Giuseppe Battistella1, Giuliana Berto2, Stefania Bazzo3. 1. Epidemiology and Statistic Unit, Azienda ULSS n.9 "Treviso", Borgo Cavalli 31, 31100 Treviso, Italy. Electronic address: gbattistella@ulss.tv.it. 2. Intensive Care Unit, Azienda ULSS n.9 "Treviso", Via Sant' Ambrogio di Fiera, 37, 31100 Treviso, Italy. Electronic address: gberto@ulss.tv.it. 3. Health Education and Research consultant, Azienda ULSS n.9 "Treviso", Via Vittoria, 54, 31010 Cimadolmo, Treviso, Italy. Electronic address: stefania.bazzo@gmail.com.
Abstract
OBJECTIVES: To explore perceptions and unconscious psychological processes underlying handwashing behaviours of intensive care nurses, to implement organisational innovations for improving hand hygiene in clinical practice. RESEARCH METHODOLOGY: An action-research intervention was performed in 2012 and 2013 in the intensive care unit of a public hospital in Italy, consisting of: structured interviews, semantic analysis, development and validation of a questionnaire, team discussion, project design and implementation. Five general workers, 16 staff nurses and 53 nurse students participated in the various stages. RESULTS: Social handwashing emerged as a structured and efficient habit, which follows automatically the pattern "cue/behaviour/gratification" when hands are perceived as "dirty". The perception of "dirt" starts unconsciously the process of social washing also in professional settings. Professional handwashing is perceived as goal-directed. The main concern identified is the fact that washing hands requires too much time to be performed in a setting of urgency. These findings addressed participants to develop a professional "habit-directed" hand hygiene procedure, to be implemented at beginning of workshifts. CONCLUSIONS: Handwashing is a ritualistic behaviour driven by deep and unconscious patterns, and social habits affect professional practice. Creating professional habits of hand hygiene could be a key solution to improve compliance in intensive care settings.
OBJECTIVES: To explore perceptions and unconscious psychological processes underlying handwashing behaviours of intensive care nurses, to implement organisational innovations for improving hand hygiene in clinical practice. RESEARCH METHODOLOGY: An action-research intervention was performed in 2012 and 2013 in the intensive care unit of a public hospital in Italy, consisting of: structured interviews, semantic analysis, development and validation of a questionnaire, team discussion, project design and implementation. Five general workers, 16 staff nurses and 53 nurse students participated in the various stages. RESULTS: Social handwashing emerged as a structured and efficient habit, which follows automatically the pattern "cue/behaviour/gratification" when hands are perceived as "dirty". The perception of "dirt" starts unconsciously the process of social washing also in professional settings. Professional handwashing is perceived as goal-directed. The main concern identified is the fact that washing hands requires too much time to be performed in a setting of urgency. These findings addressed participants to develop a professional "habit-directed" hand hygiene procedure, to be implemented at beginning of workshifts. CONCLUSIONS: Handwashing is a ritualistic behaviour driven by deep and unconscious patterns, and social habits affect professional practice. Creating professional habits of hand hygiene could be a key solution to improve compliance in intensive care settings.