Staff Attitudes toward CDCʹs Hand Hygiene Guideline

ISSUE: Although it has been four years since the publication of the new CDC Hand Hygiene Guideline for Healthcare Settings, to date no study has assessed the attitudes of staff toward recommendations in the new Guideline. PROJECT: “Attitudes Regarding Practice Guidelines” questionnaire was administered to a sample of ICU staff members in 38 U.S. hospitals. The tool has a 6-point Likert scale and two sections: Section 1 includes attitudinal statements about practice guideline in general (18 statements) and Section 2 includes 18 parallel statements specifically regarding the Hand Hygiene Guideline. Possible scores range from 0-180, with higher scores indicating more positive attitudes. Additionally, the instrument asks the respondent to name the most important factors that would either facilitate or prevent the use of the Guideline, and asks them to self-report the proportion of time when they use an alcohol hand degermer. RESULTS: 1,974 surveys were distributed, 1,346 were returned (68.2%). The respondents included of 996 nurses (74%), 222 physicians (16%), and 128 others (10%). 80% of the respondents agreed there was sufficient administrative support and resources in their setting to allow the implementation of the Guideline. 861/ 1282 (67%) reported using alcohol ‘almost always’ in their practice. Those with higher scores on the survey reported using alcohol hand hygiene significantly more frequently than those with lower scores (ANOVA, p < 0.001). 63% reported that following the Guideline would increase their risk of skin damage; they also reported frequent use of alcohol significantly less often than those who did not report that use of the Guideline would increase skin damage (65.3% and 73.0% respectively, p < 0.001). Staff named six barriers to hand hygiene, with the most frequent (92.9%) being lack of time or equipment and negative effects on skin. LESSONS LEARNED: Recommendations in the Guideline seem to be widely implemented, and a more positive attitude toward practice guidelines was associated with increased use of alcohol hand hygiene products. Nevertheless, reported barriers to hand hygiene do not seem to have changed since publication of the Guideline.