Hand hygiene.pdf

More documents

Recommendations

Info

16. BEHAVIOURAL CONSIDERATIONS 16.1 SOCIAL SCIENCES AND HEALTH BEHAVIOUR Hand hygiene behaviour varies significantly among HCWs within the same institution or unit 485 , thus suggesting that individual features could play a role in determining behaviour. Social psychology attempts to understand these features, and individual factors such as social cognitive determinants may provide additional insight on hand hygiene behaviour 541,551,552 . 16.1.1 SOCIAL COGNITIVE VARIABLES Over the last quarter of the 20th century, it was stated that social behaviour could be best understood as a function of people’s perceptions rather than as a function of real life (objective facts, etc.) 553 . This assumption gave birth to several models which were based on social cognitive variables and tried to better understand human behaviour. The determinants that shape behaviour are acquired through the socialization process and, more importantly, are susceptible to change – for which reason they are the focus of behavioural models. In other areas of health-care promotion, the application of social cognitive models in intervention strategies has regularly resulted in a change towards positive behaviour 553 . Some of the socalled “social cognitive models” applied to evaluate predictors of health behaviour include: Health Belief Model (HBM); Health Locus of Control (HLC); Protection Motivation Theory (PMT); Theory of Planned Behaviour (TPB); and Self-efficacy Model (SEM). The cognitive variables used in these models are: • knowledge; • motivation; • intention: a person’s readiness to behave in a given way, which is considered to be the immediate antecedent of behaviour; • outcome expectancy: an individual’s expectation that a given behaviour can counteract or increase a threat and how one perceives the threat; • perception of threat is based on the perceived risk/susceptibility and the perceived severity of the consequences; • perceived behavioural control (self-efficacy): the perception that performance of a given behaviour is within one’s control; • subjective norm: beliefs about the expectations of an important referent towards a given behaviour 553,554 ; • behavioural norm: an individual’s perception of the behaviour of others 555 . Subjective and behavioural norms represent the perceived social pressure towards a certain behaviour. 16.1.2 MODELLING HUMAN BEHAVIOUR Current models and theories that help to explain human behaviour, particularly as they relate to health education, can be classified on the basis of being directed at the individual (intrapersonal), interpersonal, or community levels. The social cognitive models mentioned above deal with intrapersonal and interpersonal determinants of behaviour. Among the community-level models, the theory of Ecological Perspective (also referred to as the Ecological Model of Behavioural Change) can successfully result in behavioural change. This theory is based on two key ideas: (i) behaviour is viewed as being affected by and affecting mul-
tiple levels of influence; and (ii) behaviour both influences and is influenced by the social environment. Levels of influence for health-related behaviour and conditions include intrapersonal (individual), interpersonal, institutional and community factors 556 . Intrapersonal factors are individual characteristics that influence behaviour such as knowledge, attitudes, beliefs and personality traits.These factors are contained in social cognitive determinants 553 . Interpersonal factors include interpersonal processes and primary groups, i.e. family, friends and peers, who provide social identity, support and role definition. HCWs can be influenced by or are influential in their social environments. Behaviour is often influenced by peer group pressure, which indicates that responsibilities for each HCW’s individual group should be clearly recognized and defined. Community factors are social networks and norms that exist either formally or informally between individuals, groups and organizations. For example, in the hospital, the community level would be the ward 556 . Community-level models are frameworks for understanding how social systems function and change, and how communities and organizations can be activated. The conceptual framework of community organization models is based on social networks and support, focusing on the active participation and development of communities that can help evaluate and solve health problems. Public policy factors include local policies that regulate or support practices for disease prevention, control and management. 16.1.3 APPLICATION OF SOCIAL SCIENCES TO THE INFECTION CONTROL FIELD Few studies have applied social sciences to assess HCWs’ behaviour related to infection control practices. Seto identified three fields of study in the behavioural sciences with some degree of relevance to the field of infection control: social psychology, organizational behaviour and consumer behaviour 551 . By applying a basic concept from each field, Seto and colleagues demonstrated the potential value of these theories to achieve staff compliance with different infection control policies in the hospital 551,556,557 . Social cognitive models have been applied to evaluate HCWs’ cognitive determinants towards hand hygiene behaviour 263,543,544,558,559 and are discussed in the next section (Part I, Section 16.2). Curry & Cole 560 applied the theory of Ecological Perspective and reported their experience in the medical and surgical ICUs in a large teaching hospital experiencing an increased patient colonization rate with VRE. Their intervention consisted of a multifaceted approach to the problem, considering the five levels of influence (individual, interpersonal, institutional, community and administrative factors). They implemented in-service education and developed references, policies and programmes directed at each of the five levels of influence. The Health Belief Model was employed for assessment of beliefs and intervention design. The authors observed a significant decrease in the number of patients with active surveillance cultures or clinical isolates positive for VRE within six months in both ICUs, and the benefit seemed to persist even two years later. 16.2 BEHAVIOURAL ASPECTS OF HAND HYGIENE The inability over two decades to motivate HCW compliance with hand cleansing 539,561 suggests that modifying hand hygiene behaviour is a complex task. Human health-related behaviour is the consequence of multiple influences from our biology, environment, education and culture. While these influences are usually interdependent, some have more effect than others; when the actions are unwise, they are usually the result of trade-offs with acknowledged or denied consequences. Thus, this complexity of individual, institutional
Page 2 and 3:
The WHO Guidelines on Hand Hygiene
Page 5 and 6:
CONTENTS INTRODUCTION . ...........
Page 7 and 8:
17. Organizing an education program
Page 11:
INTRODUCTION The WHO Advanced Draft
Page 14 and 15:
Handwashing. Washing hands with pla
Page 16 and 17:
still considered the standard of ca
Page 18 and 19:
treatment selectively removes glyce
Page 20 and 21:
of the organism on their hands. Mak
Page 22 and 23:
6. MODELS OF HAND TRANSMISSION 6.1
Page 24 and 25: In the 1960s, a prospective, contro
Page 26 and 27: for its ability to reduce the relea
Page 28 and 29: 8.2 SHORTCOMINGS OF TRADITIONAL TES
Page 30 and 31: tions of short-chain aliphatic alco
Page 32 and 33: 9.1.3 WATER QUALITY The physical, c
Page 34 and 35: Case study: experience of Egypt The
Page 36 and 37: and both reduced viral counts on ha
Page 38 and 39: activity of chlorhexidine is not se
Page 40 and 41: protein synthesis and alteration of
Page 42 and 43: in micelle structures formed by sur
Page 44 and 45: In all the studies that included pl
Page 46 and 47: isopropyl alcohol) were applied to
Page 48 and 49: 3) Glycerol is added using a measur
Page 50 and 51: in 2005 the costs of an alcohol-bas
Page 52 and 53: infection, risk factors that are la
Page 54 and 55: 11.4.4 SIDE-EFFECTS OF THE SURGICAL
Page 56 and 57: • Repeat the process on the other
Page 58 and 59: 12.2 ALLERGIC CONTACT DERMATITIS RE
Page 60 and 61: particularly when resources are lim
Page 62 and 63: Handrubs are available as gels, sol
Page 64 and 65: 14. HAND HYGIENE PRACTICES AMONG HE
Page 66 and 67: quantified in observational studies
Page 68 and 69: According to behavioural theories (
Page 70 and 71: of water with special leaves) outsi
Page 72 and 73: Furthermore, according to Phra Depv
Page 76 and 77: and community factors must be consi
Page 78 and 79: i. ii. iii. iv. v. vi. a) b) Educat
Page 80 and 81: tion precautions 580 . There are al
Page 82 and 83: follow the intent 588 . Studies hav
Page 84 and 85: 18. FORMULATING STRATEGIES FOR HAND
Page 86 and 87: 18.2 DEVELOPING A STRATEGY FOR GUID
Page 88 and 89: 1998 (P
Page 90 and 91: HCWs routinely to wear vinyl gloves
Page 92 and 93: quality gloves, reuse, shortage of
Page 94 and 95: • To test for holes, gloves shoul
Page 96 and 97: Figure l.20.2: Blood safety: crucia
Page 98 and 99: Consensus recommendations are that
Page 100 and 101: D. Wash hands with either plain or
Page 102 and 103: 5. SKIN CARE A. B. C. Include infor
Page 107 and 108: PART III. OUTCOME MEASUREMENTS 1. M
Page 109 and 110: 2. HAND HYGIENE AS A QUALITY INDICA
Page 111 and 112: can be seen during routine work. Da
Page 113 and 114: Case study: United Kingdom national
Page 115 and 116: PART IV. PROMOTING HAND HYGIENE ON
Page 117 and 118: ated to reinforce its principles (t
Page 119: 6. PRINCIPLES OF COUNTRYWIDE HAND H
Page 122 and 123: As many international and national
Page 124:
debate that resulted in increasing
Page 128 and 129:
23. Lee YL et al. Colonization by S
Page 130 and 131:
Interscience Conference on Antimicr
Page 132 and 133:
122. Vicca AF. Nursing staff worklo
Page 134 and 135:
171. Kauppinen J et al. Hospital wa
Page 136 and 137:
224. Krilov LR et al. Inactivation
Page 138 and 139:
276. Thomas L et al. Development of
Page 140 and 141:
326. Johnson S et al. Prospective,
Page 142 and 143:
34th Interscience Conference on Ant
Page 144 and 145:
423. Kampf G, et al. Influence of a
Page 146 and 147:
474. West DP et al. Evaluation of a
Page 148 and 149:
524. Muto C et al. Hand hygiene rat
Page 150 and 151:
578. Babcock HM et al. An education
Page 152 and 153:
Interscience Conference on Antimicr
Page 154 and 155:
679. Hirschmann H et al. The influe
Page 156:
729. Martin LS, McDougal JS, Loskos
Page 161 and 162:
Table I.8.1: Basic experimental des
Page 163 and 164:
Table I.9.1: Waterborne pathogens a
Page 165 and 166:
Table I.9.3: Virucidal activity of
Page 167 and 168:
Table I.9.4: Studies comparing the
Page 169 and 170:
Table I.9.6: Studies comparing the
Page 171 and 172:
Table I.14.1: Hand hygiene frequenc
Page 173 and 174:
Table I.14.2: Hand hygiene adherenc
Page 175 and 176:
Table I.15.1: Hand hygiene indicati
Page 177 and 178:
Table I.18.1: Strategies for succes
Page 179 and 180:
Table l.20.1: Possible problems and
Page 181 and 182:
Table I.21.1. Hand hygiene research
Page 183 and 184:
Table I.21.1: Hand hygiene research
Page 185 and 186:
Table I.21.2: Unsolved issues for r
Page 187 and 188:
Table III.2.1: Quality indicators r
Page 189 and 190:
Table V.3.1: Examples of public inf
Page 191 and 192:
Table V.4.1: Examples of national p
Page 193:
Table V.5.1: The public information
Page 197 and 198:
APPENDIX 1. DEFINITIONS OF HEALTH-C
Page 199:
APPENDIX 2. HAND AND SKIN SELF-ASSE
Page 202:
Data in coloured cells can be chang
Page 206:
NHS NICU n-P NPSA NA NS OPD PACU PA
Page 211 and 212:
AUTHORS: John Boyce Saint Raphael H
Page 213 and 214:
Garance Upham People’s Health Mov
show all

Hand hygiene.pdf

Create successful ePaper yourself

Delete template?

Save as template?