Exploring self-reported hand hygiene among registered nurses in the inpatient hospital setting using the Health Belief Model

Abstract

Methicillin Resistant Staphylococcus aureus (MRSA) is the most commonly isolated multi-drug resistant organism in the hospital setting. MRSA can result in death among people who have no identified risk factors for infection. One-third of MRSA infections are cross-transmitted as Healthcare-Associated Infections (HAIs). It is well known that the single most effective means for decreasing the risk of HAIs is hand hygiene (HH), yet poor performance among registered nurses persists. The theoretical framework used to guide the study was the Health Belief Model (HBM). The purposes of the study were to: explore the RNs’ self-reported HH performance rate; explore the RNs’ knowledge related to MRSA; identify relationships between MRSA knowledge and HBM constructs; explore the RNs’ barriers to HH performance; identify relationships between barriers and self-reported HH performance; explore relationships among HH behaviors and constructs in the HBM; explore predictors of ‘overall HH’ performance; and identify if certain demographic characteristics are related to MRSA knowledge, self-reported HH, and HBM constructs. A cross sectional descriptive study was conducted with a sample of RNs who were randomly selected. The questionnaire mailing, which included the survey, consent, and the return-stamped envelope were distributed to 684 RNs. Completed surveys (n=120) from RNs who met the sample inclusion criteria were returned within four weeks. Self-reported HH were highest during times of increased perceived susceptibility for infection. In addition, nurses were more likely to overcome barriers to HH during ‘moments’ associated with the highest perceived susceptibility. Although MRSA knowledge did not correlate with ‘overall HH’ performance, there was a significant relationship identified with self-efficacy (r=.27, p<.01), which may influence HH behaviors. The most commonly identified barriers to HH performance were system factors (e.g. ‘a high workload’). Self-efficacy and barriers represented 26% of the variability in the regression model when applying significant correlations among HBM constructs and ‘overall HH.’ The phenomenon of the RN’s HH decision making is not completely understood. More research is needed to explain predictors for HH among registered nurses. This understanding will allow researchers to plan interventions aimed at increasing knowledge and understanding about perceived susceptibility, which may in turn improve self-efficacy behaviors for HH, which could decrease HAI rates.