Hand hygiene.pdf

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Education. While HCWs must be schooled in how, when and why to clean hands,
emphasis on the derivation of their community and occupational hand hygiene
behaviour patterns may assist in altering attitudes.
Motivation. Influenced by role modelling and perceived peer pressure by senior
medical, nursing and administrative staff, motivation requires overt and continuing
support by a hospital’s administration of hand hygiene as an institutional priority 552 .
This will, in due course, act positively at both the individual and organizational
levels. Such support must be embedded in an overall safety climate directed by a
top-level management committee, with visible safety programmes, an acceptable
level of work stress, a tolerant and supportive attitude towards reported problems,
and a belief in the efficacy of preventive strategies.
Reinforcement of appropriate hand hygiene behaviour.
Cues to action, such as cartoons and even alcohol-based rub itself, should continue
to be employed.
While involvement of patients in hand hygiene programmes for HCWs has been
demonstrated to be effective 568,569 and also incorporated in a national programme 570 ,
further study of this approach is required before its widespread application. Possible
obstacles to be addressed include cultural constraints, the barrier of patient
dependency on caregivers, and the lack of applicability of this tactic to ventilated,
unconscious and/or seriously ill patients who are often at most risk of cross-infection
485 . Furthermore, whether patients reminding HCWs that they have to clean their
hands before care would interfere with the patient–caregiver relationship remains to
be properly assessed in different sociocultural and care situations.
System change.
Structural. As successful behavioural hand hygiene promotion programmes induce
increased compliance, the convenience and time-saving effects of cosmetically
acceptable alcohol-based handrubs will prove of further benefit. However, inherent
hand hygiene behaviour will always persist and will continue to require handwashing
with water and soap; thus, the accessibility of sinks must still be carefully
considered.
Philosophical. Heightened institutional priority for hand hygiene will require that a
decision be made, at least at the organizational level as for many social behaviours,
as to whether these other promotional facets of hand hygiene are then supported by
law or marketing. Rewards and/or sanctions for acceptable or unacceptable behaviour
may prove necessary and effective in both the short and long term, given both
the duration of pre-existing hand hygiene behaviour inappropriate to the health-care
setting and its continued reinforcement in the community. This approach has been
successfully applied in many countries to other public health issues such as smoking
and driving under the influence of alcohol, but further studies are necessary to
assess its application to hand hygiene promotion. Alternatively, the philosophy of
marketing may be considered; such an approach takes particular consideration of
self-interest, which may be extremely pertinent given that self-protection continues
to be the primary motivational force behind all hand hygiene practice. The value of
active participation at the institutional level and its impact on HCWs’ compliance
with hand hygiene have been demonstrated in several studies 262,530,535 .
Patterns of hand hygiene both in the community and in health care represent a complex,
socially entrenched and ritualistic behaviour. It is thus not surprising that single interventions