Hand Hygiene Practices Among Healthcare Workers Worldwide: A Systematic Review and Meta-Summary of Qualitative Research

Xiaoxing He, MD, MPH1, Sheryl Chatfield, PhD, CTRS2, Jeffrey Hallam, PhD, CHES1

1Social and Behavioral Sciences, College of Public Health, Kent State University, Kent, OH2University of South Alabama, Mobile, AL

Introduction

Methods

Results

Table 1.

Interpersonal Factor Developing Country Developed CountryBarriers: Limited knowledge, lack of

skills, impractical, skin damage belief

Limited knowledge, poor attitude, impractical, skin

damage belief

Facilitators: Self-protection, positive attitude, & training

Self-protection, personalized feedback from surveillance data & evidence of efficacy

Environment Factor

Barriers: Water scarcity, lack of AHR or resources, emergency

situations; understaff

Emergent situation, understaff

Facilitators: Improvement in resources, hand hygiene posters in

strategic places

Better resources, use of AHR, automated sinks

Social Behavioral Factor

Barriers: Tolerance of dirtiness, cultural belief of HH

disrespectful to patients

Negative role models, , adjusting own behavior to

match social norm

Facilitators: Positive role model, supervisors’ requirements

Stronger social norm, positive role models

System Factor

Barriers: Inadequate support, absence of efficiency

Lack of initiatives or sanction

Facilitators: Supervision, hand hygiene policy, & training

Audits, reinforcement

Meta-Summary

Systematic search of five computer-based literature indexes to identify relevant peer-reviewed publications

1. Medline2. PSYCINFO3. CINAHL4. EMBASE5. Web of Science Core Collection

Used a combination of subject terms, methodological terms, and outcome terms

Appraised the identified studies, using the Critical Appraisal Skills Programme (CASP) qualitative research checklist

Inclusion Criteria Study setting: Hospitals, nursing homes and healthcare

facilities worldwide Study population:

Health Care Workers Study subject: Hand Hygiene Compliance Study design: Qualitative or mixed methods with an emphasis

on qualitative study design Study outcome:

Health Care Workers’ perception of factors associated with Hand Hygiene compliance

American Public Health Association Annual Research Meeting ● Chicago , IL ● 2015

Use of individual criteria was more likely than HH guidelines

Lack of resources was a greater barrier in developing countries

Self-protection motivated higher compliance than reducing cross infection

Among new healthcare workers, work-site norm had more influence on compliance than previous training or education

Positive peers, supervisors, role models, and regular audits or performance feedback facilitated long-term compliance

Epidemiological evidence shows that although hand hygiene is a simple and effective practice on preventing cross infections, compliance remains suboptimal. Published reviews have only synthesized quantitative study results.

Specific AimsSystematically review qualitative research exploring healthcare workers’ perspectives regarding interpersonal, socio-environment, and health system factors associated with hand hygiene compliance.

Discussion

Total - 150 findings

17 grouped topics 5 major topics: Individual criteria (13%)Training & education (12%) Site norms & role models (12%)Resources (8%)Procedures & management (8%)

Conclusion

Intervention Priorities

Strengthen organizational infrastructure Develop practice norm or patient safety

climate Set-up positive role models On-going reminders or evidence-based

education and training Regular audits, feedback, or

supervisions

Achieving optimal hand hygiene compliance is a complex challenge that benefits from developing a positive practice norm at both individual and system levels

Adequate infection control policy and resource planning could improve population health at healthcare facilities worldwide