Discipline of General Practice, School of Medicine, National University of Ireland Galway, Co. Galway, Ireland.
Irish Centre for Applied Patient Safety and Simulation, School of Medicine, National University of Ireland Galway, Co. Galway, Ireland.
BMC Health Serv Res. 2020 Apr 25;20(1):353. doi: 10.1186/s12913-020-05215-4.
Improving hand hygiene (HH) compliance is one of the most important, but elusive, goals of infection control. The purpose of this study was to use the capability (C), opportunity (O), motivation (M), and behaviour (B; COM-B) model and the theoretical domains framework (TDF) to gain an understanding of the barriers and enablers of HH behaviours in an intensive care unit (ICU) in order to identify specific interventions to improve HH compliance.
A semi-structured interview schedule was developed based upon the COM-B model. This schedule was used to interview a total of 26 ICU staff: 12 ICU nurses, 11 anaesthetic specialist registrars, and three anaesthetic senior house officers.
Participants were confident in their capabilities to carry out appropriate HH behaviours. The vast majority of participants reported having the necessary knowledge and skills, and believed they were capable of carrying out appropriate HH behaviours. Social influence was regarded as being important in encouraging HH compliance by the interviewees- particularly by nurses. The participants were motivated to carry out HH behaviours, and it was recognised that HH was an important part of their job and is important in preventing infection. It is recommended that staff are provided with targeted HH training, in which individuals receive direct and individualised feedback on actual performance and are provided guidance on how to address deficiencies in HH compliance at the bedside at the time at which the HH behaviour is performed. Modelling of appropriate HH behaviours by senior leaders is also suggested, particularly by senior doctors. Finally, appropriate levels of staffing are a factor that must be considered if HH compliance is to be improved.
This study has demonstrated that short interviews with ICU staff, founded on appropriate behavioural change frameworks, can provide an understanding of HH behaviour. This understanding can then be applied to design interventions appropriately tailored to the needs of a specific unit, which will have an increased likelihood of improving HH compliance.
提高手卫生（HH）依从性是感染控制最重要但难以实现的目标之一。本研究旨在使用能力（C）、机会（O）、动机（M）和行为（B；COM-B）模型以及理论领域框架（TDF），了解重症监护病房（ICU）中 HH 行为的障碍和促进因素，以确定具体的干预措施来提高 HH 依从性。
根据 COM-B 模型制定了半结构式访谈计划。该计划共采访了 26 名 ICU 工作人员：12 名 ICU 护士、11 名麻醉专科住院医师和 3 名麻醉高级住院医师。
参与者对自己执行适当 HH 行为的能力有信心。绝大多数参与者报告说他们具备必要的知识和技能，并且相信他们能够执行适当的 HH 行为。受访者认为社会影响在鼓励 HH 依从性方面很重要，尤其是护士。参与者有动力执行 HH 行为，并且认识到 HH 是他们工作的重要组成部分，对于预防感染非常重要。建议为员工提供有针对性的 HH 培训，在培训中，个人会收到关于实际表现的直接和个性化反馈，并在执行 HH 行为时提供有关如何解决 HH 依从性不足的床边指导。还建议由高级领导为员工树立适当 HH 行为的榜样，尤其是医生。最后，要提高 HH 依从性，就必须考虑适当的人员配置水平。
本研究表明，基于适当的行为改变框架，对 ICU 工作人员进行简短的访谈可以了解 HH 行为。然后可以将这种理解应用于设计适合特定单位需求的干预措施，这将增加提高 HH 依从性的可能性。
