ABSTRACT
Hand hygiene is considered to be one of the primary practices for preventing hospital acquired infections (HAIs). However, hygiene compliance remains low in many healthcare facilities. An in-depth analysis of risks to healthcare workers (HCWs) in common tasks was needed to further understand noncompliance issues. Human factors research methods were used to: (1) characterize and compare actual and perceived risks to hygiene among HCWs in clinical tasks; (2) identify individual and workplace predictors of hygiene procedure compliance; and (3) make recommendations for further promoting HCW hygiene and reducing HAIs. A taxonomy of risk factors to hygiene was compiled from the literature and used to assess actual and perceived frequency and severity of risk factor exposure. Sixteen participants, including registered nurses, nurse practitioners and phlebotomists, were recruited for the study. Half were observed in the target tasks and the remainder were surveyed on background and interviewed regarding hygiene risk factor exposure. Observations were made at two clinics and a lab in a single hospital. Deviations from established hygiene procedures and counts of actual risk factor exposure were recorded. Study results revealed extra-individual risks, including equipment and supplies, to have high observed and perceived frequency of occurrence. The highest rated risk factors for severity concerned training opportunities, such as lack of HCW concern for acquiring infections from patients and lack of knowledge of hygiene protocols. Examination of differences among
actual and perceived risk ratings revealed the need for training on extra-individual and psychological factors in hygiene. Work location and risk factor exposure were also foundto be predictors of hygiene behavior. It was recommended that healthcare facility administrators focus on work design and HCW training towards preventing noncompliance and reducing HAIs.
