Dalla Lana School of Public Health, University of Toronto, Ontario, Canada.
Infect Control Hosp Epidemiol. 2010 Feb;31(2):144-50. doi: 10.1086/649792.
To understand the behavioral determinants of hand hygiene in our hospital.
Qualitative study based on 17 focus groups.
Mount Sinai Hospital, an acute care tertiary hospital affiliated with the University of Toronto.
We recruited 153 healthcare workers (HCWs) representing all major patient care job categories.
Focus group discussions were transcribed verbatim. Thematic analysis was independently conducted by 3 investigators.
Participants reported that the realities of their workload (eg, urgent care and interruptions) make complete adherence to hand hygiene impossible. The guidelines were described as overly conservative, and participants expressed that their judgement is adequate to determine when to perform hand hygiene. Discussions revealed gaps in knowledge among participants; most participants expressed interest in more information and education. Participants reported self-protection as the primary reason for the performance of hand hygiene, and many admitted to prolonged glove use because it gave them a sense of protection. Limited access to hand hygiene products was a source of frustration, as was confusion related to hospital equipment as potential vehicles for transmission of infection. Participants said that they noticed other HCWs' adherence and reported that others HCWs' hygiene practices influenced their own attitudes and practices. In particular, HCWs perceive physicians as role models; physicians, however, do not see themselves as such.
Our results confirm previous findings that hand hygiene is practiced for personal protection, that limited access to supplies is a barrier, and that role models and a sense of team effort encourage hand hygiene. Educating HCWs on how to manage workload with guideline adherence and addressing contaminated hospital equipment may improve compliance.
了解我院手卫生行为决定因素。
基于 17 个焦点小组的定性研究。
西奈山医院，多伦多大学附属医院，一家急症护理三级医院。
我们招募了 153 名代表所有主要患者护理工作类别的医护人员（HCWs）。
焦点小组讨论逐字记录。三位研究人员分别进行主题分析。
参与者报告说，他们的工作量现实（例如，紧急护理和中断）使得完全遵守手卫生规范是不可能的。该指南被描述为过于保守，参与者表示他们的判断足以确定何时进行手卫生。讨论揭示了参与者之间的知识差距；大多数参与者表示有兴趣获得更多信息和教育。参与者将自我保护作为执行手卫生的主要原因，许多人承认长时间戴手套，因为这让他们感到受到保护。手卫生产品的有限供应是一个令人沮丧的问题，与医院设备相关的感染传播潜在媒介的困惑也是一个问题。参与者表示，他们注意到其他 HCWs 的遵守情况，并报告说其他 HCWs 的卫生习惯影响了他们自己的态度和行为。特别是，HCWs 将医生视为榜样；然而，医生并不认为自己是榜样。
我们的研究结果证实了先前的研究结果，即手卫生是为了个人保护而进行的，供应有限是一个障碍，而榜样和团队合作意识鼓励手卫生。教育 HCWs 如何在遵守指南的情况下管理工作量，并解决受污染的医院设备问题，可能会提高依从性。
