Bopp Tamara C, Strässle Yvonne, Wyler Colette, Meier Marie-Theres, Clack Lauren, Zingg Walter, Fontijn Jehudith R, Wolfensberger Aline
Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
Department of Neonatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
Infect Control Hosp Epidemiol. 2025 May 16;46(7):1-9. doi: 10.1017/ice.2025.82.
Hand hygiene is effective to prevent transmission of pathogens and healthcare-associated infections. Despite efforts by hospitals to improve hand hygiene adherence among healthcare practitioners (HCP), adherence in neonatology wards is often limited.
Identifying determinants, i.e., facilitators and barriers, to hand hygiene adherence among frontline HCP in neonatology.
Qualitative implementation research study.
Department of Neonatology of the University Hospital Zurich, Switzerland.
Semi-structured interviews with frontline HCP and Infection Prevention and Control (IPC) experts were conducted in November 2022. Interviews were coded deductively according to the Theoretical Domains Framework (TDF) and the Capability, Opportunity, Motivation and Behavior model (COM-B), and inductively to capture nuances in the data. Determinants whose addressing was perceived to likely improve hand hygiene adherence in the current setting were rated as "high priority".
A total of 42 interviews were conducted, 27 (64%) with nurses, six (14%) with physicians, four (10%) with other professions, and five (12%) with IPC experts. Sixteen determinants were identified, twelve of which were high-priority, four in each COM-B domain. Knowledge, attention control, planning workflows, and habits & automatisms were found in "Capability," workload & emergencies, invisibility of germs, role models, and being observed in "Opportunity," and bad conscience, experience consequences of (non-) adherence, self-reflection, and intention to adhere to hand hygiene in "Motivation."
DISCUSSION/CONCLUSION: Facilitators from all COM-B domains and barriers from "Capability" and "Opportunity" influence hand hygiene behavior in neonatology settings. Our findings can now inform interventions to improving hand hygiene adherence in neonatal settings.
手部卫生对于预防病原体传播和医疗保健相关感染有效。尽管医院努力提高医护人员（HCP）对手部卫生的依从性，但新生儿病房的依从性往往有限。
确定新生儿科一线医护人员手部卫生依从性的决定因素，即促进因素和障碍。
定性实施研究。
瑞士苏黎世大学医院新生儿科。
2022年11月对一线医护人员和感染预防与控制（IPC）专家进行了半结构化访谈。访谈根据理论领域框架（TDF）和能力、机会、动机和行为模型（COM-B）进行演绎编码，并进行归纳编码以捕捉数据中的细微差别。那些在当前环境中被认为解决后可能会提高手部卫生依从性的决定因素被评为“高度优先”。
共进行了42次访谈，其中27次（64%）是与护士进行的，6次（14%）是与医生进行的，4次（10%）是与其他职业进行的，5次（12%）是与IPC专家进行的。确定了16个决定因素，其中12个是高度优先的，每个COM-B领域各有4个。在“能力”方面发现了知识、注意力控制、工作流程规划和习惯与自动化；在“机会”方面发现了工作量与紧急情况、细菌不可见性、榜样作用和被观察情况；在“动机”方面发现了内疚感、（不）依从的经验后果、自我反思以及坚持手部卫生的意图。
讨论/结论：所有COM-B领域的促进因素以及“能力”和“机会”方面的障碍都会影响新生儿科环境中的手部卫生行为。我们的研究结果现在可以为改善新生儿科环境中手部卫生依从性的干预措施提供参考。
