Page 286 - Encyclopedia of Nursing Research

InFeCTIon ConTRoL n 253

This represented the fifth highest rate of con- studies only consider two opportunities for
cern expressed by participants across the hand hygiene, that is, before and after patient
27 member states. Greeks scored the risk of contact (Rosenthal et al., 2005; Swoboda et al., I
acquiring a HCaI highest at 81% and austria 2007), whereas others base their indications
lowest at 18% (european Commission, 2010) for hand hygiene on published sets of hand
The provision of quality patient care hygiene guidelines, for example, the CDC
is not simply about exhorting individu- incorporating nine different opportunities
als within hospital settings to change their (Larson, Quiros, Giblin, & Lin, 2007) or five
own practices; the environment in which sequential steps (Pittet et al., 2006). Methods
health care workers’ work in must be consid- of quantifying hand hygiene compliance dif-
ered as well (Buetow & Roland, 1999; West, fer, for example, self-reported, direct obser-
2001). The importance of considering the vation, or proxy measurement, that is, the
environment that health care workers’ prac- use of hand hygiene agent (Boyce, 2008).
tice in was emphasized in a seminal report Seminal publications on the most prom-
by the Institute of Medicine in the United ising ways to address health care workers’
States in 2004. Serious concerns were raised noncompliance with hand hygiene guide-
about health care workers’ work environ- lines focus on the importance of addressing
ments, particularly nurses, and their impact personal variables that may influence behav-
on patient outcomes. The authors noted that ior (Gould, Moralejo, & Drey, 2007; naikoba &
typical nursing work environments are char- Hayward, 2001; Pittet, 2004). a variety of
acterized by many serious threats to patient perspectives have been used to examine
safety (Page, 2004) and suggested that these hand hygiene behavior and how it can be
threats may be caused by organizational promoted. The World Health organization
management practices, work design issues, (2009, pp. 87–88) emphasizes the role of edu-
and organizational culture. cation, motivation, cues to action, patient
The report First Do No Harm concluded empowerment, and the need for structural
that it is not acceptable for patients to be and philosophical change to health care sys-
harmed by the health care system that is tems. Some authors highlight the possible
supposed to offer healing and comfort. one effect of hospital organizational features on
of the report’s main conclusions is that the health care workers’ hand hygiene behavior
majority of adverse patient outcomes result and resultant acquisition of HCaIs (Larson,
from faulty systems, processes, and condi- Cloonan, Sugrue, & Parides, M, 2000; Pittet,
tions that lead people to make mistakes or 2000; Whitby, Slater, Tong, & Johnson, 2008).
engage in suboptimal practices, that is, it is others focus on the role of social cognitive
not a “bad apple” problem. The impact of models, such as the health belief model,
health care workers’ work environment on health locus of control, protection motiva-
health care workers hand hygiene behavior tion theory, theory of planned behavior,
is a poorly studied area. and the self-efficacy model (World Health
Hand hygiene research varies enor- organization, 2009). additionally, the-
mously in terms of methods and interventions. oretical perspectives such as PReCeDe
Some studies focus on a particular occupa- (Creedon, 2005) and the importance of role
tional group only (Gould & Chamberlain, modeling (Lankford et al., 2003) deserve
1997; Rosenthal, McCormick, Guzman, mentioning.
Villamayor, & orellano, 2003; Van de Mortel & none of the theoretical approaches have
Heyman, 1995), whereas others include all yet made a cogent contribution to provid-
health care workers’ involved in patient care ing an answer to understanding why health
(Creedon, 2005; Swoboda, earsing, Strauss, care hand hygiene behavior is clearly a prob-
Lane, & Lipsett, 2007; Trick et al., 2007). Some lem and it is telling that the World Health