• David De Wandel, Lea Maes, Sonia Labeau, Carine Vereecken, and Stijn Blot.
• Faculty of Health Care, University College Ghent, Ghent, Belgium. david.dewandel@hogent.be
• Am. J. Crit. Care. 2010 May 1;19(3):230-9.

BackgroundAlthough hand hygiene is the most effective measure for preventing cross-infection, overall compliance is poor among health care workers.ObjectivesTo identify and describe predictors and determinants of noncompliance with hand hygiene prescriptions in intensive care unit nurses by means of a questionnaire.MethodsA questionnaire based on a behavioral theory model was filled out by 148 nurses working on a 40-bed intensive care unit in a university hospital. Subjects were asked to fill out the 56-item questionnaire twice within a 2- to 6-week period. During this period, no interventions to enforce hand hygiene occurred on the unit.ResultsResponse rate for the test was 73% (108/148); response rate for the retest was 53% (57/108). The mean self-reported compliance rate was 84%. Factor analysis revealed 8 elementary factors potentially associated with compliance. Internal consistency of the scales was acceptable. Intraclass correlation was low (<0.60) for 2 subscales but acceptable (>0.60) for 6 subscales. A low self-efficacy was independently associated with noncompliance (beta = .379; P = .001). After exclusion of this variable, a negative attitude toward time-related barriers was associated with noncompliance (beta = -.147; P < .001).ConclusionsNeither having good theoretical knowledge of hand hygiene guidelines nor social influence or moral perceptions had any predictive value relative to hand hygiene practice. A valid questionnaire to identify predictors and determinants of noncompliance with hand hygiene has been designed. Nurses reporting a poor self-efficacy or a poor attitude toward time-related barriers appear to be less compliant.

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