Non-adherence to hand hygiene among those involved in the provision of health care is the principal route by which infection is spread. However, despite an extensive research base, regular education and the application of prescriptive rules there has been a consistent failure to achieve long-term adherence in appropriate hand hygiene practice. Where improved adherence has been achieved there has been little evidence to show that it was for anything other than a limited period with individuals ultimately reverting back to their original practice. This paper therefore proposes that the principal cause of non-adherence to safe hand hygiene practice among those involved in the provision of health care is psychosocial in its nature. Further, until strategies are developed that will reflect this, the well-being of individuals seeking health care intervention will continue to be compromised.
Earl ML , Jackson MM , Rickman LS.Improved rates of compliance with hand antisepsis guidelines: a three-phase observational study . Am J Nurs2001;101(3): 26-33
2.
Kmietowicz Z.Hospital infection rate rise in England out of control . BMJ2000;320: 534 . Available online at bmj.com/cgi/content/full/320/7234/534?ck=nck (accessed December 2002)
3.
Gaynes R , Richards C , Edwards J , Emori TG , Horan T , Alonso-Echanove J , et al . Feeding back surveillance data to prevent hospital-acquired infections . Emerg Infect Dis2001;7(2): 295-298
4.
Pittet D , Hugonnet S , Harbarth S , Mourouga P , Sauvan V , Touveneau S , et al . Effectiveness of a hospital-wide programme to improve compliance with hand hygiene . Lancet2000;356(9238): 1307-1312
5.
Butler KJ.Hand hygiene in intensive care . Care Crit Ill1998;14(2): 57-59
6.
Elliott PR.Handwashing practice in nurse education . Prof Nurse1996;11(6), 357, 359-360
7.
National Audit Office.The Management and Control of Hospital-acquired Infection in Acute NHS Trusts in England. London: The Stationery Office , 2000
8.
Lawton R , Parker D.Procedures and the professional: the case of the British NHS . Soc Sci Med1999;48: 353-361
9.
Reason J , Parker D , Lawton R.Organisational controls and safety: the varieties of role-related behaviour . J Occup Organ Psychol1998;71: 289-304
10.
Grilli R , Lomas J.Evaluating the message: the relationship between compliance rate and the subject of a practice guideline . Med Care1994;32(3): 202-213
Weinstein N.Why it won’t happen to me: perceptions of risk factors and susceptibility . Health Psychol1984;3: 431-457
13.
Ajzen I.Theory of planned behaviour . Organ Beh Hum Decision Processes1991;50: 179-211
14.
Hamm RM.Clinical Intuition and Clinical Analysis: Expertise and the Cognitive Continuum. In: Dowie J , Elstein A , editors. Professional Judgement - A Reader in Clinical Decision Making. Cambridge: Cambridge University Press , 1988. pp. 78-105
15.
Kahney H.Problem Solving: Current Issues. Second edition. MiltonKeynes: Open University Press , 1993
16.
Claxton G.Knowing without knowing why . Psychologist1998;11(5): 217-220
17.
The Psychologist199812 (2)
18.
Wiebe DJ , McCallum D.Health practices and hardiness as mediators in the stress-illness relationship . Health Psychol1986;5: 425-438
19.
Roth I , Frisby JP.Perception and Representation A Cognitive Approach. Milton Keynes: Open University Press , 1992
20.
Reason J.Human Error. Cambridge: Cambridge University Press , 1998
21.
Williams REO , Blowers R , Garrod LP , Shooter RA , editors. Hospital Infection: Causes and Prevention. Second edition. London: Lloyd-Luke Medical Books , 1966
McFarlane A.Why do we forget to remember handwashing?Prof Nurse1990;5(5): 250-252
24.
Ayliffe GAJ , Lowbury EJL , Geddes AM , Williams JD.Control of Hospital Infection. Third edition. London: Chapman and Hall Medical , 1993
25.
Wilson J.Infection Control in Clinical Practice. London: Bailliere Tindall , 1995
26.
Loveday H , Harper P , Pellowe C , Robinson N , Pratt R.Standard principles for preventing HAIs . Nurs Times2001;97(13): 36-39
27.
Jarvinen G , Members of the Santa Cruz Policy Coordinating Office. Guide to Writing Policy and Procedure Documents. California: Santa Cruz Policy Coordinating Office, University of California , 1994
28.
Bennett P , Murphy S.Psychology and Health Promotion. Milton Keynes: Open University Press , 1997
29.
Department of Health.Communicating About Risks to Public Health: Pointers to Good Practice. London: The Stationery Office , 1998. Available online at www.doh.gov.uk/pointers.htm (accessed December 2002)
30.
Rotter J.Some problems and misconceptions related to the construct of internal versus external control of reinforcement . J Consult Clin Psychol1975;43: 56-67
31.
Wallston KA , Wallston BS.Who Is Responsible For Your Health? The Construct of Health Locus of Control. In: Sanders GS , Suls J , editors. Social Psychology of Health and Illness. Hillsdale: Erlbaum , 1982. pp. 65-95
32.
Conner M , Norman P.Predicting Health Behaviour. Milton Keynes: Open University Press , 1995
33.
Charles C , Gafni A , Whelan T.How to improve communication between doctors and patients . BMJ2000;320: 1220-1221
34.
Pfaff SJ.Education: past, present and future . Am J Infect Control1982;10(4): 133-137
35.
Wilkinson R , Caulfield H.The Human Rights Act: A Practical Guide for Nurses. London: Whurr , 2001
36.
Hall MA , Berenson RA.Ethical practice in managed care: a dose of realism . Ann Intern Med1998;128, 395-402
37.
Seedhouse D.Ethics - The Heart of Health Care. Chichester: John Wiley , 1998
38.
Ridgely Seymer L.Florence Nightingale - Selected Writings of Florence Nightingale. New York: Macmillan , 1954. Available online at: www.fordam.edu/halsall/mod/nightingalerural.html (accessed December 2002)
