Importance of structured training programs and good role models in hand hygiene in developing countries.

The aim of this study is to identify the beliefs and perceptions associated with hand hygiene performance in two different institutions with limited resources and recently established infection control programme later than developed institutions. The study was conducted in two different hospitals (University Hospital-U-hospital and Community Hospital-C-hospital) in the same city by a self administered questionnaire. Most questions were drawn from questionnaires used previously in other studies from "industrialized" countries based on "The Theory of Planned Behavior". All nurses, nurse students (last class), physicians and intern medical students in the U-hospital, and all nurses in the C-hospital were included into the study. Of 1764 questionnaires, 941 (41%) were returned. The return rate was highest for nurses in C-hospital (63.8% [303 of 475]) and lowest for senior physicians in U-hospital (7.5% [16 of 212]). Out of the respondent a total of 16 (1.7%) were senior physicians, 110 (11.6%) were physician assistants, 400 (42.6%) were nurses in the U-hospital, 303 (32%) were nurses in the C-hospital, 66 (7%) were medical students and 46 (4.9%) were nurse students. Seven hundred and ninety five (85.9%) of 926 respondents were female. Respondents provided demographic information and data about various behavioral, normative, and control beliefs that determined their intentions with respect to performing hand hygiene. Among individuals from the other professional categories, a greater percentage of U-hospital nurses (57.6% vs. 53.9%, respectively) believed that healthcare-associated infections to be greater than 20%, and mortality rate among infected patients to be greater than 5%. C-hospital nurses generally believed the frequency, severity, and impact of healthcare-associated infections to be lower than U-hospital nurses and other individuals. However, all professional categories believed that good hand hygiene effectively prevents infections (98%). In univariate analysis, receipt of structured training in hand hygiene, perceived colleagues adherence's as good, adherence models good practices for others, having been observed for their adherence (normative beliefs), the perception that hand hygiene is relatively easy to perform and high workload (control beliefs) was associated with good hand hygiene. However, in multivariate analysis, high self reported adherence to hand hygiene was independently associated with receipt of structured training in hand hygiene, perceived good adherence by colleagues, the perception that hand hygiene is relatively easy to perform and having been observed for their adherence. In a country with limited resources, intention to comply was associated with training and strong normative and control beliefs. Also, in two different kinds of institution with the similar hand hygiene promotion campaign in the same city, the believes of nurses were different. In developing countries, more resources have to be allocated for training of HCWs and easy access for hand hygiene products. Crown