The influence of knowledge, perceptions, and beliefs, on hand hygiene practices in nursing homes

doi:10.1016/j.ajic.2008.04.258

American Journal of Infection Control

Volume 37, Issue 2, March 2009, Pages 164-167

https://doi.org/10.1016/j.ajic.2008.04.258 Get rights and content

There are few studies that have assessed factors influencing infection control practices among health care workers (HCW) in nursing homes. We conducted a cross-sectional survey of HCWs (N = 392) in 4 nursing homes to assess whether knowledge, beliefs, and perceptions influence reported hand hygiene habits. Positive perceptions and beliefs regarding effectiveness of infection control in nursing homes were associated with reported appropriate glove use and fingernail characteristics, respectively, among HCWs. Further research on hand hygiene interventions, including targeted educational in-services should be conducted in the nursing home setting.

Section snippets

Study design

A cross-sectional survey of nursing staff in nursing homes was utilized to assess knowledge, beliefs, perceptions and practices of hand hygiene-related infection control practices. The survey was conducted in February 2005 among 4 nursing homes in southeastern Michigan. An invitation to participate in infection control research was sent to 105 nursing homes: 22 reported interest and 13 homes agreed to participate. Nursing homes were approached based on proximity to the University of Michigan.

Results

A total of 343 of 392 questionnaires were returned, providing a response rate of 87.5%. Of the 343 participants, 330 responded to all questions of interest, and their characteristics are shown in Table 1. Figure 1 shows the proportion of subjects responding positively to hand hygiene practices. More than 80% of the participants believed that hand hygiene is useful, that gloves were useful for preventing infections, and that artificial nails are associated with higher counts of gram-negative

Discussion

Our study provides important insight regarding hand hygiene knowledge among nursing home HCW and uncovered some inconsistencies. A majority of HCW recognized hand hygiene as useful when providing patient care, believed that gloves are effective in preventing infection, and believed that artificial nails are associated with higher counts of gram-negative bacteria. This knowledge also translated into good hand hygiene practices such as avoiding artificial nails. In contrast, only 40% of HCWs

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HH remains the most effective and least expensive measure to prevent transmission of pathogenic organisms in health care settings. Despite calls from numerous local, national, and international organizations and infection prevention societies, compliance with HH remains dismal, averaging only 30% to 50%.19–26 Reasons frequently reported for poor compliance with HH measures by HCWs include skin irritation from frequent washing, too little time due to a high workload, and simply forgetting.
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Hospital-acquired infections are a major patient safety issue. We examined staff members' knowledge, attitudes, reported and observed adherence to guidelines, and perceptions of barriers to use of contact precautions.
A survey and nonparticipant observation study was used to examine knowledge, attitudes, perceptions, and actual behavior of staff on 3 medical/surgical units at a 600-bed Magnet-designated academic medical center (MDAMC) and a 110-bed community medical center (CMC) in the southeastern United States.
Correct knowledge answers ranged from 75% (CMC) to 100% (MDAMC). CMC participants were less likely to perceive time as a barrier (5% vs 25%; P = .050); more MDAMC participants were motivated by supervisors' recognition (87% vs 33%; P = .001). No statistically significant differences existed between groups on reported behaviors. Upon observation, fewer CMC participants demonstrated 4 of 5 evidence-based contact precaution behaviors compared with MDMC participants (P < .001). Hand hygiene before glove application was similarly low at both sites.
Despite a decade of focus on improving patient safety, low adherence to evidence-based practice guidelines for implementation of contact precautions remains. Ongoing efforts are needed both at the system and practitioner level to improve practice adherence.
Infection Prevention in Alternative Health Care Settings
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Hand hygiene remains the most effective and least expensive measure to prevent transmission of pathogenic organisms in a health care setting. Despite calls from numerous local, national, and international organizations and infection prevention societies, compliance with hand hygiene remains dismal averaging only 30% to 50%.5–8 Reasons frequently reported for poor compliance with hand hygiene measures by HCWs include skin irritation from frequent washing, too little time because of high workload, and simply forgetting.
Healthcare-Associated Infections and Prevention Programs in General Nursing versus Residential Homes—Results of the Point Prevalence Survey in Polish Long-Term Care Facilities
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: Supported by the University of Michigan-Medical School, Institute of Gerontology, Pepper Center Research Career Development Core (to A.E.A.), and by a National Institutes of Health NIA K23 AG028943, ASP/AGS T Franklin Williams Research Scholarship (to C.L.M.).

: Conflicts of interest: The authors report no conflicts of interest.

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Brief ReportThe influence of knowledge, perceptions, and beliefs, on hand hygiene practices in nursing homes

Section snippets

Study design

Results

Discussion

Am J Infect Control

Am J Infect Control

Am J Infect Control

Brief Report
The influence of knowledge, perceptions, and beliefs, on hand hygiene practices in nursing homes