Motivational factors of influence on high-quality hand hygiene performance among emergency medical services providers: A multicenter survey.
Background Healthcare-associated infections (HAI) have a severe impact on patient outcomes, and high-quality hand hygiene (HH) is a valid preventive measure, but HH compliance in the emergency medical services (EMS) is inadequate. Thus, improvement is highly necessary. Few studies have investigated HH perception among EMS providers and those that have, report on challenges related to practical measures. No study has investigated motivational factors; thus in this study, we aim to quantify components of EMS providers’ motivation to comply with HH.
Methods A cross-sectional, anonymous, self-administered questionnaire consisting of 24 items (inspired by WHOs Perception Survey for Health-Care Workers) provided information on demographics, practical measures and various behavioral-, normative-, and control beliefs that determine intentions to perform high-quality HH among 6305 providers from Finland, Sweden, Denmark and Australia. Written and/or verbal reminders were provided at least one time during the study period from November 2017 to February 2018.
Results A total of 933 questionnaires were returned (response rate 15%). Demographics: of the respondents, 795 (86%) were advanced-care providers, 746 (81%) male and 686 (75%) had > 5 years of EMS experience. In total, 563 (61%) had received HH training within the last three years, 858 (93%) perceived HH a regular routine. Practical measures: access to HH supplies was perceived effective to improve HH by 740 (80%) respondents, training and education by 488 (52%) and being “a good example” by 562 (60%). Behavioral beliefs: 724 (78%) estimated the annual HAI rate > 15%, 900 (97%) perceived HAI severe to patient outcome, and 914 (98%) perceived HH highly preventive. Normative beliefs: 518 (56%) believed that HH had a high organizational priority, 260 (28%) that HH was important to their managers, 353 (38%) to their colleges, and 551 (59%) to the patients. Also, 511 (55%) perceived their colleges HH compliance high (> 80% compliance rate). Control believe: 646 (69%) perceived HH easy to perform.
Moreover, training and education, organizational priority, colleges’ HH compliance rate, HHs importance to colleges and patients, being “a good example” and perceiving HH easy to perform were separately associated with a high self-reported HH compliance.
Conclusion These results underline the need for practical measures such as access to HH supplies, simple and clear instructions and training and education, and is thus comparable to prior findings. Moreover, they illustrate that organizational priority, role models, and self-efficacy are motivational components that have the potential to empower HH compliance within this cohort. However, future interventional studies are needed to investigate the effect of a multimodal improvement strategy including both practical and behavioral aspects.
