Improved Hand Hygiene Compliance is Associated with the Change of Perception toward Hand Hygiene among Medical Personnel

Abstract

Background: Hand hygiene compliance has improved significantly through hand hygiene promotion programs that have includedposter campaign, monitoring and performance feedback, and education with special attentions to perceived subjective norms. Weinvestigated factors associated with improved hand hygiene compliance, focusing on whether the improvement of hand hygienecompliance is associated with changed perception toward hand hygiene among medical personnel. Materials and Methods: Hand hygiene compliance and perceptions toward hand hygiene among medical personnel were comparedbetween the second quarter of 2009 (before the start of a hand hygiene promotion program) and the second quarter of 2012. Weassessed adherence to hand hygiene among medical personnel quarterly according to the WHO recommended method for directobservation. Also, we used a modified self-report questionnaire to collect perception data. Results: Hand hygiene compliance among physicians and nurses improved significantly from 19.0% in 2009 to 74.5% in 2012 (P <0001), and from 52.3% to 91.2% (P < 0.001), respectively. These improvements were observed in all professional status or all medicalspecialties that were compared between two periods, regardless of the level of the risk for cross-transmission. Hand hygienecompliance among the medical personnel continued to improve, with a slight decline in 2013. Perceptions toward hand hygieneimproved significantly between 2009 and 2012. Specifically, improvements were evident in intention to adhere to hand hygiene,knowledge about hand hygiene methods, knowledge about hand hygiene indications including care of a dirty and a clean body siteon the same patient, perceived behavioral and subjective norms, positive attitude toward hand hygiene promotion campaign, perceptionof difficulty in adhering to hand hygiene, and motivation to improve adherence to hand hygiene. Conclusions: The examined hand hygiene promotion program resulted in improved hand hygiene compliance and perceptiontoward hand hygiene among medical personnel. The improved perception increased hand hygiene compliance. Especially, theperception of being a role model for other colleagues is very important to improve hand hygiene compliance among clinicians.