Targeting Behaviors Using Transtheoretical Model To Improve Hand Hygiene Adherence Among Intensive Care Unit Healthcare Workers
A quasi-experimental study was performed at Thammasat University Hospital. Baseline HCW demographics, self-reported stage of HH behavior within the Trantheoretical Model (TTM), and observed HH adherence were examined. Pre-intervention period (P1) was from January 1, 2012 to December 31, 2012 and post-intervention period (P2) was from January 1, 2013 to December 31, 2013. Six ICUs were group randomized to one of three strategies: HH education by Infection Control Division every 3 months (S1); intensified HH interventions by study investigator (S2); and intensified HH interventions together with increasing alcohol hand rub at all bedsides, nursing stations, physician working stations, and procedure stations (S3). Intensified HH education included monthly education that emphasized HH adherence and impact on patient safety and weekly workgroup discussion exploring reasons for not performing HH among HCWs with different behaviors. Each strategy consisted of 2 ICUs.
Results: There were 125 HCWs from 6 ICUs (42 in S1; 41 in S2; 42 in S3) with 1,936 HH observations over both periods. During P1, 70 HCWs (56%) self-reported HH Maintenance, 26 HCWs (21%) reported HH Action, and 29 HCWs (23%) reported HH Preparation or less commitment. Most HCWs were nurses (75/125; 60%) and nurse assistant (25/125; 20%). Compared to P1, overall HH adherence in P2 improved in ICUs in S2 (65% vs. 85%; P= 0.02) and S3 (66% vs. 95%; P = 0.005), but not ICUs in S1 (68% vs. 71%; P = 0.84). Improvement in HH adherence in ICUs in S2 was shown among HCWs who reported HH Preparation or lower commitment (21% vs. 84%; P<0.001), while improvement in HH adherence in ICUs in S3 occurred among HCWs who self-reported HH preparation or lower commitment stage (24% vs. 89%; P<0.001) and HH Action and Maintenance stages (78% vs. 96%; P<0.001).
Conclusion: Our findings suggest that HH intervention should be tailored to the HCWs self-reported HH commitment. Additional studies to translate behavioral theory into practice will further inform on sustainable improvement in HH adherence.
L. Mundy, None