Nurses' motivation to wash their hands: A standardized measurement approach

doi:10.1053/apnr.2001.24412

Applied Nursing Research

Volume 14, Issue 3, August 2001, Pages 136-145

https://doi.org/10.1053/apnr.2001.24412 Get rights and content

Abstract

Handwashing is a simple procedure that is critical to prevention and control of infections, yet many health care workers (HCWs) do not practice hand hygiene according to recommended guidelines. The Handwashing Assessment Inventory (HAI) is a self-report instrument that is designed to measure the motivational schema of HCWs for handwashing.

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Cited by (44)

Hand-hygiene-related clinical trials reported between 2014 and 2020: a comprehensive systematic review
2021, Journal of Hospital Infection
There is general consensus that hand hygiene is the most effective way to prevent healthcare-associated infections. However, low rates of compliance amongst healthcare workers have been reported globally. The coronavirus disease 2019 pandemic has further emphasized the need for global improvement in hand hygiene compliance by healthcare workers.
This comprehensive systematic review provides an up-to-date compilation of clinical trials, reported between 2014 and 2020, assessing hand hygiene interventions in order to inform healthcare leaders and practitioners regarding approaches to reduce healthcare-associated infections using hand hygiene.
CINAHL, Cochrane, EMbase, Medline, PubMed and Web of Science databases were searched for clinical trials published between March 2014 and December 2020 on the topic of hand hygiene compliance among healthcare workers. In total, 332 papers were identified from these searches, of which 57 studies met the inclusion criteria.
Forty-five of the 57 studies (79%) included in this review were conducted in Asia, Europe and the USA. The large majority of these clinical trials were conducted in acute care facilities, including hospital wards and intensive care facilities. Nurses represented the largest group of healthcare workers studied (44 studies, 77%), followed by physicians (41 studies, 72%). Thirty-six studies (63%) adopted the World Health Organization's multi-modal framework or a variation of this framework, and many of them recorded hand hygiene opportunities at each of the ‘Five Moments’. However, recording of hand hygiene technique was not common.
Both single intervention and multi-modal hand hygiene strategies can achieve modest-to-moderate improvements in hand hygiene compliance among healthcare workers.
Investigating the effect of preparation for and participation in a hand-sanitizing relay on nursing students’ ability to recall the WHO 6-step hand hygiene technique
2018, American Journal of Infection Control
This study explored whether preparation for a hand-sanitizing relay affected nursing students' ability to recall, 12 months later, the World Health Organization 6-step hand hygiene technique. No significant difference was observed in recall between those who participated in the relay and those who did not (P = .736). The most frequently missed step was Step 3 (palm to palm with fingers interlaced). Our results suggest that regular feedback may be an important additional component in future interventions.
An elicitation study of critical care nurses’ salient hand hygiene beliefs
2017, Intensive and Critical Care Nursing
Citation Excerpt :
Transferability was established by including two distinct institutions of varying size, mission, and geographical setting. Additionally, participants’ HH belief responses were corroborated with previous literature findings (Jenner et al., 2002; O'Boyle et al., 2001; Pittet, 2004; White et al., 2015). To enhance dependability, the investigators met for periodic debriefings throughout the data collection period and periodic code checks during data analysis.
To describe critical care nurses’ hand hygiene attitudinal, normative referent, and control beliefs.
Hand hygiene is the primary strategy to prevent healthcare-associated infections. Social influence is an underdeveloped hand hygiene strategy.
This qualitative descriptive study was conducted with 25 ICU nurses in the southeastern United States. Data were collected using the Nurses’ Salient Belief Instrument.
Thematic analysis generated four themes: Hand Hygiene is Protective; Nurses look to Nurses; Time-related Concerns; and Convenience is Essential.
Nurses look to nurses as hand hygiene referents and believe hand hygiene is a protective behaviour that requires time and functional equipment.
Influencing factors on hand hygiene behavior of nursing students based on theory of planned behavior: A descriptive survey study
2016, Nurse Education Today
Hand hygiene is the single most important measure to prevent transmission of infection, but the compliance rate of healthcare workers is relatively low.
This study was conducted to identify the knowledge, beliefs, behavior, and affecting factors about hand hygiene among nursing students.
A descriptive survey study.
The study was carried out in two South Korean nursing schools.
A total 208 nursing students participated in this study.
Questionnaires were used to collect data.
The percentage of correct answers in the survey section concerning hand hygiene knowledge was 68.1%. No significant difference in the knowledge, behavioral beliefs, normative beliefs, or control beliefs data was found related to general characteristics. Behavioral beliefs correlated with normative beliefs (r = .25, p < .001) and hand hygiene behavior (r = .17, p = .017), and control beliefs correlated with hand hygiene behavior (r = .18, p = .010).
The results suggest that knowledge is not enough to change the beliefs related to hand hygiene; positive behavioral beliefs and strong control beliefs are also needed to increase hand hygiene compliance.
Use of hand-held computers to determine the relative contribution of different cognitive, attitudinal, social, and organizational factors on health care workers' decision to decontaminate hands
2014, American Journal of Infection Control
Citation Excerpt :
Jenner et al25 found that observed practice was unrelated to self-reports of behavior and to their professed intentions. Similarly, in 1 large study, neither the reported cognitive factors nor intention predicted observed hand hygiene practice.24 Whitby et al5 summarize that hand hygiene research has found that intention to wash hands did not predict observed handwashing behavior and that the relationship between intention and self-reported estimates of compliance is weak.
Observational and survey methods have limitations in measuring hand hygiene behavior. The ability of a personal digital assistant to anonymously gather data at the point of decision making could potentially address these.
Participants were provided with a personal digital assistant to be used for three 2-hour periods and asked to rate influential factors of the Health Belief Model (HBM). Participants were also required to enter what they thought they should do and what they actually did.
A total of 741 hand hygiene opportunities was recorded. All HBM constructs were higher for hand hygiene opportunities where there was compliance versus noncompliance, with a significant difference for patient pressure, my risk, perceived benefits, perceived seriousness, and availability of good facilities. Only 20% of doctors, 28% of nurses, and 66% of physiotherapists always did what they thought they should. There was no correlation between self-reported and actual compliance.
The HBM appeared to be a useful theoretical framework. Surprisingly, participants rated their compliance as high despite having recorded instances where they did not do what they thought they should do. This suggests that staff may have a different definition of compliance than strict observation of the guidelines.
Sociocognitive determinants of observed and self-reported compliance to hand hygiene guidelines in child day care centers
2013, American Journal of Infection Control
Citation Excerpt :
However, the results of a systematic review on HH in hospitals remained inconclusive concerning the relationship between knowledge and HH behavior.9 Previous studies have shown an association/correlation between perceived behavioral control and self-reported HH behavior of nurses22,31 and between habit and self-reported HH behavior of physicians and nurses.22 Habit has also been identified as a significant predictor of observed HH behavior in Kenyan households.32
Although hand hygiene (HH) has proven to be an effective measure to prevent infections, HH compliance is generally low. We assessed sociocognitive determinants of caregivers’ HH behavior in child day care centers (DCCs) to develop an effective HH intervention.
Caregivers’ compliance to HH guidelines was observed. Observed caregivers completed a questionnaire on self-reported HH compliance, sociocognitive determinants, and sociodemographic data. To determine sociocognitive determinants of observed compliance, multilevel logistic regression analyses were performed. Self-reported compliance was analyzed using linear regression.
In 122 participating DCCs, 350 caregivers and 2,003 HH opportunities were observed. The response rate on the questionnaire was 100%. Overall observed HH compliance was 42% (841/2,003). Overall mean self-reported HH compliance was 8.7 (scale, 0-10). Guideline knowledge (odds ratio [OR], 1.27; 95% confidence interval [CI]: 1.03-1.56) and perceived disease severity (OR, 0.93; 95% CI: 0.87-0.99) were associated with observed compliance. Guideline knowledge (β = 0.31; P < .001), guideline awareness (β = 0.16; P < .001), perceived importance (β = 0.20; P = .004), perceived behavioral control (β = 0.24; P < .001), habit (β = 0.27; P < .001), and children at home (β = 0.30; P = .002) were associated with self-reported compliance.
When developing HH interventions for caregivers in DCCs, improving guideline knowledge should be considered as this was associated with both observed and self-reported HH compliance. Furthermore, increasing guideline awareness, perceived importance, and perceived behavioral control can contribute to better HH, as well as making HH a habitual behavior.

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Original ArticlesNurses' motivation to wash their hands: A standardized measurement approach

Abstract

Original Articles
Nurses' motivation to wash their hands: A standardized measurement approach