The combined application of hand hygiene and non-sterile gloves by nurses in a tertiary hospital: a multi methods study
Abstract Background The application of hand hygiene (HH) and the use of non-sterile gloves (NSG) in daily care is highly intertwined. We aimed (1) to assess the combined application of HH and NSG among nurses and (2) to explore determinants that influence their ability to combine both measures in th...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2024-02-01
|
| Series: | Antimicrobial Resistance and Infection Control |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13756-024-01378-5 |
| _version_ | 1797273207371202560 |
|---|---|
| author | Mireille Dekker Rosa van Mansfeld Marjon Borgert Jolanda Maaskant Frederique Paulus Annamarike Seller Irene P. Jongerden |
| author_facet | Mireille Dekker Rosa van Mansfeld Marjon Borgert Jolanda Maaskant Frederique Paulus Annamarike Seller Irene P. Jongerden |
| author_sort | Mireille Dekker |
| collection | DOAJ |
| description | Abstract Background The application of hand hygiene (HH) and the use of non-sterile gloves (NSG) in daily care is highly intertwined. We aimed (1) to assess the combined application of HH and NSG among nurses and (2) to explore determinants that influence their ability to combine both measures in their care. Methods In a multi-methods study, we combined direct observations of care episodes with semi-structured interviews with nurses in two affiliated university hospitals. Topics were based on Flottorp’s checklist of determinants of practice. Results In total, we observed 205 care episodes and interviewed 10 nurses. Observations revealed that the combination of NSG and HH was correctly applied in 19% of care episodes in which a single procedure was executed, and in 2% of care episodes in which multiple procedures were performed. From the interviews, we found determinants that influenced compliance, covered mainly by three out of seven of Flottorp’s checklist domains. Nurses indicated that their knowledge of protocols was limited to HH and protocols were hardly ever actively consulted; visual reminders within their workplace were used as sources of information. Nurses’ behavior was primarily influenced by their ability to operationalize this information and their ability to integrate both infection prevention measures into their care. The intention to apply and combine HH and NSG use was influenced by their risk assessment of cross-contamination, by the urge to self-protect and gut feeling. The feasibility to execute HH and NSG protocols is influenced by the urgency and the complexity of the care episode. Conclusions The combined correct application with HH and NSG measures by nurses is low. Nurses are instructed in a fragmented way while in the day to day care HH and NSG use are highly intertwined. Operationalization and simplification of infection prevention protocols, in which instructions on both infection prevention measures are fused, should be considered. Strategies to improve practice should consider the power of habit and nurses urge to self-protect. |
| first_indexed | 2024-03-07T14:41:16Z |
| format | Article |
| id | doaj.art-e8a6d37f88114504a69a4a3041291b67 |
| institution | Directory Open Access Journal |
| issn | 2047-2994 |
| language | English |
| last_indexed | 2024-03-07T14:41:16Z |
| publishDate | 2024-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Antimicrobial Resistance and Infection Control |
| spelling | doaj.art-e8a6d37f88114504a69a4a3041291b672024-03-05T20:23:57ZengBMCAntimicrobial Resistance and Infection Control2047-29942024-02-011311810.1186/s13756-024-01378-5The combined application of hand hygiene and non-sterile gloves by nurses in a tertiary hospital: a multi methods studyMireille Dekker0Rosa van Mansfeld1Marjon Borgert2Jolanda Maaskant3Frederique Paulus4Annamarike Seller5Irene P. Jongerden6Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Vrije Universiteit AmsterdamDepartment of Medical Microbiology and Infection Prevention, Amsterdam UMC, Vrije Universiteit AmsterdamAmsterdam UMC, Department of Intensive Care, University of AmsterdamAmsterdam UMC, Department of Internal Medicine, University of AmsterdamAmsterdam UMC, Department of Intensive Care, University of AmsterdamDepartment of Human Resources, Amsterdam University Medical Centers, University of AmsterdamDepartment of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research instituteAbstract Background The application of hand hygiene (HH) and the use of non-sterile gloves (NSG) in daily care is highly intertwined. We aimed (1) to assess the combined application of HH and NSG among nurses and (2) to explore determinants that influence their ability to combine both measures in their care. Methods In a multi-methods study, we combined direct observations of care episodes with semi-structured interviews with nurses in two affiliated university hospitals. Topics were based on Flottorp’s checklist of determinants of practice. Results In total, we observed 205 care episodes and interviewed 10 nurses. Observations revealed that the combination of NSG and HH was correctly applied in 19% of care episodes in which a single procedure was executed, and in 2% of care episodes in which multiple procedures were performed. From the interviews, we found determinants that influenced compliance, covered mainly by three out of seven of Flottorp’s checklist domains. Nurses indicated that their knowledge of protocols was limited to HH and protocols were hardly ever actively consulted; visual reminders within their workplace were used as sources of information. Nurses’ behavior was primarily influenced by their ability to operationalize this information and their ability to integrate both infection prevention measures into their care. The intention to apply and combine HH and NSG use was influenced by their risk assessment of cross-contamination, by the urge to self-protect and gut feeling. The feasibility to execute HH and NSG protocols is influenced by the urgency and the complexity of the care episode. Conclusions The combined correct application with HH and NSG measures by nurses is low. Nurses are instructed in a fragmented way while in the day to day care HH and NSG use are highly intertwined. Operationalization and simplification of infection prevention protocols, in which instructions on both infection prevention measures are fused, should be considered. Strategies to improve practice should consider the power of habit and nurses urge to self-protect.https://doi.org/10.1186/s13756-024-01378-5Infection PreventionNosocomial infectionsGuideline AdherenceCross-transmissionGlove-useHospitals |
| spellingShingle | Mireille Dekker Rosa van Mansfeld Marjon Borgert Jolanda Maaskant Frederique Paulus Annamarike Seller Irene P. Jongerden The combined application of hand hygiene and non-sterile gloves by nurses in a tertiary hospital: a multi methods study Antimicrobial Resistance and Infection Control Infection Prevention Nosocomial infections Guideline Adherence Cross-transmission Glove-use Hospitals |
| title | The combined application of hand hygiene and non-sterile gloves by nurses in a tertiary hospital: a multi methods study |
| title_full | The combined application of hand hygiene and non-sterile gloves by nurses in a tertiary hospital: a multi methods study |
| title_fullStr | The combined application of hand hygiene and non-sterile gloves by nurses in a tertiary hospital: a multi methods study |
| title_full_unstemmed | The combined application of hand hygiene and non-sterile gloves by nurses in a tertiary hospital: a multi methods study |
| title_short | The combined application of hand hygiene and non-sterile gloves by nurses in a tertiary hospital: a multi methods study |
| title_sort | combined application of hand hygiene and non sterile gloves by nurses in a tertiary hospital a multi methods study |
| topic | Infection Prevention Nosocomial infections Guideline Adherence Cross-transmission Glove-use Hospitals |
| url | https://doi.org/10.1186/s13756-024-01378-5 |
| work_keys_str_mv | AT mireilledekker thecombinedapplicationofhandhygieneandnonsterileglovesbynursesinatertiaryhospitalamultimethodsstudy AT rosavanmansfeld thecombinedapplicationofhandhygieneandnonsterileglovesbynursesinatertiaryhospitalamultimethodsstudy AT marjonborgert thecombinedapplicationofhandhygieneandnonsterileglovesbynursesinatertiaryhospitalamultimethodsstudy AT jolandamaaskant thecombinedapplicationofhandhygieneandnonsterileglovesbynursesinatertiaryhospitalamultimethodsstudy AT frederiquepaulus thecombinedapplicationofhandhygieneandnonsterileglovesbynursesinatertiaryhospitalamultimethodsstudy AT annamarikeseller thecombinedapplicationofhandhygieneandnonsterileglovesbynursesinatertiaryhospitalamultimethodsstudy AT irenepjongerden thecombinedapplicationofhandhygieneandnonsterileglovesbynursesinatertiaryhospitalamultimethodsstudy AT mireilledekker combinedapplicationofhandhygieneandnonsterileglovesbynursesinatertiaryhospitalamultimethodsstudy AT rosavanmansfeld combinedapplicationofhandhygieneandnonsterileglovesbynursesinatertiaryhospitalamultimethodsstudy AT marjonborgert combinedapplicationofhandhygieneandnonsterileglovesbynursesinatertiaryhospitalamultimethodsstudy AT jolandamaaskant combinedapplicationofhandhygieneandnonsterileglovesbynursesinatertiaryhospitalamultimethodsstudy AT frederiquepaulus combinedapplicationofhandhygieneandnonsterileglovesbynursesinatertiaryhospitalamultimethodsstudy AT annamarikeseller combinedapplicationofhandhygieneandnonsterileglovesbynursesinatertiaryhospitalamultimethodsstudy AT irenepjongerden combinedapplicationofhandhygieneandnonsterileglovesbynursesinatertiaryhospitalamultimethodsstudy |