Decision-Making, Lack of Knowledge Tank Hand Hygiene Compliance

To understand reasons for hand hygiene noncompliance, just ask noncompliant healthcare workers. This is the approach researchers took in a study whose results have been published in the American Journal of Infection Control.

Researchers observed healthcare workers during their daily routines and collected real-time explanations of noncompliance directly after a healthcare worker missed a hand hygiene opportunity. Responses were then sorted according to the Theory Domains Framework, a heuristic to organize components of behavior change research.

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Of the 207 explanations for skipped hand hygiene, 69 percent were attributable to reasons of memory, attention or decision-making and knowledge. Of the memory/attention/decision-making category (44 percent), healthcare workers cited memory, loss of concentration and distraction by interruptions as factors contributing to noncompliance. Of the knowledge category (25 percent), healthcare workers citied lack of knowledge of specific hand hygiene indications.

Of the 10 remaining domains, none accounted for more than 9 percent of the remaining explanations.

The researchers concluded hand hygiene compliance could benefit from interventions targeted toward automatic associative learning and conscious decision-making. Ensuring healthcare workers are properly educated on when handwashing is appropriate is also key, they said.

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