Understanding healthcare staff’s hand hygiene adherence: A theory-driven approach

Literature Review: Healthcare staff’s hand hygiene adherence has been associated with reduced healthcare-associated infection rates. Addressing poor adherence is therefore imperative. The use of psychological theory in hand hygiene research is lacking. A systematic review was conducted of the application and efficacy of the theory of planned behaviour to understanding healthcare staff’s hand hygiene. Five databases were searched yielding nine relevant articles. The amount of variance accounted for across studies varied widely, explaining 35-70% of intention and 15-79% of actual behaviour. Current methodological limitations and heterogeneity of research aims limit the conclusions that can be drawn and inhibit an overall goodness-of-fit statistic being calculated. A revised model of the theory in relation to hand hygiene is proposed and salient issues discussed. Research Report: Despite a wealth of research, our understanding of hand hygiene adherence and how to improve it remains poor. Reasons for this may lie in an overreliance on self-report methodologies and a lack of reference to psychological theory (Edwards et al. 2012). Therefore a theory-informed, mixed-methods investigation was undertaken to identify key factors influencing nursing staff’s hand hygiene adherence within Critical Care. Three methodologies were triangulated and used concurrently: a) a quantitative questionnaire; b) a Delphi consensus approach; and c) ward observations. ‘Memory, Attention and Decision Processes’ were clearly highlighted as key to staff’s hand hygiene across all three methodologies, whilst ‘Environmental Context and Resources’ were highlighted across the two self-report methodologies. Findings suggest that interventions should prioritise addressing factors related to ‘Memory, Attention and Decision Processes’. ‘Environmental Context and Resources’ were also deemed important but appeared to reflect staff’s perception of busyness and difficulties prioritising hand hygiene rather than externally visible factors. Limitations and implications are discussed. Critical Appraisal: The researcher’s account of the research process, reflections, learning points and critique are offered.