Cleaning Staff's Attitudes about Hand Hygiene in a Metropolitan Hospital in Australia: A Qualitative Study

doi:10.3390/ijerph16061067

. 2019 Mar 25;16(6):1067.

doi: 10.3390/ijerph16061067.

Cleaning Staff's Attitudes about Hand Hygiene in a Metropolitan Hospital in Australia: A Qualitative Study

Marguerite C Sendall^{1

2}, Laura K McCosker^{3

4}, Kate Halton⁵

Affiliations

¹ School of Public Health and Social Work, Queensland University of Technology, Victoria Park Road, Kelvin Grove QLD 4159, Australia. m.sendall@qut.edu.au.
² Institute of Health and Biomedical Innovation, Queensland University of Technology, Musk Avenue, Kelvin Grove QLD 4159, Australia. m.sendall@qut.edu.au.
³ School of Public Health and Social Work, Queensland University of Technology, Victoria Park Road, Kelvin Grove QLD 4159, Australia. lkmccosker@ozemail.com.au.
⁴ Institute of Health and Biomedical Innovation, Queensland University of Technology, Musk Avenue, Kelvin Grove QLD 4159, Australia. lkmccosker@ozemail.com.au.
⁵ Institute of Health and Biomedical Innovation, Queensland University of Technology, Musk Avenue, Kelvin Grove QLD 4159, Australia. k.halton@gmail.com.

PMID: 30934579
PMCID: PMC6466087
DOI: 10.3390/ijerph16061067

Cleaning Staff's Attitudes about Hand Hygiene in a Metropolitan Hospital in Australia: A Qualitative Study

Marguerite C Sendall et al. Int J Environ Res Public Health. 2019.

. 2019 Mar 25;16(6):1067.

doi: 10.3390/ijerph16061067.

Authors

Marguerite C Sendall^{1

2}, Laura K McCosker^{3

4}, Kate Halton⁵

Affiliations

¹ School of Public Health and Social Work, Queensland University of Technology, Victoria Park Road, Kelvin Grove QLD 4159, Australia. m.sendall@qut.edu.au.
² Institute of Health and Biomedical Innovation, Queensland University of Technology, Musk Avenue, Kelvin Grove QLD 4159, Australia. m.sendall@qut.edu.au.
³ School of Public Health and Social Work, Queensland University of Technology, Victoria Park Road, Kelvin Grove QLD 4159, Australia. lkmccosker@ozemail.com.au.
⁴ Institute of Health and Biomedical Innovation, Queensland University of Technology, Musk Avenue, Kelvin Grove QLD 4159, Australia. lkmccosker@ozemail.com.au.
⁵ Institute of Health and Biomedical Innovation, Queensland University of Technology, Musk Avenue, Kelvin Grove QLD 4159, Australia. k.halton@gmail.com.

PMID: 30934579
PMCID: PMC6466087
DOI: 10.3390/ijerph16061067

Abstract

Background: In 2009, the National Hand Hygiene Initiative (NHHI) was implemented in hospitals across Australia with the aim of improving hand hygiene practices and reducing healthcare-associated infections. Audits conducted post-implementation showed the lowest rates of compliance with hand hygiene practices are among operational staff including hospital cleaners. There is limited information about hand hygiene issues in hospital cleaners to inform development of evidence-based interventions to improve hand hygiene compliance in this group.

Aim: This qualitative study was undertaken to explore the attitudes of hospital cleaning staff regarding hand hygiene and the National Hand Hygiene Initiative.

Methodology: Focus groups were conducted with 12 cleaning staff at a large Australian hospital implementing the National Hand Hygiene Initiative.

Findings: Hospital cleaners recognise the importance of hand hygiene in preventing healthcare-associated infections. Cleaners cite peer support, leadership, and the recognition and reward of those excelling in hand hygiene as strong motivators. Barriers to optimal hand hygiene practice include the presence of multiple conflicting guidelines, hand hygiene "overload" and a lack of contextualised education programs. This exploratory qualitative study reveals three themes about attitudes of hospital cleaning staff towards hand hygiene. These themes are: (1) "The culture of hand hygiene: It's drummed into us"; (2) "Reminders and promotion for hand hygiene: We just need a big 'Please wash your hands' sign"; and (3) "The personal value of hand hygiene: Like he said, it's second nature to us".

Conclusion: Hand-hygiene messages and training need to be more consistent and contextualised to achieve improvements in hand hygiene practices in hospital cleaning staff in Australia.

Keywords: attitudes; hand hygiene; hospital cleaners; infection control; qualitative research.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

**Diagram 1**
Five Moments for Hand Hygiene [5].

See this image and copyright information in PMC

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References

1. Naikoba S., Hayward A. The effectiveness of interventions aimed at increasing handwashing in healthcare workers—A systematic review. J. Hosp. Infect. 2001;47:173–180. doi: 10.1053/jhin.2000.0882. - DOI - PubMed
1. Gould D.J., Drey N.S., Moralejo D., Grimshaw J., Chudleigh J. Interventions to improve hand hygiene compliance in patient care. Cochrane Database Syst. Rev. 2010;9:CD005186. - PubMed
1. Backman C., Zoutman D.E., Marck P.B. An integrative review of the current evidence on the relationship between hand hygiene interventions and the incidence of health care-associated infections. Am. J. Infect. Control. 2008;36:333–348. doi: 10.1016/j.ajic.2007.08.007. - DOI - PubMed
1. Grayson M.L., Russo P.L., Cruickshank M., Bear J.L., Gee C.A., Hughes C.F., Johnson P.D., McCann R., McMillan A.J., Mitchell B.G., et al. Outcomes from the first 2 years of the Australian National Hand Hygiene Initiative. Med. J. Australia. 2011;195:615–619. doi: 10.5694/mja11.10747. - DOI - PubMed
1. Hand Hygiene Australia Five Moments for Hand Hygiene. [(accessed on 22 July 2017)]; Available online: https://www.hha.org.au/hand-hygiene/5-moments-for-hand-hygiene.

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[1] Naikoba S., Hayward A. The effectiveness of interventions aimed at increasing handwashing in healthcare workers—A systematic review. J. Hosp. Infect. 2001;47:173–180. doi: 10.1053/jhin.2000.0882. - DOI - PubMed

[2] Naikoba S., Hayward A. The effectiveness of interventions aimed at increasing handwashing in healthcare workers—A systematic review. J. Hosp. Infect. 2001;47:173–180. doi: 10.1053/jhin.2000.0882. - DOI - PubMed

[3] Gould D.J., Drey N.S., Moralejo D., Grimshaw J., Chudleigh J. Interventions to improve hand hygiene compliance in patient care. Cochrane Database Syst. Rev. 2010;9:CD005186. - PubMed

[4] Gould D.J., Drey N.S., Moralejo D., Grimshaw J., Chudleigh J. Interventions to improve hand hygiene compliance in patient care. Cochrane Database Syst. Rev. 2010;9:CD005186. - PubMed

[5] Backman C., Zoutman D.E., Marck P.B. An integrative review of the current evidence on the relationship between hand hygiene interventions and the incidence of health care-associated infections. Am. J. Infect. Control. 2008;36:333–348. doi: 10.1016/j.ajic.2007.08.007. - DOI - PubMed

[6] Backman C., Zoutman D.E., Marck P.B. An integrative review of the current evidence on the relationship between hand hygiene interventions and the incidence of health care-associated infections. Am. J. Infect. Control. 2008;36:333–348. doi: 10.1016/j.ajic.2007.08.007. - DOI - PubMed

[7] Grayson M.L., Russo P.L., Cruickshank M., Bear J.L., Gee C.A., Hughes C.F., Johnson P.D., McCann R., McMillan A.J., Mitchell B.G., et al. Outcomes from the first 2 years of the Australian National Hand Hygiene Initiative. Med. J. Australia. 2011;195:615–619. doi: 10.5694/mja11.10747. - DOI - PubMed

[8] Grayson M.L., Russo P.L., Cruickshank M., Bear J.L., Gee C.A., Hughes C.F., Johnson P.D., McCann R., McMillan A.J., Mitchell B.G., et al. Outcomes from the first 2 years of the Australian National Hand Hygiene Initiative. Med. J. Australia. 2011;195:615–619. doi: 10.5694/mja11.10747. - DOI - PubMed

[9] Hand Hygiene Australia Five Moments for Hand Hygiene. [(accessed on 22 July 2017)]; Available online: https://www.hha.org.au/hand-hygiene/5-moments-for-hand-hygiene.

[10] Hand Hygiene Australia Five Moments for Hand Hygiene. [(accessed on 22 July 2017)]; Available online: https://www.hha.org.au/hand-hygiene/5-moments-for-hand-hygiene.

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Cleaning Staff's Attitudes about Hand Hygiene in a Metropolitan Hospital in Australia: A Qualitative Study

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Cleaning Staff's Attitudes about Hand Hygiene in a Metropolitan Hospital in Australia: A Qualitative Study

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Conflict of interest statement

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