Hand-washing compliance was examined by thematic analysis of focus group discussions in nurses, mothers and children. Perceptions in these groups were identical, with the purpose of hand-cleansing seen as self-protection from infection. This assessment is not grounded in microbiology, but is strongly driven by emotion. Two types of hand-cleansing (???hand-hygiene???) behaviour were identified: (a) ???inherent??? hand-washing. This behaviour is taught by mothers to their children early in life. The behaviour occurs when hands have been visibly or ???emotionally??? soiled or feel sticky, and drives most hand-hygiene undertaken in the community; and (b) ???elective??? hand-hygiene, which occurs in the absence of perceived threat. As patient contact by healthcare workers is frequently assessed by healthcare workers as not posing risk, healthcare workers omit much elective hand-hygiene, leading to potential cross-infection. Modelling responses of 754 nurses on the Theory of Planned Behaviour for these two hand-hygiene behaviours in the healthcare setting explained 64% of elective hand-hygiene and 76% of inherent hand-washing intention. Translation of hand-washing behaviour patterns of the community into the healthcare setting is the predominant driver of all hand-hygiene in healthcare workers. In-hospital elective hand-hygiene behaviour is further significantly predicted by belief in the benefit from the activity, peer pressure and role modelling of senior physicians and administrators. For inherent hand-washing intent, only attitudes and peer behaviour are predictive. Time constraints, commonly implicated to explain poor compliance, are important mostly to elective hand-hygiene. Reduction in necessary effort by introducing an alcohol-based hand rub without a concomitant behavioural modification program will therefore have only minimal impact. Further components essential to hand-hygiene programs have been identified. These accord with the outcomes of the modelling and include the need for institutional recognition of hand-hygiene as a priority, overt clinician leadership support, and reinforcement of purpose by both education and performance feedback. In the long-term, society would be best served by altering the entire paradigm of hand-hygiene behaviour with nationwide campaigns based on principles of social marketing. Ideally, hand-hygiene should be taught by mothers and reinforced in early education programs as behaviour that is self-protective but with the defining theme: ???clean your hands, and protect others, not just yourself.???

Hemos leído con interés el artículo titulado: “Estrategia de uno en uno para mejorar la técnica correcta de higiene de manos” de Orozco Hernández y colaboradores, publicado en el volumen 38, número 5.1 Aunque consideramos que el estudio puede ser importante en la búsqueda de estrategias para mejorar la técnica de lavado de manos en personal de salud, nos gustaría expresarle algunas dudas que surgen y que requieren clarificación.

Introduction: The Hawthorne effect, or behaviour change due to awareness of being observed, is believed to inflate directly observed hand hygiene compliance rates, but evidence is limited. Methods: A real-time location system tracked hospital hand hygiene auditors and recorded alcohol-based hand rub and soap dispenses. Rates of hand hygiene events per dispenser per hour within sight of auditors were compared to dispensers not exposed to auditors. Results: The event rate in dispensers visible to auditors (3.75/dispenser/hour) was significantly higher than unexposed dispensers at the same time (1.48) and in prior weeks (1.07). The rate increased significantly when auditors were present compared to five minutes prior to arrival. There were no significant changes inside patient rooms. Conclusions: Hand hygiene event rates increase in hallways when auditors are visible and the increase occurs after the auditors’ arrival, consistent with the existence of a Hawthorne effect localized to areas where auditors are visible.

No description available.

Excerpt: A study by Tromp et al1 concluded that “Our multifaceted hand hygiene improvement program resulted in a sustained improvement of hand hygiene knowledge and compliance in nurses as well as physicians.” However, the support for the conclusions is weak because of a number of drawbacks. These drawbacks would inhibit the application of those conclusions in health care. The first drawback is the absence of a control group and, secondly, the contradictions in the data, as explained below.

No description available.

No / Not available

No / Despite wide acknowledgment that hand hygiene is the pre-eminent measure in the control of health-care-associated infection, Didier Pittet and colleagues 1 have highlighted that there is still a need for a systematic programme of research that will allow the development of new¿as well as refinement of existing¿approaches to hand cleansing. One of the key priorities Pittet and colleagues identified is the need for investigations into the relative importance of between and within patient cross-transmission

No / Direct contact between health care staff and patients is generally considered to be the primary route by which most exogenously-acquired infections spread within and between wards. Handwashing is therefore perceived to be the single most important infection control measure that can be adopted, with the continuing high infection rates generally attributed to poor hand hygiene compliance. Methods Through the use of simple mathematical models, this paper demonstrates that under conditions of high patient occupancy or understaffing, handwashing alone is unlikely to prevent the transmission of infection. Conclusions The study demonstrates that applying strict nurse cohorting in combination with good hygiene practice is likely to be a more effective method of reducing transmission of infection in hospitals.

No description available.