Working in IPC, you get interested in hand hygiene compliance, whether you like it or not! I was struck by a recent quanti/quali (yes, qualitative!) study in the Journal of Hospital Infection exploring drivers towards hand hygiene compliance. The key findings is that, all other things considered, individual motivation is the biggest driver towards hand hygiene compliance. So, perhaps we need to enlist the services of Mr Motivator*?!

This is quite an unusual cross-sectional study design, combining qualitative and qualitative methods to provide some new insights on hand hygiene behaviours. Observational hand hygiene compliance data was collected from 9 Dutch hospitals. In parallel, staff were survey using the COM-B model (capability, opportunity, motivation – behaviour). Environmental determinants (e.g. speciality, workload, ward infrastructure) were also considered.

The observed hand hygiene compliance rate was 65% (pretty good given the average is about 40%). Perhaps unsurprisingly, there was no correlation between self-reported hand hygiene compliance and observed hand hygiene compliance. Putting all these variables into a multi-variable analysis with observed hand hygiene compliance found that only ward and individual motivation remained significant. This suggests that individual motivation trumps issues related to capability and opportunity when it comes to driving hand hygiene behaviour.

This isn’t perhaps surprising. The evidence from quality improvement work suggests that a huge variety of interventions aimed at all sorts of different drivers (from audit and feedback through to audio prompts) improves hand hygiene behaviours. So, to move the needle in improving hand hygiene behaviours, we need to win hearts and minds. The good news is that Mr Motivator is available for bookings.

* Mr Motivator was a TV personal trainer who rose to fame in the 1980s in England for being, well, very motivating!