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Changing the paradigm: messages for hand hygiene education and audit from cluster analysis

Research output: Contribution to journalArticle

D.J. Gould, D. Navaïe, E. Purssell, N.S. Drey, S. Creedon

Original languageEnglish
JournalJournal of Hospital Infection
Early online date29 Jul 2017
Accepted/In press24 Jul 2017
E-pub ahead of print29 Jul 2017


King's Authors


Background Hand hygiene is considered the foremost infection prevention measure. How health workers accept and make sense of the hand hygiene message is likely to contribute to success and sustainability of initiatives to improve performance, which is still often poor. Methods Survey of nurses in critical care units in three National Health Service trusts in England to explore opinions about hand hygiene, use of alcohol handrubs, audit with performance feedback and other key hand hygiene-related issues. Data were analysed descriptively and subjected to cluster analysis. Results Three main clusters of opinion were visualised, each forming a statistically significant group: positive attitudes, pragmatism and scepticism. A smaller cluster suggested possible guilt about ability to perform hand hygiene. Conclusion Cluster analysis identified previously unsuspected constellations of beliefs about hand hygiene that offer a plausible explanation of behaviour. Health workers might respond to education and audit differently according to these beliefs. Those holding predominantly positive opinions might comply with hand hygiene policy and perform well as infection prevention link nurses and champions. Those holding pragmatic attitudes are likely to respond favourably to the need for professional behaviour and need to protect themselves from infection. Greater persuasion may be needed to encourage those who are sceptical about the importance of hand hygiene to comply with guidelines. Interventions to increase compliance should be sufficiently broad in scope to tackle different beliefs. Alternatively cluster analysis of hand hygiene beliefs could be used to identify the most effective educational and monitoring strategies for a particular clinical setting.

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