Open Access Highly Accessed Study protocol

Improving physician hand hygiene compliance using behavioural theories: a study protocol

Janet E Squires12*, Kathryn N Suh34, Stefanie Linklater1, Natalie Bruce4, Kathleen Gartke5, Ian D Graham12, Alan Karovitch3, Joanne Read6, Virginia Roth34, Karen Stockton4, Emma Tibbo7, Kent Woodhall8, Jim Worthington9 and Jeremy M Grimshaw13

Author Affiliations

1 Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada

2 School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada

3 Department of Medicine, The Ottawa Hospital/University of Ottawa, Ottawa, ON, Canada

4 Infection Prevention and Control, The Ottawa Hospital, Ottawa, ON, Canada

5 Department of Surgery, The Ottawa Hospital/University of Ottawa, Ottawa, ON, Canada

6 Ambulatory Care/Logistical Services, The Ottawa Hospital, Ottawa, ON, Canada

7 Quality and Patient Safety, The Ottawa Hospital, Ottawa, ON, Canada

8 Perioperative and Regional Cancer Programs, The Ottawa Hospital, Ottawa, ON, Canada

9 Medical Affairs, Quality and Patient Safety, The Ottawa Hospital, Ottawa, ON, Canada

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Implementation Science 2013, 8:16  doi:10.1186/1748-5908-8-16

Published: 4 February 2013

Abstract

Background

Healthcare-associated infections affect 10% of patients in Canadian acute-care hospitals and are significant and preventable causes of morbidity and mortality among hospitalized patients. Hand hygiene is among the simplest and most effective preventive measures to reduce these infections. However, compliance with hand hygiene among healthcare workers, specifically among physicians, is consistently suboptimal. We aim to first identify the barriers and enablers to physician hand hygiene compliance, and then to develop and pilot a theory-based knowledge translation intervention to increase physicians’ compliance with best hand hygiene practice.

Design

The study consists of three phases. In Phase 1, we will identify barriers and enablers to hand hygiene compliance by physicians. This will include: key informant interviews with physicians and residents using a structured interview guide, informed by the Theoretical Domains Framework; nonparticipant observation of physician/resident hand hygiene audit sessions; and focus groups with hand hygiene experts. In Phase 2, we will conduct intervention mapping to develop a theory-based knowledge translation intervention to improve physician hand hygiene compliance. Finally, in Phase 3, we will pilot the knowledge translation intervention in four patient care units.

Discussion

In this study, we will use a behavioural theory approach to obtain a better understanding of the barriers and enablers to physician hand hygiene compliance. This will provide a comprehensive framework on which to develop knowledge translation interventions that may be more successful in improving hand hygiene practice. Upon completion of this study, we will refine the piloted knowledge translation intervention so it can be tested in a multi-site cluster randomized controlled trial.