| Domain and specific belief |
N (%) |
Interview quote |
| Knowledge |
|
|
| I believe that what I consider to be good hand hygiene fits with current guidelines |
33 (79) |
Q: Are you confident that what you consider to be good hand hygiene is in accordance with the current guidelines? A: I do, I think so, and based upon what I do, it tends to be from how I have been instructed to wash my hands and carry on practice, so I would hope so. (Medicine resident) |
| I am not confident that what I believe to be good hand hygiene fits with current guidelines |
2 (18) |
Q: Are you confident that what you consider to be good hand hygiene is in accordance with the current guidelines? A: Umm, probably not completely. (Medicine resident) |
| I am aware of hand hygiene guidelines and/or have heard of the 4 moments of hand hygiene |
28 (67) |
Q: Are you aware of any guidelines about hand hygiene? A: Uh, I know there are, but I've never really, like, read them or looked into them. Q: So are you familiar with the term "the 4 moments of hand hygiene"? A: Yes, sounds familiar. (Surgery resident) |
| I am not aware of hand hygiene guidelines and/or the 4 moments of hand hygiene |
14 (33) |
A: I know there are [hand hygiene guidelines], but I've never really, like, read them or looked into them. (Surgery resident) A: With the 4 what? No, I don't recall them. (Medicine staff physician) |
| I am aware of evidence linking hand hygiene to healthcare-associated infections |
27 (64) |
A: Certainly, I've seen a number of studies. I wouldn't be able to quote them, but you know they have a lot of biologic possibilities, so I'd probably just look at the abstract and agree with it. (Medicine staff) |
| I am not aware of evidence linking hand hygiene to healthcare-associated infections |
9 (21) |
Q: Are you aware of any evidence that links hand hygiene to healthcare-associated infections? A: Not that I've read, but I guess it makes sense. (Surgery staff) |
| Skills |
|
|
| I consider hand hygiene a skill |
26 (62) |
A: You can go in and say, "Oh, yeah, I washed my hands," but did you really wash your hands, did you really scrub them to get them clean? So yeah, it is a skill. (Medicine staff) |
| I do not consider hand hygiene a skill |
10 (24) |
A: I wouldn't call it a skill, no. I mean, I think, like, a skill is something that takes a lot of time to be able to perfect. I think it's [hand hygiene] something that if you've seen it and you know you're instructed on doing it, if you just repeat it a couple of times, it just becomes a routine thing. (Medicine resident) |
| I have had training in hand hygiene practice |
26 (62) |
Q: Were you ever trained in the proper technique for hand hygiene? A: I believe so … I cannot recall specifically, but yes, I had, like, I think it was videos showing how to do, like, you know when it's with alcohol, and then I had a specific one for doing the [surgical] scrubbing, I think. (Surgery resident) |
| I have not had training in hand hygiene practice |
15 (36) |
A: I don't think I was ever trained, no. (Surgery staff) |
| Beliefs about capabilities |
|
|
| Hand hygiene is easy to practice |
36 (86) |
A: It couldn't be any easier. The stuff [alcohol gel] is all over the place. (Medicine staff) |
| Hand hygiene is difficult to practice |
8 (19) |
Q: Are there any competing tasks or time constraints that might influence whether or not you practice hand hygiene? A: Well, I think, like, we were kind of saying, if you were in a situation where you're trying to do too much and you're carrying things in and out of rooms and what have you, it's not that you wouldn't be trying to practice hand hygiene but that you might not be able to do it as effectively, right. (Medicine resident) |
| I am confident that I am following hand hygiene guidelines when practicing hand hygiene |
20 (48) |
Q: Are you confident that you are following the guidelines when practicing hand hygiene? A: Again, to the extent that I know them, I believe I am, yes. (Surgery staff) |
| I am not confident that I am following hand hygiene guidelines when practicing hand hygiene |
6 (14) |
Q: Are you confident that you are following the guidelines when practicing hand hygiene? A: I don't think so, not strictly, not all of them anyway. (Surgery staff) |
| When there is an emergency situation, I am less likely to practice hand hygiene |
14 (33) |
A: Life-threatening situations. I mean, I don't see myself, you know, looking for a sink when a patient is having a cardiac arrest. (Medicine staff) |
| Beliefs about consequences |
|
|
| Practicing hand hygiene reduces the transmission of infection |
41 (98) |
A: The benefits [of hand hygiene] would be, like, decreased intrahospital spread of infection would be, I think, 1 important measure. (Medicine resident) |
| Practicing hand hygiene damages my hands |
22 (52) |
A: I mean, it [practicing hand hygiene] doesn't affect me with a 1-time use or a 2-time use, but if it's a consistent over time use, my hands begin to get dry and cracked, and then I get real issues if I use soaps. (Surgery staff) |
| It is very likely that improper hand hygiene will lead to a healthcare-associated infection |
14 (33) |
Q: In your opinion, how likely is it that improper hand hygiene will lead to a healthcare-associated infection? A: I think it could be very likely, depending especially on the patient you're treating and the next patient you're going to after that. (Medicine staff) |
| It is likely that improper hand hygiene will lead to a healthcare-associated infection |
10 (24) |
Q: In your opinion, how likely is it that improper hand hygiene will lead to a healthcare-associated infection? A: Not, I can't give you numbers. I wouldn't know, but I think it's pretty likely. (Surgery resident) |
| It is somewhat likely that improper hand hygiene will lead to a healthcare-associated infection |
11 (26) |
Q: In your opinion, how likely is it that improper hand hygiene will lead to a healthcare-associated infection? A: How likely? I guess somewhat likely. (Medicine staff) |
| It is unlikely that improper hand hygiene will lead to a healthcare-associated infection |
3 (7) |
A: I think it's rare, but probably the risk is not zero, but it's very small. (Surgery staff) |
| There are no negative aspects to practicing hand hygiene |
11 (26) |
A: There is no negative aspect. (Surgery staff) |
| Goals |
|
|
| Hand hygiene is always a necessity |
14 (33) |
Q: In what situations do you think hand hygiene is unnecessary? A: I'm not sure if any situation. I think hand hygiene is always necessary. (Surgery resident) |
| When taking all priorities into consideration, hand hygiene is a 10 |
12 (29) |
Q: Considering your other priorities on a scale of 1–10, with 10 being very important, how important do you think it is for you to practice hand hygiene? A: 10, yeah, 10, it's critical. (Medicine staff) |
| When taking all priorities into consideration, hand hygiene is a 8–9 |
23 (55) |
A: I would say sort of 8 out of 10, but that doesn't mean that it ranks more importantly than other things or less importantly. It's just it's an important thing to do. (Surgery resident) |
| When taking all priorities into consideration, hand hygiene is a 7 or less |
4 (10) |
Q: Considering your other priorities on a scale of 1–10, with 10 being very important, how important do you think it is for you to practice hand hygiene? A: 7. (Surgery staff) |
| Memory, attention, and decision processes |
|
|
| Hand hygiene is an automatic process for me |
30 (71) |
A: No, it's not a conscious decision, no, it's unconscious for sure. I don't think about it, I do it automatically. (Surgery staff) |
| Easily visible hand hygiene stations makes it easier to remember to practice hand hygiene |
29 (69) |
A: I would say that for people that are learning to get into the rhythm, it would be putting those receptacles in visible places so that they're kind of reminders when coming in and out of rooms. (Medicine resident) |
| Practicing hand hygiene is a conscious decision/is not an automatic process for me |
25 (60) |
A: Often I'm thinking, like, where is the dispenser, like, yes, I do make it a conscious decision. (Medicine staff physician) |
| Not practicing hand hygiene is not a conscious decision |
9 (21) |
A: No, I don't think there's much of a specific "I'm not going to practice hand hygiene," but sometimes you know you may forget. (Medicine resident) |
| Reminders are useful for my hand hygiene practice |
19 (45) |
A: I need reminders … as a human, I tend to forget from time to time, and if I have reminder in the hospital, I do it. (Surgery resident) |
| I do not need help remembering to practice hand hygiene |
6 (14) |
Q: Is there anything that would make it easier to remember hand hygiene? A: Umm, for me, I don't think it's an issue. (Medicine staff) |
| When not touching a patient or patient environment, hand hygiene is not always necessary |
15 (36) |
Q: In what situations do you think hand hygiene is unnecessary? A: I sometimes think it's unnecessary if I walk into a room just to have a quick chat with somebody, and I don't touch anybody or anything in the room. I don't think you need to maybe be as diligent in your handwashing just to have a conversation with somebody. (Medicine resident) |
| Practicing hand hygiene is a habit |
8 (19) |
A: It's a habit, and it's just part of cleanliness that goes along with everything. (Surgery staff) |
| There are no triggers that remind me to practice hand hygiene |
7 (17) |
A: I just try to do it [hand hygiene] before I go into the room, so it's kind of becomes a habit and when I leave, but the trigger, I'm not sure if I have any memory tricks. (Medicine resident) |
| There are no specific situations where I find myself forgetting to practice hand hygiene more often than others |
7 (17) |
Q: Are there certain situations where you find yourself forgetting to practice hand hygiene more often than others? A: Umm, that's a good question. I'd like to say I don't think so. You know, if I'm in, it doesn't matter if I'm in recovery room, ICU, our in-patient ward, or out-patient clinic. I mean, I think I make a pretty conscientious effort to do it in all those different locations. (Surgery staff) |
| There are specific situations where I forget to practice hand hygiene more often than others |
18 (43) |
A: I think I remember most times, but, you know, the thing is, so, for example, a patient in ICU with a, you know, someone's crashing in the unit. They're crashing in their bed, like I have done this several times, I admit, where I just walk in the room because you're just going after the patient, and then the nurses come back and say, "Well, the patient's MRSA," or "The patient's got C. diff," you know, like, help, just give me a gown or something and go on, but you still, you do clearly, you still forget. (Medicine staff) |
| Environmental context and resources |
|
|
| Easy access to hand hygiene stations makes it easier to practice hand hygiene (many subgroups if needed) |
41 (98) |
A: The negative aspect has to do with the time involved and especially the lack of convenience, and not just convenience, in fact, the decreased efficiency when rooms and hallways and patient encounters are not properly set up for appropriate hand hygiene. (Surgery resident) |
| Practicing hand hygiene takes time/time as a resource influences my hand hygiene practice |
25 (60) |
A: When you know you are very busy and you're pushing through a list of patients, it occupies your mind how to see your patients in a reasonable amount of time, so that's what displaces the thought of cleansing your hands before and after each visit. (Medicine resident) |
| Hand hygiene is not time consuming/no time constraints influence my hand hygiene practice |
12 (29) |
A: It's not time consuming for me because it's just so, you know, you do it as you're walking down the hall. You do it as you're walking into the room. You don't shake hands because your hands, like, you know, you do it in front of the patient. Like, you know, as long as you're multitasking while you're doing it, it's not time consuming. (Medicine staff) |
| When I am busy, I am less likely to comply with hand hygiene guidelines |
20 (48) |
A: As well when, you know, you are very busy and you're pushing through a list of patients, you know that's the—it occupies your mind, is, you know, how to see your patients in a reasonable amount of time, so that's what displaces, you know, the thought of cleansing your hands before and after each visit. (Medicine resident) |
| I do not have any feelings about current hand hygiene guidelines |
16 (38) |
Q: Do you have any strong feelings about the current hand hygiene guidelines? A: No, I think that I'm in agreement with them, but nothing, no strong feelings. (Medicine resident) |
| The location of hand hygiene stations is important in facilitating hand hygiene practice |
13 (31) |
A: The negative aspect has to do with the time involved and especially the lack of convenience, and not just convenience, in fact, the decreased efficiency when rooms and hallways and patient encounters are not properly set up for appropriate hand hygiene. (Surgery resident) |
| Social professional role and identity |
|
|
| Hand hygiene is a standard part of my patient consultations |
40 (95) |
A: In fact, I like to make it [hand hygiene] a very visible part of my patient consultation. When they first see me, I try and make sure that I'm actually still in the process of putting alcohol-based hand rub on my hands so that they know I'm performing hand hygiene. (Medicine staff) |
| My hand hygiene practice is in line with my peers |
19 (45) |
A: Everybody always thinks they're better than everybody else. No, I'm probably just average, you know. (Medicine staff) |
| Hand hygiene is not specific to just my specialty |
14 (33) |
Q: Do you think that hand hygiene is something specific to physicians in general medicine? A: I hope not. So, no. (Medicine staff) |
| Hand hygiene should be performed by all healthcare professionals |
16 (38) |
A: I think every healthcare professional has to use it [hand hygiene]. (Medicine resident) |
| Hand hygiene should be performed by everyone |
12 (29) |
A: It's something that's, uh, everybody should do. (Medicine resident) |
| My hand hygiene practice is better than my peers |
13 (31) |
A: I mean, there's going to be some physicians who do a better job of it than I do, but I would say I probably do focus on it more than the majority of them do. (Surgery staff) |
| Physician hand hygiene compliance is suboptimal |
11 (26) |
Q: What is your impression of the compliance of others in your profession with hand hygiene guidelines? A: I think it's lacking. (Surgery staff) |
| Social influence |
|
|
| Other team members influence my hand hygiene practice |
15 (36) |
A: I'd say when we're rounding and when you see the staff doing it, every single person that's rounding with the staff does the same thing. (Medicine resident) |
| Other team members do not influence my hand hygiene practice |
18 (43) |
Q: Do other team members influence your decision to practice hand hygiene? A: No. (Medicine staff) |
| Patients expectations do not influence me to perform hand hygiene |
11 (26) |
A: I think they [patients and their families] have a reason to expect it [hand hygiene] from us, like I don't do it to satisfy them, their wishes. (Medicine resident) |
| Patients expectations influence my hand hygiene practice |
15 (36) |
A: Yes, indirectly of course, I think the expectation from me to provide them [patients and their families] the best care, and part of that is good hand hygiene. (Surgery resident) |
| I have never been asked by a patient if I have performed proper hand hygiene |
12 (29) |
A: No, I can't remember 1 instance of feedback from any patient or their families about it [hand hygiene]. (Surgery staff) |
