Understanding hand hygiene behaviour in the intensive care unit to inform interventions: an interview study

Area of Science:

• Healthcare quality improvement
• Infection control
• Behavioral science in medicine

Background:

• Hand hygiene (HH) compliance is critical for infection control but remains a significant challenge in healthcare settings.
• Understanding the factors influencing HH behaviors is essential for developing effective interventions.

Purpose of the Study:

• To explore barriers and enablers of hand hygiene behaviors in an intensive care unit (ICU).
• To utilize the Capability, Opportunity, Motivation, and Behavior (COM-B) model and Theoretical Domains Framework (TDF) to inform intervention design.

Main Methods:

• Semi-structured interviews were conducted with 26 ICU staff members, including nurses and anaesthetists.
• Interviews were guided by the COM-B model to systematically assess factors influencing hand hygiene.

Main Results:

• Staff expressed high confidence in their capability and knowledge regarding hand hygiene.
• Social influence, particularly from nurses, and motivation were identified as key factors in HH compliance.
• Recommendations include targeted HH training with individualized feedback, leadership modeling of behaviors, and adequate staffing.

Conclusions:

• Behavioral science frameworks effectively elucidate HH behaviors in ICUs.
• Tailored interventions based on a deep understanding of unit-specific barriers and enablers can significantly improve HH compliance.