Healthcare workers' hand decontamination practices: compliance with recommended guidelines

Aim. This paper reports a study of healthcare workers' handwashing/hand hygiene practices from a behavioural perspective. Background. Hospital acquired infection poses a very real and serious threat to all who are admitted to hospital. Pathogens are readily transmitted on healthcare workers' hands, and hand hygiene substantially reduces this transmission. Evidence-based guidelines for healthcare workers' hand hygiene practices exist, but compliance with these is internationally low. Methods. A quasi-experimental design with a convenient sample was used. The Predisposing, Reinforcing, Enabling Constructs in Educational Diagnosis and Evaluation Health Education Theory was used as the theoretical framework, and the data were collected in 2001. Healthcare workers' handwashing practices (observation of behaviour, n = 314) and their predisposition (attitudes, beliefs and knowledge) towards compliance with hand hygiene guidelines (questionnaire, n = 62) were studied. Nurses, doctors, physiotherapists and care assistants involved in direct patient care in the study unit participated in the study. The interventional hand hygiene programme aimed to predispose healthcare workers to adopt hand hygiene behaviour (poster campaign and educational handout), reinforce (feedback on pretest results) and enable the behaviour (provision of an alcohol hand rub beside each patients bedside). Results. Implementation of the multifaceted interventional behavioural hand hygiene programme resulted in an overall improvement in compliance with hand hygiene guidelines (51-83%, P < 0-001). Furthermore, healthcare workers believed that their skin condition improved (P < 0-001). An increase in knowledge about handwashing guidelines was also found. Conclusions. In order to be effective, efforts to improve compliance with handwashing guidelines must be multifaceted. Alcohol hand rubs (with emollients) need to be provided at each patient's bedside. Issues surrounding healthcare workers' skin irritation need to be addressed urgently.