Factors affecting hand hygiene behavior among health care workers of intensive care units in teaching hospitals in Korea: importance of cultural and situational barriers

Jeong, Heon-jae; Jo, Heui-sug; Lee, Hye-jean; Kim, Min-ji; Yoon, Hye-yeon

doi:2015.21.1.36

Qual Improv Health Care > Volume 21(1); 2015 > Article

Quality Improvement in Health Care 2015;21(1): 36.
DOI: https://doi.org/10.14371/QIH.2015.21.1.36 Published online June 30, 2015.

Factors affecting hand hygiene behavior among health care workers of intensive care units in teaching hospitals in Korea: importance of cultural and situational barriers

Heon-jae Jeong¹, Heui-sug Jo², Hye-jean Lee³, Min-ji Kim⁴, Hye-yeon Yoon⁵

¹Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health
²Department of Health Management and Policy, School of Medicine, Kangwon National University
³Department of Preventive Medicine, Kangwon National University Hospital
⁴Annenberg School for Communication, University of Pennsylvania
⁵Center for Patient Education, The Care Quality Research Group

Abstract

In Intensive Care Units (ICUs), where severely ill patients are treated, importance of reducing Hospital Acquired Infection (HAI) cannot be overstated. One of the simplest and most effective actions against HAI is proper hand hygiene (HH) behavior of Health Care Workers (HCWs). However, compliance varies across different cultures and different job types of HCWs (physicians, residents and nurses). This study aims to understand determinants of HH behavior by HCWs' job types in Korea. Qualitative analysis was performed based on Reasoned Action Approach style interviews with staff physicians, residents and nurses across 7 teaching hospitals. We found that all HCWs strongly believe HH is important in reducing HAI. There were, however, job type-specific HH behavior modifying factors; staff physicians stated feeling pressure to be HH behavior role model. Residents identified Quality Improvement team that measured compliance as a facilitator; a notable barrier for residents was senior physicians not washing their hands, because they were afraid of appearing impudent to their seniors. Nurses designated their chief nurse as a key referent. All participants mentioned heavy workload and lack of access to alcohol-based sanitizer as situational barriers, and sore and dry hand as deterrents to HH compliance.

Key words Patient safety;Hand Hygiene;Hospital acquired infection;Intensive Care Unit (ICU);Safety culture;Reasoned action approach;