Hand hygiene behavior: translating behavioral research into infection control practice

Area of Science:

• Infection Control
• Public Health
• Healthcare Quality Improvement

Background:

• The World Health Organization (WHO) introduced "My Five Moments for Hand Hygiene" (5MHH) in 2009 to standardize hand hygiene (HH) practices.
• Uncertainty exists regarding the actual uptake and adherence to these critical HH recommendations among healthcare workers (HCWs).

Purpose of the Study:

• To prospectively assess healthcare worker (HCW) compliance with the WHO's "My Five Moments for Hand Hygiene" (5MHH) guidelines.
• To investigate factors influencing HCW hand hygiene compliance using behavioral theories.
• To compare self-reported HH compliance with observed behaviors.

Main Methods:

• Prospective observation of 123 HCWs (968 observations) performing "My Five Moments for Hand Hygiene" (5MHH).
• Post-observation surveys administered to consenting HCWs, utilizing constructs from the transtheoretical model (TTM) and theory of planned behavior (TPB).
• Comparison of observed HH compliance rates with self-reported data and theoretical behavioral measures.

Main Results:

• Observed mean HH compliance was 23.2%, significantly lower than the self-reported 82.4%.
• Compliance varied by hospital unit, patient type (immunocompromised), and provider-patient interactions.
• Self-reported adherence to TTM stages and TPB scores correlated with observed and self-reported HH compliance.

Conclusions:

• Observed adherence to "My Five Moments for Hand Hygiene" (5MHH) is influenced by hospital unit and patient encounter type.
• Behavioral measures derived from TTM and TPB show a correlation with hand hygiene commitment.
• Significant discrepancies exist between observed and self-reported hand hygiene compliance among HCWs.