Improving Hand Hygiene Compliance in Healthcare Settings Using Behavior Change Theories: Reflections

Abstract

Background: Although hand hygiene is the most effective method for preventing healthcare-associated infections, hand hygiene practice falls short in many healthcare facilities. The compliance rate is mostly linked to system design and easily accessible hand hygiene products. System change, healthcare worker motivation, and complex behavioral considerations seem to play a significant role. Summary: This article discusses the application of behavioral theories in hand hygiene promotion in a theoretical manner. The program relies on the transtheoretical model (TTM) of health behavior change, John Keller's (ARCS) Model of Motivational Design, and the theory of planned behavior (TPB). Thus, the program links attitudes and behavior to hand hygiene promotion. Conclusions: The TTM of health behavior change helps to tailor interventions to predict and motivate individual movement across the pathway to change. A program could be based on this theory with multiple intercalations with John Keller's ARCS and the TPB. Such a program could be strengthened by linking attitudes and behavior to promote hand hygiene. The program could utilize different strategies such as organization cultural change that may increase the attention as well as fostering the movement in the ARCS stages. In addition, modeling TPB by creating peer pressure, ability to overcome obstacles, and increasing knowledge of the role of hand hygiene may lead to the desired outcome. The understanding and application of behavior change theories may result in an effective program to improve awareness and raise intention and thus may increase the potential for success of hand hygiene promotion programs.

Keywords:

• hand hygiene
• behavioral theory
• infection control

Acknowledgments

Jaffar A. Al-Tawfiq acknowledges the use of Saudi Aramco Medical Services Organization facilities in obtaining the research data used in this article. Opinions expressed in the article are those of the authors and not necessarily of SAMSO. This paper is based on a major paper submitted to the Clinical Teacher Certificate program at University of Toronto. Didier Pittet thanks the healthcare workers at the University of Geneva Hospitals for their contribution to patient safety and quality of care.