Focus Group Study of Hand Hygiene Practice among Healthcare Workers in a Teaching Hospital in Toronto, Canada

OBJECTIVE. To understand the behavioral determinants of hand hygiene in our hospital. DESIGN. Qualitative study based on 17 focus groups. SETTING. Mount Sinai Hospital, an acute care tertiary hospital affiliated with the University of Toronto. PARTICIPANTS. We recruited 153 healthcare workers (HCWs) representing all major patient care job categories. METHODS. Focus group discussions were transcribed verbatim. Thematic analysis was independently conducted by 3 investigators. RESULTS. Participants reported that the realities of their workload (eg, urgent care and interruptions) make complete adherence to hand hygiene impossible. The guidelines were described as overly conservative, and participants expressed that their judgement is adequate to determine when to perform hand hygiene. Discussions revealed gaps in knowledge among participants; most participants expressed interest in more information and education. Participants reported self-protection as the primary reason for the performance of hand hygiene, and many admitted to prolonged glove use because it gave them a sense of protection. Limited access to hand hygiene products was a source of frustration, as was confusion related to hospital equipment as potential vehicles for transmission of infection. Participants said that they noticed other HCWs' adherence and reported that others HCWs' hygiene practices influenced their own attitudes and practices. In particular, HCWs perceive physicians as role models; physicians, however, do not see themselves as such. CONCLUSIONS. Our results confirm previous findings that hand hygiene is practiced for personal protection, that limited access to supplies is a barrier, and that role models and a sense of team effort encourage hand hygiene. Educating HCWs on how to manage workload with guideline adherence and addressing contaminated hospital equipment may improve compliance. Infect Control Hosp Epidemiol 2010; 31:144-150