Brief report
A tool to assess barriers to adherence to hand hygiene guideline

https://doi.org/10.1016/j.ajic.2003.05.005Get rights and content

Abstract

This Brief Report presents results of preliminary testing of a tool, “Attitudes Regarding Practice Guidelines,” adapted from previous work by Cabana et al to examine barriers to adherence to practice guidelines. In a small sample of 21 clinicians (10 infectious disease physicians and 11 clinical nurses), the test-retest reliability was .86 and Chronbach α was .80, indicating acceptable levels of stability. It is recommended that the instrument undergo further testing and adaptation as a measure of potential barriers to adherence to practice guidelines in general, and to the new Hand Hygiene Guideline for Healthcare Settings specifically.

Section snippets

Conceptual underpinnings for the tool

Cabana et al2 reviewed 76 studies that assessed physician barriers to adherence to clinical practice guidelines. On the basis of this review, they identified 7 categories of barriers to guideline adherence related to general knowledge, attitudes, and behaviors (Table 1). The majority of studies examined only a single barrier, and Cabana concluded that intervention programs that fail to consider the variety of barriers to adherence are less likely to succeed. These 7 barriers were used as a

Description of the tool

The tool uses a 6-point Likert scale and has 2 sections. Part 1 includes attitudinal statements about practice guidelines in general (18 statements), and part 2 includes 18 statements specifically regarding the Hand Hygiene Guideline. Part 1 was designed to be used as a general tool with any practice guideline because attitudes regarding guidelines in general may influence one's response to specific guidelines. Possible scores range from 0 to 180, with higher scores indicating fewer perceived

Results

The questionnaire took respondents 5 to 10 minutes to complete. The test-retest reliability coefficient for the 21 health care professionals taking the survey was .86, and the standardized α coefficient in the item analysis was .80. One physician refused to participate in the testing because he said that “guidelines are worthless.”

Discussion

The publication of the Hand Hygiene Guideline provides a unique opportunity to engage staff in efforts to improve practice and adherence to standards. To do this, it would be helpful to understand what staff members perceive as the barriers to implementing practice guidelines in general and the Hand Hygiene Guideline in particular. For example, the fact that one physician refused to participate in the pilot testing because he judged practice guidelines to be unimportant has implications for his

References (4)

There are more references available in the full text version of this article.

Cited by (53)

  • A comparative study of hand hygiene and alcohol-based hand rub use among Irish nursing and medical students

    2018, Nurse Education Today
    Citation Excerpt :

    Hand hygiene education and training had been delivered to all cohorts as part of the students' curricula. Following a literature review, a validated questionnaire originally developed at Colombia University, New York and designed to assess barriers to adherence to US hand hygiene guidelines was selected as the study instrument (Larson, 2004, Centres for Disease Control, 2002). The survey was modified to reflect the WHO hand hygiene guidelines and additional questions were added (WHO, 2009).

View all citing articles on Scopus
View full text