Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Implementation Science
Published in: Implementation Science 1/2013

Open Access 01-12-2013 | Study protocol

Improving physician hand hygiene compliance using behavioural theories: a study protocol

Authors: Janet E Squires, Kathryn N Suh, Stefanie Linklater, Natalie Bruce, Kathleen Gartke, Ian D Graham, Alan Karovitch, Joanne Read, Virginia Roth, Karen Stockton, Emma Tibbo, Kent Woodhall, Jim Worthington, Jeremy M Grimshaw

Published in: Implementation Science | Issue 1/2013

Login to get access

Abstract

Background

Healthcare-associated infections affect 10% of patients in Canadian acute-care hospitals and are significant and preventable causes of morbidity and mortality among hospitalized patients. Hand hygiene is among the simplest and most effective preventive measures to reduce these infections. However, compliance with hand hygiene among healthcare workers, specifically among physicians, is consistently suboptimal. We aim to first identify the barriers and enablers to physician hand hygiene compliance, and then to develop and pilot a theory-based knowledge translation intervention to increase physicians’ compliance with best hand hygiene practice.

Design

The study consists of three phases. In Phase 1, we will identify barriers and enablers to hand hygiene compliance by physicians. This will include: key informant interviews with physicians and residents using a structured interview guide, informed by the Theoretical Domains Framework; nonparticipant observation of physician/resident hand hygiene audit sessions; and focus groups with hand hygiene experts. In Phase 2, we will conduct intervention mapping to develop a theory-based knowledge translation intervention to improve physician hand hygiene compliance. Finally, in Phase 3, we will pilot the knowledge translation intervention in four patient care units.

Discussion

In this study, we will use a behavioural theory approach to obtain a better understanding of the barriers and enablers to physician hand hygiene compliance. This will provide a comprehensive framework on which to develop knowledge translation interventions that may be more successful in improving hand hygiene practice. Upon completion of this study, we will refine the piloted knowledge translation intervention so it can be tested in a multi-site cluster randomized controlled trial.
Appendix
Available only for authorised users
Literature
1.
World Health Organization Patient Safety: WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety Challenge, Clean Care is Safer Care. 2009, Geneva Switzerland: World Health Organization
2.
Gravel D, Taylor G, Ofner M, Johnston L, Loeb M, Roth VR, Stegenga J, Bryce E: Point prevalence survey for healthcare-associated infections within Canadian adult acute-care hospitals. J Hosp Infect. 2007, 66: 243-248. 10.1016/j.jhin.2007.04.008.CrossRefPubMed
3.
Baker GR, Norton PG, Flintoft V, Blais R, Brown A, Cox J, Etchells E, Ghali WA, Hebert P, Majumdar SR, O’Beirne M, Palacios-Derflingher L, Reid RJ, Sheps S, Tamblyn R: The Canadian Adverse Events Study: The incidence of adverse events among hospital patients in Canada. CMAJ. 2004, 170: 1678-1686.CrossRefPubMedPubMedCentral
4.
World Health Organization Patient Safety: WHO Guidelines on Hand Hygiene in Health Care: a Summary. 2009, Geneva, Switzerland: World Health Organization
5.
Health Canada Infection Control Guidelines: Handwashing, Cleaning, Disinfection and Sterilization in Health Care. Can Comm Dis Rep. 1998, 24S8: 1-66.
6.
Boyce JM, Pittett D: Guideline for hand hygiene in health-care settings: recommendations of the healthcare infection control practices advisory committee and the HICPAC/SHEA/APIC/IDSA hand hygiene task force. Infection Control and Hospital Epidemiology. 2002, 23: 1-45.CrossRef
7.
8.
Larson E, Association for Professionals in Infection Control and Epidemiology 1992–1993, 1994 APIC Guidelines Committee: APIC guideline for handwashing and hand antisepsis in health care settings. Am J Infect Control. 1995, 23: 251-269. 10.1016/0196-6553(95)90070-5.CrossRefPubMed
9.
Public Health Ontario: Just Clean Your Hands - Your 4 Moments for Hand Hygiene. 2011, Public Health Ontario: Ontario Agency for Health Protection and Promotion, 7-8-2012
10.
11.
Bischoff WE, Reynolds TM, Sessler CN, Edmond MB, Wenzel RP: Handwashing complicance by health care workers. The impact of introducing an accessible, alcohol-based hand antiseptic. Arch Intern Med. 2000, 160: 1017-1021. 10.1001/archinte.160.7.1017.CrossRefPubMed
12.
Earl ML, Jackson MM, Rickman LS: Improved rates of compliance with hand antisepsis guidelines: a three phase observational study. Am J Nurs. 2001, 101: 26-33.CrossRefPubMed
13.
Moongtui W, Gauthier D, Turner J: Using peer feedback to improve handwashing and glove usage among Thai health care workers. Am J Infect Control. 2000, 28: 365-369. 10.1067/mic.2000.107885.CrossRefPubMed
14.
Muto CA, Sistrom MG, Farr BM: Hand hygiene rates unaffected by installation of dispensers of a rapidly acting hand antiseptic. Am J Infect Control. 2000, 28: 273-276. 10.1067/mic.2000.103242.CrossRefPubMed
15.
Rosenthal VD, McCormick RD, Guzman S, Villamayor C, Orellano PW: Effect of education and performance feedback on handwashing: the benefit of administrative support in Argentinian hospitals. Am J Infect Control. 2003, 31: 85-92. 10.1067/mic.2003.63.CrossRefPubMed
16.
Kaplan LM, McGuckin M: Increasing handwashing compliance with more accessible sinks. Infect Control. 1986, 7: 408-410.PubMed
17.
Larson EL, McGinley KJ, Foglia A, Leyden JJ, Boland N, Larson J, Altobelli LC, Salazar-Lindo E: Handwashing practices and resistance and density of bacterial hand flora on two pediatric units in Lima, Peru. Am J Infect Control. 1992, 20: 65-72. 10.1016/S0196-6553(05)80003-3.CrossRefPubMed
18.
Pittet D, Mourouga P, Perneger TV: Compliance with handwashing in a teaching hospital. Infection Control Program. Ann Intern Med. 1999, 130: 126-130.CrossRefPubMed
19.
20.
Gould D, Moralejo D, Drey N, Chudleigh J: Interventions to improve hand hygiene compliance in patient care. Cochrane Database of Systematic Reviews. 2010, CD005186
21.
Gould DJ, Chudleigh JH, Moralejo D, Drey N: Interventions to improve hand hygiene compliance in patient care. Cochrane Database of Systematic Reviews. 2007
22.
23.
Chagpar A, Banez C, Lopez R, Cafazzo JA: Challenges of Hand Hygiene in Healthcare: The development of a tool kit to create supportive processes and environments. Healthcare Quarterly. 2010, 13: 59-66.CrossRefPubMed
24.
25.
Boscart VM, Fernie GR, Lee JH, Jaglal SB: Using psychological theory to inform methods to optimize the implementation of a hand hygiene intervention. Implement Sci. 2012, 7: 77-10.1186/1748-5908-7-77.CrossRefPubMedPubMedCentral
26.
27.
Wharton K, Karlowicz G: Barriers to full compliance with hand-washing guidelines in a neonatal intensive care unite 1487. Pediatr Res. 1998, 43: 254-CrossRef
28.
Askarian M, Mirzaei K, Mundy LM, McLaws ML: Assessment of knowledge, attitudes, and practices regarding isolation precautions among Iranian healthcare workers. Infection Control & Hospital Epidemiology. 2005, 26: 105-108. 10.1086/502495.CrossRef
29.
Stein AD, Makarawo TP, Ahmad MF: A survey of doctors’ and nurses’ knowledge, attitudes and compliance with infection control guidelines in Birmingham teaching hospitals. J Hosp Infect. 2003, 54: 68-73. 10.1016/S0195-6701(03)00074-4.CrossRefPubMed
30.
Evanoff B, Kim L, Mutha S, Jeffe D, Haase C, Andereck D, Fraser V: Compliance with universal precautions among emergency department personnel caring for trauma patients. Ann Emerg Med. 1999, 33: 160-165. 10.1016/S0196-0644(99)70389-6.CrossRefPubMed
31.
Pittet D, Simon A, Hugonnet S, Pessoa-Silva CL, Sauvan V, Perneger TV: Hand hygiene among physicians: performance, beliefs, and perceptions. Ann Intern Med. 2004, 141: 1-8.CrossRefPubMed
32.
Berhe M, Edmond MB, Bearman GM: Practices and an assessment of health care workers’ perceptions of compliance with infection control knowledge of nosocomial infections. Am J Infect Control. 2005, 33: 55-57. 10.1016/j.ajic.2004.07.011.CrossRefPubMed
33.
Tibballs J: Teaching hospital medical staff to handwash. The Medical Journal of Australia. 2012, 164: 395-398.
34.
Kelen GD, Green GB, Hexter DA, Fortenberry DC, Taylor E, Fleetwood DH, Sivertson KT: Substantial improvement in compliance with universal precautions in an emergency department following institution of policy. Arch Intern Med. 1991, 151: 2051-2056. 10.1001/archinte.1991.00400100121020.CrossRefPubMed
35.
Moore S, Goodwin H, Grossberg R, Toltzis P: Compliance with universal precautions among pediatric residents. Archives of Pediatrics & Adolescent Medicine. 1998, 152: 554-557.CrossRef
36.
Jang JH, Wu S, Kirzner D, Moore C, Tong A, McCreight L, Stewart R, Green K, McGeer A: Physicians and hand hygiene practice: a focus group study. J Hosp Infect. 2010, 76: 87-89. 10.1016/j.jhin.2010.04.021.CrossRefPubMed
37.
Lankford MG, Zembower TR, Trick WE, Hacek DM, Noskin GA, Peterson LR: Influence of role models and hospital design on hand hygiene of healthcare workers. Emergency Infectious Diseases. 2003, 9: 217-223. 10.3201/eid0902.020249.CrossRef
38.
Cantrell D, Shamriz O, Cohen MJ, Stern Z, Block C, Brezis M: Hand hygiene compliance by physicians: marked heterogeneity due to local culture?. Am J Infect Control. 2009, 37: 301-305. 10.1016/j.ajic.2008.05.001.CrossRefPubMed
39.
Craig P, Dieppe PA, Macintyre S, Michie S, Nazareth I, Petticrew M: Developing and evaluating complex interventions: the new Medical Research Council guidance. Br Med J. 2008, 337: 979-983. 10.1136/bmj.a979.CrossRef
40.
Campbell M, Fitzpatrick R, Haines A, Kinmonth AL, Sandercock P, Spiegelhalter D, Tyrer P: Framework for design and evaluation of complex interventions to improve health. BMJ. 2000, 321: 694-696. 10.1136/bmj.321.7262.694.CrossRefPubMedPubMedCentral
41.
42.
Sandelowski M: Sample size in qualitative research. 1995, 18: 179-183.
43.
Francis J, Johnston M, Robertson C, Glidewell L, Entwistle V, Eccles M, Grimshaw J: What is an adequate sample size? Operationalising data saturation for theory-based interview studies. Psychol Heal. 2010, 25: 1229-1245. 10.1080/08870440903194015.CrossRef
44.
Cane J, O’Connor D, Michie S: Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci. 2012, 7: 37-10.1186/1748-5908-7-37.CrossRefPubMedPubMedCentral
45.
Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A: Making psychological theory useful for implementing evidence based practice: a consensus approach. Quality and Safety in Health Care. 2005, 14: 26-33. 10.1136/qshc.2004.011155.CrossRefPubMedPubMedCentral
46.
French S, Green S, O’Connor D, McKenzie J, Francis J, Michie S, Buchbinder R, Schattner P, Spike N, Grimshaw J: Developing theory-informed behaviour change interventions to implement evidence into practice: a systematic approach using the Theoretical Domains Framework. Implement Sci. 2012, 7: 38-10.1186/1748-5908-7-38.CrossRefPubMedPubMedCentral
47.
Morse JM, Field PA: Qualitative research methods for health professionals. 1995, Thousand Oaks, CA: Sage
48.
Marshall C, Rossman G: Designing Qualitative Research. 1989, Newbury Park: Sage
49.
Crabtree B, Miller W: Doing Qualitative Research. 1992, Newbury Park: Sage
50.
51.
52.
53.
Thompson C, McCaughan D, Cullum N, Sheldon TA, Raynor P: Increasing the visibility of coding decision in team-based qualitative research. Int J Nurs Stud. 2004, 41: 15-20. 10.1016/j.ijnurstu.2003.03.001.CrossRefPubMed
54.
Miles MB, Huberman AM: Qualitative Data Analysis: An Expanded Sourcebook. 1994, Thousand Oaks, CA: Sage
55.
Francis JJ, Stockton C, Eccles MP, Cuthbertson BH, Grimshaw JM, Hyde C: Evidence based selection of theories for designing behaviour change interventions: Using methods based on theoretical construct domains to understans clinicians’ blood transfusion behaviour. Br J Health Psychol. 2009, 14: 625-646. 10.1348/135910708X397025.CrossRefPubMed
56.
Zhang Y, Wildemuth BM: Qualitative analysis of content. Applications of Social Research Methods to Questions in Information and Library Science. 2009, Westport, CT: Libraries Unlimited, 308-319.
57.
Patton MQ: Qualitative evaluation and research methods. 1990, Thousand Oaks, California: Sage Publications, Inc, 2-
58.
van Bokhoven MA, Kok G, Van der Weijden T: Designing a quality improvement intervention: a systematic approach. Quality and Safety in Health Care. 2003, 12: 215-220. 10.1136/qhc.12.3.215.CrossRefPubMedPubMedCentral
59.
Michie S, Johnston M, Francis J, Hardeman W, Eccles M: From theory to intervention: mapping theoretically derived behavioural determinants to behaviour change techniques. Appl Psychol. 2008, 57: 660-680. 10.1111/j.1464-0597.2008.00341.x.CrossRef
60.
Bloor M, Franskland J, Thomas M, Robson K: Focus groups in social research. 2001, London: SageCrossRef
Metadata
Title
Improving physician hand hygiene compliance using behavioural theories: a study protocol
Authors
Janet E Squires
Kathryn N Suh
Stefanie Linklater
Natalie Bruce
Kathleen Gartke
Ian D Graham
Alan Karovitch
Joanne Read
Virginia Roth
Karen Stockton
Emma Tibbo
Kent Woodhall
Jim Worthington
Jeremy M Grimshaw
Publication date
01-12-2013
Publisher
BioMed Central
Published in
Implementation Science / Issue 1/2013
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/1748-5908-8-16

Other articles of this Issue 1/2013

Implementation Science 1/2013 Go to the issue

Methodology

Evaluation of a large-scale weight management program using the consolidated framework for implementation research (CFIR)

Study protocol

Enhanced implementation of low back pain guidelines in general practice: study protocol of a cluster randomised controlled trial

Research

Feedback GAP: pragmatic, cluster-randomized trial of goal setting and action plans to increase the effectiveness of audit and feedback interventions in primary care

Systematic review

Measuring factors affecting implementation of health innovations: a systematic review of structural, organizational, provider, patient, and innovation level measures

Methodology

Development and initial validation of the Influences on Patient Safety Behaviours Questionnaire

Debate

The dynamic sustainability framework: addressing the paradox of sustainment amid ongoing change