Hand hygiene.pdf

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