Research for infection protection

Abstract: The gap between knowledge and action – it is the attitude that matters

Hand hygiene is the most effective and, at the same time, simplest measure to prevent infection. According to a study, this also is the opinion of 86 % of healthcare staff. 75 % even believe that good and consistent hand hygiene measures may prevent at least half of all nosocomial infections.

This awareness of the hand disinfection’s importance, however, goes against how healthcare workers actually act: only every second hand disinfection actually necessary is carried out.

With their investigation of personal attitudes of nursing staff and physicians towards hand hygiene, the researchers at the Institute of Psychology & Education, Department of Social Psychology of the University of Ulm, Germany provide new answers and a possible explanation for this gap.

A field study conducted at the Heidenheim Hospital examined the influence of personal attitudes on hand hygiene behaviour of healthcare personnel. For this, 67 nurses and physicians solved tasks on the computer and afterwards filled in a questionnaire, which was to record the basic personality traits such as conscientiousness and empathy as well as different aspects of daily work.

The study distinguished two types of attitudes: explicit and implicit. Explicit attitudes are direct evaluations that can be formulated and expressed consciously.

In contrast, implicit attitudes are not accessible consciously. They are reflected in the tendencies to unconsciously assess things positively or negatively.

Explicit attitudes correspond to deliberate, planned behaviours. However, in order to systematically think about actions two conditions need to be fulfilled: motivation and opportunity (e.g. time). But implicit attitudes determine the action with spontaneous, unplanned behaviours. They are based on the impulsive, automatic activation of favourable or unfavourable connotations in the brain. Implicit attitudes use up less resources and allow us to continue to act in stress situations or under time pressure.

Considering the complex work routine, hand hygiene behaviour of healthcare workers in most cases is such a spontaneous behaviour. And this also provides a key to understand why compliance often is poor although the importance of hand hygiene is recognised.

Hand hygiene behaviour is very much determined by the implicit attitude towards hand hygiene. This particularly applies to situations with high workloads and physical strains – scenarios that are common for nursing and medical personnel. The study result shows: the more favourable the implicit attitude of nursing staff and physicians towards hand hygiene, the more frequent they disinfect their hands. The medical staff’s conscious attitude, however, did not have a relevant influence on the hand hygiene compliance.

Innovative programmes to promote hand hygiene compliance should therefore address the implicit attitudes. Those interventions that link hand hygiene to favourable connotations in a perceptible way seem to be promising. Positive connotations may include a hand disinfectant’s pleasant scent, the good feel it leaves on the skin or its noticeable skincare effect. Also pleasant experiences or positively perceived words can be used for interventions.

In addition to a favourable implicit attitude towards hand hygiene it is the healthcare staff’s ability to empathise that has a positive effect on the hand hygiene behaviour. In simple terms: the more empathetic a nurse or physician is, the more frequent she or he disinfects her/his hands in the moments decisive for patient protection. Hence, another good approach to increase hand hygiene compliance and thus improve patient protection are empathy training sessions.

Speech by Prof. Dr. Johannes Keller, Head of Social Psychology, University of Ulm, Germany, held at the Lunchtime Symposium “Healthy skin – better infection protection. New findings on hand hygiene compliance.” 10 July 2015, Berlin, arranged by the BODE SCIENCE CENTER, Hamburg, scientific centre of excellence of PAUL HARTMANN AG, Heidenheim.