Major ArticlesUnderstanding adherence to hand hygiene recommendations: The theory of planned behavior*,**
Section snippets
Setting
Intensive care and postintensive care units are settings in which hand hygiene is especially important because patients are vulnerable to nosocomial infections. Severity of their illnesses, presence of a high number of invasive devices, and frequent physical contact with caregivers are common risk factors. From July 1996 through October 1997 data were collected on hand hygiene practices and attitudes of nurses toward hand hygiene. These nurses worked in adult medical/surgical intensive care
Results
Hand hygiene observation was completed for all enrolled participants (70 critical care and 50 postcritical care nurses). Nurses were observed on all shifts: 69 (57%) during the day, 26 (22%) during the evening, and 25 (21%) at night. Observation time for the entire study totaled approximately 215 hours; most observation periods (n = 80; 66%) lasted 61 to 120 minutes.
Discussion
Hand hygiene is acknowledged to be a fundamental practice in providing safe health care to patients; however, the motivational issues involved in adherence to guidelines have not been elucidated. Progress in explaining and understanding variation in adherence to hand hygiene recommendations has been impeded by lack of a theoretical perspective. Intervention studies with a cognitive focus designed primarily to increase HCW knowledge about handwashing have generally been unsuccessful at improving
Acknowledgements
We wish to thank Laura Duckett, PhD, RN, for her invaluable support and guidance. We also thank Sharon Ridgeway, PhD, RN, and Nancy Van Drunen, BS, RN, for assistance with data collection.
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Supported in part by grants from the Georgetown University School of Nursing, the 3M Enrich Program, and the Association of Professionals in Infection Control Research Foundation.
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Reprint requests: Carol A. O'Boyle, PhD, RN, Assistant Professor, School of Nursing, 6-101 Weaver-Densford Hall, University of Minnesota, 308 Harvard St, SE, Minneapolis, MN 55455-0342.