BEHAVIORAL DETERMINANTS OF HAND HYGIENE COMPLIANCE IN INTENSIVE CARE UNITS

Background Although hand hygiene is the most effective measure for preventing cross-infection, overall compliance is poor among health care workers. Objectives To identify and describe predictors and determinants of noncompliance with hand hygiene prescriptions in intensive care unit nurses by means of a questionnaire. Methods A questionnaire based on a behavioral theory model was filled out by 148 nurses working on a 40-bed intensive care unit in a university hospital. Subjects were asked to fill out the 56-item questionnaire twice within a 2- to 6-week period. During this period, no interventions to enforce hand hygiene occurred on the unit. Results Response rate for the test was 73% (108/148); response rate for the retest was 53% (57/108). The mean self-reported compliance rate was 84%. Factor analysis revealed 8 elementary factors potentially associated with compliance. Internal consistency of the scales was acceptable. Intraclass correlation was low (<0.60) for 2 subscales but acceptable (>0.60) for 6 subscales. A low self-efficacy was independently associated with noncompliance (beta =.379; P =.001). After exclusion of this variable, a negative attitude toward time-related barriers was associated with noncompliance (beta = -.147; P <.001). Conclusions Neither having good theoretical knowledge of hand hygiene guidelines nor social influence or moral perceptions had any predictive value relative to hand hygiene practice. A valid questionnaire to identify predictors and determinants of noncompliance with hand hygiene has been designed. Nurses reporting a poor self-efficacy or a poor attitude toward time-related barriers appear to be less compliant. (American Journal of Critical Care. 2010;19:230-240)