Hand hygiene.pdf

have failed to induce a sustained improvement in HCW behaviour. Multilevel, multimodal
and multidisciplinary strategies, responding to these behavioural determinants, would seem
to hold most promise 262,526,552 .
HCW education is an inherent component of the work of the infection control team.
Through education, the infection control team can alter inappropriate patient-care practices
and traditionally, a formal programme of education is relied on to successfully introduce
new infection control policies in health care. However, it is now recognized that for hand
hygiene, education alone may not be sufficient. HCWs’ attitudes and compliance with hand
hygiene are extremely complex and multifactorial 552,561,571-573 , and studies indicate that a
successful programme would have to be multidisciplinary and multifaceted 526,572 .
Education is important and critical for success and represents one of the cornerstones for
improvement of hand hygiene practices 574 . The reasons why education is important can be
summarized as follows:
1. Successful hand hygiene programmes reported in the literature inevitably have an
educational component 262,518,526,530 . They are not all consistently successful and
their impact is not always sustainable. Some 573 appear to have only a short-term
influence, particularly the one-time educational interventions 507,575 . This is the
reason for stressing again that educational programmes alone are inadequate and
other behaviour modifying strategies must be included in a multifaceted approach to
achieve change 526,572 .There is also clear evidence that adequate physical facilities for
hand cleansing could affect the success of the programme and these must certainly
be in place 263,571 . However, all this does not negate the critical role of the formal
education programme for achieving compliance with hand hygiene.
2. Surveys and studies on HCWs have shown that valid information and knowledge on
hand hygiene do influence good practices 263,576 . This is consistent with the finding
that informational power is the most influential social power in infection control 577 .
An educational programme providing accurate and pertinent facts is therefore indispensable
for success.
3. Educational programmes have been reported as an essential ingredient for success
in other infection control strategies, including the control of ventilator-associated
pneumonia 578 , reducing needlestick injuries 579 , and the implementation of isolai.
ii.
Confirmation of behavioural determinants of hand hygiene in all other health-care
occupational groups and in varying ethnic and professional groups is essential to
ensure that these findings are constant and the implications that flow from them are
universally relevant.
The impact in practice of each behavioural factor impacting, in theory, on hand
hygiene must be carefully measured and considered, so as to design cost-effective
motivational programmes suitable for both high- and low-resource health-care
settings.
17. ORGANIZING AN EDUCATION PROGRAMME TO
PROMOTE HAND HYGIENE