWs who are currently working in the ICUs of various major hospitals located in the capital city of Riyadh, Saudi Arabia.
Results
We interviewed 49 HCWs working in ICUs, with an average age of 38 and 8 years of experience. The HCWs comprised doctors (n = 12), anesthesiologists (n = 6), and nurses (n = 31). There were 34 females and 15 males among the participants. Our analysis revealed several factors that impact hand hygiene compliance, including individual, work/environment, team, task, patient, organizational, and management concerns. Furthermore, several obstacles and possibilities for enhancement have been identified.
Conclusion
The results of this study would enhance our comprehension of hand hygiene practices and serve as a foundation for creating future strategies and assessment methods to enhance compliance with hand hygiene protocols in ICUs.
... Research shows that IPC compliance is often hindered by a lack of understanding of complex IPC standards and guidelines, as well as a lack of knowledge of preventive measures during routine patient care, and the potential risks of microorganism transmission to patients (Alhumaid et al., 2021). Additionally, poor compliance is caused by a lack of information relating to the appropriateness, efficacy, and use of IPC measures (Smiddy et al., 2015). Education and training are therefore crucial pillars of safe and effective IPC practice (Islam et al., 2020). ...
Introduction
The World Health Organization (WHO) advocates for the strengthening of education and training in infection prevention and control (IPC) in higher educational institutions (HEIs). This is fundamental to ensure health science students are confident and competent in clinical practice.
Aim
Explore the preparedness of undergraduate health science students for IPC practice.
Search strategy
The PubMed, Cumulative Index to Nursing and Allied Health Literature, EMBASE, ProQuest, Scopus, Web of Science, ClinicalKey, and Google Scholar databases and grey literature will be searched for relevant articles.
Inclusion criteria
Quantitative, and mixed methods studies on teaching and learning, technological methods, strengths and limitations, and challenges of IPC practice in HEI undergraduate curricula.
Participant characteristics
Undergraduate health science students including medical, nursing, pharmacy, dental, physiotherapy, radiology, medical imaging, and paramedicine.
Setting and time frame
Studies published anywhere in the world, in English, and from 2010 to 2023.
Search terms
Preparedness, health science students, infection prevention and control, technology, higher education institutions.
Data extraction
The data extracted will be recorded on a data extraction form.
Assessment of risk of bias
This will be conducted according to the criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions.
Ethics and dissemination
No ethical approval was required for this protocol. Interim findings will be presented at relevant local and international conferences and a manuscript will be published in a peer reviewed journal.
Discussion
This systematic review will provide a baseline for recommendations for developing innovative ways to improve IPC teaching and learning in HEI.
... Some studies have attempted theoretical explorations of IPC behaviors in healthcare workers from a systems-oriented perspective, such as normalization process theory and non-representational theory [12,13]. However, there is a lack of an explicit definition of key components or pathway regarding IPC mechanism [14]. Consequently, a system-related pathway exploration to fully understand the mechanisms of IPC. ...
Background
The evidence of preferences for infection prevention and control (IPC) intervention from system perspective was lacked. This study aimed to elicit nurses’ preferences for the intervention designed to improve IPC behaviors based on the Systems Engineering Initiative to Patient Safety (SEIPS) model using Discrete Choice Experiment (DCE).
Methods
A DCE was conducted among nurses who were on active duty and willing to participate from July 5th to 10th, 2021 in a tertiary hospital in Ganzhou City, Jiangxi Province, using convenience sampling. A self-administered questionnaire included scenarios formed by six attributes with varying levels based on SEIPS model: person, organization, tools and technology, tasks, internal environment and external environment. A conditional logit and latent class logit model were performed to analyze the data.
Results
A total of 257 valid questionnaires were analyzed among nurses. The results from the latent class logit model show that nurses’ preferences can be divided into three classes. For nurses in multifaceted-aspect-preferred class (41.9%), positive coefficients were obtained in those six attributes. For person-preferred class (19.7%), only person was positively significant. For environment-preferred class (36.4%), the most important attribute were tasks, tools and technology, internal environment and external environment.
Conclusions
This finding suggest that nurses have three latent-class preferences for interventions. Multifaceted interventions to improve IPC behaviors based on the SEIPS model are preferred by most nurses. Moreover, relevant measured should be performed targeted the latent class of person-preferred and external-environment-preferred nurses.
... In a literature review of studies from Europe, Asia, Australia and USA, Smiddy et al. 17 showed that healthcare professional's compliance with guidelines was related to motivational factors and the healthcare professional's perception of the work environment. The motivational factors were influenced by others, and the environmental factors were related to organisational culture, time and knowledge. ...
... The motivational factors were influenced by others, and the environmental factors were related to organisational culture, time and knowledge. 17 Other studies have shown that perceived barriers to non-compliance were related to the patient's ability and preferences 18 as well as environmental factors such as equipment and time. 19 In the present study, patient characteristics (mainly pain) were the main reasons that hindered the use of compression. ...
Introduction
To minimise the risks associated with ionising radiation, it is necessary for all staff involved to employ specific techniques to reduce radiation exposure of the patient. These techniques include using compression during examinations of the pelvic region and lumbar spine, using a gonad shield, and asking women if they are pregnant. However, some staff do not use these techniques consistently. Increasing compliance requires determining why staff are non‐compliant. Thus, this study aims to qualitatively investigate why radiographers do not use these techniques.
Methods
This qualitative study is based on a cross‐sectional electronic survey with open‐ended questions. The data were analysed using an inductive qualitative content analysis with quantification of the findings. In total, 111 radiographers from 20 hospitals in Sweden participated.
Results
Three categories appear related to barriers that could obstruct the radiographer from using compression, gonad shields and asking about pregnancy: patient characteristics, interaction between the patient and the radiographer and issues related to the situation and examination.
Conclusions
The barriers to not using radiation protection measures varied depending on the specific measure. However, the barriers were mainly related to the patient experiencing pain, communication difficulties and cultural reasons. In addition, the lack of adequate and user‐friendly equipment was seen as a barrier to applying compression and using gonad shielding.
... Lack of healthcare staff knowledge appear after participation in education and training programs. (Smiddy et al., 2015;Yousef et al., 2019) There are many studies around the world assessed the staff knowledge, attitude and practice related to standard precaution show that medical staff have inadequate competency on standard precaution especially hand hygiene and appropriately using PPE. (Al Ra'awji et al., 2018). ...
The healthcare staff, to apply prevention and control Health associated infection guidelines need basic knowledge on standard precaution and the medical staff to gain this knowledge they need education through effective training. For that reason, training is a fundamental part of every infection control programs. Aim of the study is to evaluate the Sulaimni governmental and non-governmental hospitals training process on the infection control. A descriptive cross-sectional study was carried at inside Sulaimani city (11 governmental and 7 non-governmental) hospitals in the Kurdistan Region of Iraq and the data collected by constructed questionnaire form from both hospital administrations and also from 200 healthcare workers who working in those hospitals from 2nd October 2022 to 25th February 2023. The result show that most of the Sulaimni hospitals their infection control responsible of staff training 11 (61.1%), provide continuous training on the infection control 16 (88.9%) and 9 (56.25%) provide training when the workers need it. For healthcare staff, majority of the healthcare staff 111 (55.5%) did not attended any training on the infection control and 142 (71%) did not attended any training in the current hospitals they working in it now. In conclusion, the study reveals that most of the Sulaimni hospitals claim that they having a continuous training based on the evaluated data on the healthcare staff knowledge. Contrast majority of the healthcare staff reported that they did not attend any infection control training in the previous or the current hospital.
... Some studies have attempted theoretical explorations of IPC behaviors in healthcare workers from a systems-oriented perspective, such as normalization process theory and non-representational theory [12,13]. However, there is a lack of an explicit de nition of key components or pathway regarding IPC mechanism [14]. Consequently, a system-related pathway exploration to fully understand the mechanisms of IPC. ...
Background
The evidence of preferences for infection prevention and control (IPC) intervention from system perspective was lacked. This study aimed to elicit nurses' preferences for the intervention designed to improve IPC behaviors based on the Systems Engineering Initiative to Patient Safety (SEIPS) model using Discrete Choice Experiment (DCE).
Methods
A DCE was conducted among nurses from July 5th to 10th, 2021. Scenarios were formed by six attributes with varying levels based on SEIPS model: person, organization, tools and technology, tasks, internal environment and external environment. A conditional logit model and latent class logit model were performed to analyze the data.
Results
A total of 257 valid questionnaires were analyzed among nurses. The results from the latent class logit model show that nurses’ preferences can be divided into three classes. For class one (41.9%), positive coefficients were obtained in those six attributes. For class two (19.7%) only person was positively significant. For class three (36.4%), the most important attribute were tasks, tools and technology, internal environment and external environment.
Conclusions
This finding suggest that nurses have three latent-class preferences for interventions. Multifaceted interventions to improve IPC behaviors based on the SEIPS model are preferred by most nurses. Moreover, relevant measured should be performed targeted the latent class of person-preferred and external-environment-preferred nurses.
... Over the past several years it has become increasingly evident that infection prevention initiatives focused on optimizing hand hygiene have not realized their hopedfor impact on healthcare-associated pathogen (HAP) transmission in well-resourced healthcare settings [129][130][131][132][133]. Accepting our inability to quantify the absolute risk of pathogen acquisition directly from healthcare workers' hands, there is good circumstantial evidence that such transmission accounts for a substantial proportion of HAP transmission. ...
As today’s most prevalent and costly healthcare-associated infection, hospital-onset Clostridioides difficile infection (HO-CDI) represents a major threat to patient safety world-wide. This review will discuss how new insights into the epidemiology of CDI have quantified the prevalence of C. difficile (CD) spore contamination of the patient-zone as well as the role of asymptomatically colonized patients who unavoidable contaminate their near and distant environments with resilient spores. Clarification of the epidemiology of CD in parallel with the development of a new generation of sporicidal agents which can be used on a daily basis without damaging surfaces, equipment, or the environment, led to the research discussed in this review. These advances underscore the potential for significantly mitigating HO-CDI when combined with ongoing programs for optimizing the thoroughness of cleaning as well as disinfection. The consequence of this paradigm-shift in environmental hygiene practice, particularly when combined with advances in hand hygiene practice, has the potential for significantly improving patient safety in hospitals globally by mitigating the acquisition of CD spores and, quite plausibly, other environmentally transmitted healthcare-associated pathogens.
... Health workers expressed motivation to use holsters due in part to a fear of infection and a desire for self-protection. Selfprotection from infection has been reported as a key motivator for hand hygiene among health workers in other worldwide settings (Jang et al. 2010;Alex-Hart & Opara 2011;Smiddy et al. 2015). Fear of infection and a desire for self-protection also contributed to participant preference for individual control of holsters, with several participants saying they were worried about cross-contamination from a shared device. ...
Hand hygiene is central to the prevention of healthcare-associated infection. In low-income settings, barriers to health worker hand hygiene may include inconsistent availability of hand hygiene supplies at the point of care. However, there is a lack of knowledge of interventions to improve and sustain health worker hand hygiene in these settings. This pilot study evaluates acceptability and feasibility of a personally-worn hand hygiene holster device for improving point-of-care access to alcohol-based handrub (ABHR). Holsters were distributed to clinical staff at a hospital in Liberia in July–September 2021. Data collection included 2,066 structured observations of hand hygiene behavior, six spot checks of supply availability, and focus group discussions with 13 clinical staff. The Integrated Behavioral Model for Water, Sanitation, and Hygiene (IBM-WASH) provided a framework for study design and qualitative analysis. Acceptability of the intervention was high, with users reporting that holsters were comfortable, easy to use, and aligned with their professional identities. Feasibility depended on consistent ABHR availability, which may diminish sustainability of this intervention. The hand hygiene holster is a promising tool for improving health worker hand hygiene behavior, but solutions to ABHR supply chain and distribution constraints are necessary to support sustainability of this intervention.
HIGHLIGHTS
This pilot study evaluated the feasibility and acceptability of a hand hygiene holster device to improve access to point-of-care hand hygiene in Liberian health facilities.;
Users reported satisfaction with holsters and many felt that this intervention made hand hygiene more accessible during patient care.;
Further research should explore the impact of the holster intervention on health worker hand hygiene behavior.;
