Predicting hand hygiene among Iranian health care workers using the theory of planned behavior

This study was conducted to identify significant predictors of handwashing associated with hospital elective (clean) and hospital inherent (dirty) contacts.

This cross-sectional survey of 1,700 health care workers was based on the theory of planned behavior. Data were aggregated into components according to the theory and tested for predictors of hospital elective and hospital inherent handwashing using multiple logistic regression analysis. The α value was set at 0.05, and odds ratios (ORs) for significant predictors were adjusted by interquartile range. All wards studied were in private and government hospitals associated with the University of Medical Sciences, Shiraz, Iran between April and September 2008.

Of the 1,200 healthcare workers surveyed 1,077 (90%), of whom 83% were nurses, returned a completed survey. Hospital elective handwashing practice was positively influenced by community elective practice (adjusted OR [aOR], 2.1; P < .000), hospital inherent practice (aOR, 1.6; P < .000), perception that handwashing required little effort (aOR, 1.1; P = .039), and subjective norms (nursing peers) (aOR, 1.1; P = .025) and negatively influenced by poor attitudes regarding handwashing (aOR, 0.91; P = .01). Hospital inherent handwashing practice was positively influenced by hospital elective practice (aOR 2.5; P < .000), community inherent practice (aOR, 1.5; P = .001), subjective norms (infection control practitioners) (aOR, 1.4; P = .001, and attitudes (aOR, 1.1; P = .001) and negatively influenced by poor subjective norms (nurses) (aOR, 0.74; P < .000).

Community-based handwashing practices exerted a strong influence on handwashing compliance in the hospital. Given this interdependence between community and hospital handwashing, a campaign to improve awareness of the benefit of community handwashing may improve clinicians' compliance.