Heathcare Worker's Knowledge, Beliefs and Attitudes about Hand Hygiene (HH) Performance

Background:
HH prevents healthcare-associated infections (HAI) but adherence is suboptimal.

Objective:
To investigate healthcare workers’ (HCWs) knowledge, beliefs, and attitudes about HH. 
 
Methods:
We sent emails to ~7000 U of Iowa HCWs regarding an online survey (initial emails in 6-7/2009; follow-up e-mails in 7-8/2009). We used chi-square analyses to assess if responses differed by profession. Alpha was 0.05; all reported p-values were 2-tailed.

Results:
1339 HCWs responded: 601 nurses (Ns), 419 physicians (Ps), & 319 other healthcare workers (OHCWs). 58.8% of Ps, 5.8% of Ns, & 27.0% of OHCWs were male. The median age was 36-40 years for Ps & 41-45 for Ns & OHCWs. The median years since graduation was 6-10 for Ps & OHCWs & 11-20 for Ns. Respondents reported having had adequate training in HH (98.2% Ns; 91.4% Ps; 97.1% OHCWs) & knowing indications for performing HH (95.3% Ns; 86.2% Ps; 91.2% OHCWs). Most respondents identified these indications for HH: “before direct contact with patients” (Ns 98.7%; Ps 97.1%; OHCWs 93.1%), “after direct contact with patients” (Ns 99.2%; Ps 97.4%; OHCWs 90.0%;), & “after removing gloves” (Ns 99.0%; Ps 90.0%; OHCWs 90.6%;). Ns (97.0%) were more likely than Ps (90.3%) or OHCWs (90.5%) to rate HH efficacy for preventing HAI as 4 or 5 (5 = extremely effective) (p ≤ .0001 both comparisons). Ns (76.3%) were more likely than Ps (66.2%) or OHCWs (59.5%) to rate HAI severity as 4 or 5 (5 = extremely severe; Ns vs. Ps p = .0005; Ns vs. OHCWs p ≤ .0001; Ps vs. OHCWs p = .08). Ps were least likely to believe that they would acquire an infection from a patient (Ps vs. OHCWs, p = .0004; Ps vs. Ns p < .0001; OHCWs vs. Ns p = .60). Ps were less likely than others to report that their HH adherence was ≥ 90% (86.2% OHCWs; 81.2% Ns; 70.0% Ps). All groups agreed that the 2 most important reasons for non-adherence with HH were “they forget to do it” & “they don’t have substantial contact with the patient or with anything in the patient’s room” & that the 2 most important measures for improving HH would be signs posted at patients’ doorways” & “knowing current unit-specific infection rates.” Ps were least likely to think their colleagues or the person with the strongest influence on their professional attitudes wanted them to perform good HH (P ≤ .0001). However, Ps (55.2%) were as likely as Ns (51.1%) & OHCWs (50.0%) to report that their HH performance affected their colleagues’ behavior.

Conclusions:
OHCWs, Ns, & Pns identified indications for proper HH. Self-reported HH adherence rates for 13% to 30% of respondents were < 90%. Respondents did not think they needed training in HH but felt reminders at the point of care to perform HH & reports of HAI rates would improve HH performance. Ps were less likely than Ns or OHCWs to think that the person who most influenced their professional attitudes cared about how they practiced HH, indicating that Ps’ mentors may be less likely to be role models for HH & to teach their trainees that HH is important than are mentors for Ns or for OHCWs.