Gracilene R Assis1, Glaucia G Benuti2, Maria Lívia T Moretto3, Cláudia G Vidigal3, Robert Plant Dos Santos4, Renata D Lobo5, Maria Clara Padoveze6, Antonio Carlos Pedroso de Lima4, Julio M Singer4, Anna S Levin7. 1. Department of Infectious Diseases and LIM54, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. 2. Divisão de Psicologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. 3. Department of Clinical Psychology, Instituto de Psicologia, Universidade de São Paulo, São Paulo, Brazil. 4. Department of Statistics, Instituto de Matemática e Estatística, Universidade de São Paulo, São Paulo, Brazil. 5. Infection Control Department, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil. 6. Department of Nursing in Collective Health, Escola de Enfermagem, Universidade de São Paulo, São Paulo, Brazil. 7. Department of Infectious Diseases and LIM54, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Infection Control Department, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil. Electronic address: gcih.adm@hc.fm.usp.br.
Abstract
BACKGROUND: Most bloodstream infections related to vascular catheters can be avoided if evidence-based practices are applied during insertion and maintenance. In practice, adherence by health care workers (HCWs) is unsatisfactory and is the main current challenge. The objective of this study is to investigate associations between adherence to infection control practices and performance in psychological tests. METHODS: We conducted a prospective observational study in 4 intensive care units involving HCWs. Physicians were observed for adherence to hand hygiene (HH). Nurses were observed during central venous catheter dressing and handling. HCWs were then evaluated psychologically. RESULTS: There were 7,572 observations of 248 HCWs. Adherence to different steps of central venous catheter manipulation ranged widely: from 13% for HH before procedure to 95% regarding the use of gloves. Adherence to HH ranged from 14% before to 99% after dressing. For physicians, HH ranged from 10% before touching patients to 98% after touching body fluids, and adherence was associated with age, self-esteem, and aggression. For nurses, adherence was positively associated with deference, and negatively associated with nurturance. CONCLUSIONS: Psychosocial variables affect the quality of care that HCWs provide. The next step would be to define what type of psychological interventions could be effective.
BACKGROUND: Most bloodstream infections related to vascular catheters can be avoided if evidence-based practices are applied during insertion and maintenance. In practice, adherence by health care workers (HCWs) is unsatisfactory and is the main current challenge. The objective of this study is to investigate associations between adherence to infection control practices and performance in psychological tests. METHODS: We conducted a prospective observational study in 4 intensive care units involving HCWs. Physicians were observed for adherence to hand hygiene (HH). Nurses were observed during central venous catheter dressing and handling. HCWs were then evaluated psychologically. RESULTS: There were 7,572 observations of 248 HCWs. Adherence to different steps of central venous catheter manipulation ranged widely: from 13% for HH before procedure to 95% regarding the use of gloves. Adherence to HH ranged from 14% before to 99% after dressing. For physicians, HH ranged from 10% before touching patients to 98% after touching body fluids, and adherence was associated with age, self-esteem, and aggression. For nurses, adherence was positively associated with deference, and negatively associated with nurturance. CONCLUSIONS: Psychosocial variables affect the quality of care that HCWs provide. The next step would be to define what type of psychological interventions could be effective.