The Prevalence of Poor Hand Washing Among Doctors in Acute Hospitals

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ACKNOWLEDGEMENT

I would take this opportunity to thank my research supervisor, family and friends for their support and guidance without which this research would not have been possible.

DECLARATION

I, [type your full first names and surname here], declare that the contents of this dissertation/thesis represent my own unaided work, and that the dissertation/thesis has not previously been submitted for academic examination towards any qualification. Furthermore, it represents my own opinions and not necessarily those of the University.

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ABSTRACT

This action research project explored how to improve hand hygiene practices across Hospital Health Authority. Hand hygiene has been established as the single most effective method in controlling preventable healthcare-acquired infections; it is a critical patient safety initiative worldwide. A literature review sought to understand how barriers and risks for hand hygiene adherence, along with behaviour change theories and current hand hygiene improvement strategies, contribute to an organizational hand hygiene culture. Through use of a Quantitative survey and qualitative focus groups, this study delved into hand hygiene compliance practices with doctors at two Hospital Authority acute care sites' medical units, to understand how to transform the current hand hygiene compliance culture. All research was conducted following the Tri-Council Policy Statement, providing assurance that ethical principles involving human participants' contributions in the research process were respected and valued.

ACKNOWLEDGEMENTII

DECLARATIONIII

ABSTRACTIV

CHAPTER 1: INTRODUCTION1

Background1

Introduction2

Significance of the study3

Research questions5

CHAPTER 2: LITERATURE REVIEW6

Introduction6

Organizational Culture6

Definition and Meaning of Culture6

Three Levels of Culture7

Development of Culture9

Importance of Organizational Culture11

Hand Hygiene Best Practice Standards and Guidelines14

Association for Professionals in Infection Control and Epidemiology16

Centres for Disease Control Hand Hygiene Task Force17

World Health Organization18

The Institute for Healthcare Improvement22

The British Commission of Safety and Quality in Health care23

Summary of literature24

CHAPTER 3: RECOMMENDATIONS25

Study Recommendations25

Hand Hygiene Priority26

Financial and Human Resources27

Mandatory Hand Hygiene Education and Training27

Patient Safety Culture28

Leadership Communication28

Multidisciplinary Hand Hygiene Committee29

CHAPTER 4: SUMMARY AND CONCLUSION31

Summary31

Conclusion31

Measurement of Hand Hygiene Compliance34

Social Marketing for Hand Hygiene35

Education, Training, Knowledge Translation, and Behaviour Modification35

Empowering Patients36

Emerging Trends in Hand Hygiene Improvement Initiatives36

Implications for Future Research37

REFERENCES38

APPENDIX ONE43

LITERATURE SUMMARY43

APPENDIX TWO45

RESEARCH MATRIX45

CHAPTER 1: INTRODUCTION

Background

Hand washing is the process of rubbing two hands together using soap and water to remove dirt and transient microorganisms (Montano 2002, 34). The importance of hand washing appears to be such a simple, fundamental concept that one would presume it is fully integrated into personal and professional healthcare practice. Unfortunately, healthcare workers' compliance with hand washing procedures is low despite significant efforts locally, nationally, and internationally to research and implement viable, sustainable solutions in healthcare facilities (Larson 2005, 88-106).

It was less than two hundred years ago that the association was made between the transmissions of organisms from patient to patient via the hands of healthcare workers. A Viennese obstetrician, Ignaz Semmelweis, postulated that a substance on the hands of physicians and medical students was responsible for causing child bed fever in an obstetrical clinic. Due to the foundational work of Semmelweis and other key scientists of that time, including Louis Pasteur, Florence Nightingale, Robert Koch, and James Lister, the relationship between hand washing ...