Explaining hand hygiene practice: an extended application of the Theory of Planned Behaviour

Health care workers' hand hygiene practice is universally sub-optimal. This contributes to the 8% prevalence rate of hospital-acquired infection which is currently costing the National Health Service in England nearly £1 billion per annum. It is estimated that about 30% of hospital-acquired infections could be prevented if health care workers adhered to hand hygiene guidelines. The aim of the study was to identify psychological constructs predictive of health care workers' hand hygiene behaviour in order to determine ways to improve practice. We used a cross-sectional survey of 104 hospital-based health care workers. Data were analyzed through hierarchical logistic regression. The model correctly classified 79% of cases in intention to perform appropriate hand hygiene and 87% of self-reported hand hygiene behaviour. Attitudes and personal responsibility were significant predictors of intention, whilst perceived behavioural control and intention were significant predictors of behaviour. The theoretical framework shows where future interventions to improve hand hygiene practice should be targeted.