• Heidi Storm Vikke, Svend Vittinghus, Martin Betzer, Matthias Giebner, Hans Jørn Kolmos, Karen Smith, Maaret Castrén, Veronica Lindström, Marja Mäkinen, Heini Harve, and Christian Backer Mogensen.
• Department of Clinical Research, University of Southern Denmark, Odense, Denmark. hevi@falck.dk.
• Scand J Trauma Resus. 2019 Feb 5; 27 (1): 10.

BackgroundHand hygiene (HH), a cornerstone in infection prevention and control, lacks quality in emergency medical services (EMS). HH improvement includes both individual and institutional aspects, but little is known about EMS providers' HH perception and motivations related to HH quality. Therefore, we aimed to investigate the HH perception and assess potential factors related to self-reported HH compliance among the EMS cohort.MethodsA cross-sectional, self-administered questionnaire consisting of 24 items (developed from the WHOs Perception Survey for Health-Care Workers) provided information on demographics, HH perceptions and self-reported HH compliance among EMS providers from Denmark.ResultsOverall, 457 questionnaires were answered (response rate 52%). Most respondents were advanced-care providers, males, had > 5 years of experience, and had received HH training < 3 years ago. HH was perceived a daily routine, and the majority rated their HH compliance rate ≥ 80%. Both infection severity and the preventive effect of HH were acknowledged. HH quality was perceived important to colleagues and patients, but not as much to managers. Access to supplies, simple instructions and having or being "a good example" were perceived most effective to improve HH compliance. Self-reported HH compliance was associated with years of experience and perceptions of HCAI's impact on patient outcome, HH's preventive effect, organizational priority, HH's importance to colleagues and patients, and the effort HH requires (p ≤ 0.05).ConclusionDanish EMS providers acknowledged the impact of infections and the preventive effect of HH, and perceived access to HH supplies at the point of care, having or being "a good example" and simple instructions effective to improve HH compliance. Moreover, several behavioral-, normative- and control beliefs were associated with self-reported HH compliance, and thus future improvement strategies should be multimodal.

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