In the era of corona virus: health care professionals’ knowledge, attitudes, and practice of hand hygiene in Saudi primary care centers: a cross-sectional study
Identifieur interne : 000917 ( Pmc/Corpus ); précédent : 000916; suivant : 000918In the era of corona virus: health care professionals’ knowledge, attitudes, and practice of hand hygiene in Saudi primary care centers: a cross-sectional study
Auteurs : Ali Alfahan ; Samia Alhabib ; Imad Abdulmajeed ; Saeed Rahman ; Samira BamuhairSource :
- Journal of Community Hospital Internal Medicine Perspectives [ 2000-9666 ] ; 2016.
Abstract
Hand hygiene is one of the essential means to prevent the spread of infections. The aim of this study was to assess the knowledge, attitudes, and practice (KAP) of hand hygiene in primary care settings.
A cross-sectional study using a self-reported questionnaire was conducted in primary care settings located in Riyadh, Kingdom of Saudi Arabia, under the service of King Abdulaziz Medical City (KAMC). The Institutional Review Board of KAMC Research Centre approved the study. Data were analyzed using IBM SPSS software.
A total of 237 participants were included in the analysis. Participants who received hand hygiene training within the last 3 years (2012–2014) scored higher on a knowledge scale. Generally, there was an overall positive attitude from participants toward hand hygiene practice. In total, 87.54% acknowledged that they routinely used alcohol-based hand rub, 87.4% had sufficiently decontaminated hands even under high work pressure, and 78.6% addressed that this practice was not affected by less compliant colleagues.
Practicing hand hygiene was suggested to be influenced by variables related to the environmental context, social pressure, and individual attitudes toward hand hygiene. We believe that addressing beliefs, attitudes, capacity, and supportive infrastructures to sustain hand-hygiene routine behaviors are important components of an implementation strategy in enhancing health care workers’ KAP of hand hygiene.
Url:
DOI: 10.3402/jchimp.v6.32151
PubMed: 27609728
PubMed Central: 5016750
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">In the era of corona virus: health care professionals’ knowledge, attitudes, and practice of hand hygiene in Saudi primary care centers: a cross-sectional study</title><author><name sortKey="Alfahan, Ali" sort="Alfahan, Ali" uniqKey="Alfahan A" first="Ali" last="Alfahan">Ali Alfahan</name><affiliation><nlm:aff id="AF0001">Department of Family Medicine and Primary Health Care, National Guard Health Affairs (NGHA), Riyadh, Kingdom of Saudi Arabia</nlm:aff></affiliation></author><author><name sortKey="Alhabib, Samia" sort="Alhabib, Samia" uniqKey="Alhabib S" first="Samia" last="Alhabib">Samia Alhabib</name><affiliation><nlm:aff id="AF0002">Department of Family & Community Medicine, King Abdullah bin Abdulaziz University Hospital, Riyadh, Kingdom of Saudi Arabia</nlm:aff></affiliation></author><author><name sortKey="Abdulmajeed, Imad" sort="Abdulmajeed, Imad" uniqKey="Abdulmajeed I" first="Imad" last="Abdulmajeed">Imad Abdulmajeed</name><affiliation><nlm:aff id="AF0003">Department of Community Medicine, National Guard Health Affairs (NGHA), Riyadh, Kingdom of Saudi Arabia</nlm:aff></affiliation></author><author><name sortKey="Rahman, Saeed" sort="Rahman, Saeed" uniqKey="Rahman S" first="Saeed" last="Rahman">Saeed Rahman</name><affiliation><nlm:aff id="AF0003">Department of Community Medicine, National Guard Health Affairs (NGHA), Riyadh, Kingdom of Saudi Arabia</nlm:aff></affiliation></author><author><name sortKey="Bamuhair, Samira" sort="Bamuhair, Samira" uniqKey="Bamuhair S" first="Samira" last="Bamuhair">Samira Bamuhair</name><affiliation><nlm:aff id="AF0004">Department of Medical Microbiology, College of Medicine, King Saud University for Health Science (KSAU-HS), National Guard Health Affairs (NGHA), Riyadh, Kingdom of Saudi Arabia</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">27609728</idno><idno type="pmc">5016750</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5016750</idno><idno type="RBID">PMC:5016750</idno><idno type="doi">10.3402/jchimp.v6.32151</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">000917</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000917</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">In the era of corona virus: health care professionals’ knowledge, attitudes, and practice of hand hygiene in Saudi primary care centers: a cross-sectional study</title><author><name sortKey="Alfahan, Ali" sort="Alfahan, Ali" uniqKey="Alfahan A" first="Ali" last="Alfahan">Ali Alfahan</name><affiliation><nlm:aff id="AF0001">Department of Family Medicine and Primary Health Care, National Guard Health Affairs (NGHA), Riyadh, Kingdom of Saudi Arabia</nlm:aff></affiliation></author><author><name sortKey="Alhabib, Samia" sort="Alhabib, Samia" uniqKey="Alhabib S" first="Samia" last="Alhabib">Samia Alhabib</name><affiliation><nlm:aff id="AF0002">Department of Family & Community Medicine, King Abdullah bin Abdulaziz University Hospital, Riyadh, Kingdom of Saudi Arabia</nlm:aff></affiliation></author><author><name sortKey="Abdulmajeed, Imad" sort="Abdulmajeed, Imad" uniqKey="Abdulmajeed I" first="Imad" last="Abdulmajeed">Imad Abdulmajeed</name><affiliation><nlm:aff id="AF0003">Department of Community Medicine, National Guard Health Affairs (NGHA), Riyadh, Kingdom of Saudi Arabia</nlm:aff></affiliation></author><author><name sortKey="Rahman, Saeed" sort="Rahman, Saeed" uniqKey="Rahman S" first="Saeed" last="Rahman">Saeed Rahman</name><affiliation><nlm:aff id="AF0003">Department of Community Medicine, National Guard Health Affairs (NGHA), Riyadh, Kingdom of Saudi Arabia</nlm:aff></affiliation></author><author><name sortKey="Bamuhair, Samira" sort="Bamuhair, Samira" uniqKey="Bamuhair S" first="Samira" last="Bamuhair">Samira Bamuhair</name><affiliation><nlm:aff id="AF0004">Department of Medical Microbiology, College of Medicine, King Saud University for Health Science (KSAU-HS), National Guard Health Affairs (NGHA), Riyadh, Kingdom of Saudi Arabia</nlm:aff></affiliation></author></analytic><series><title level="j">Journal of Community Hospital Internal Medicine Perspectives</title><idno type="eISSN">2000-9666</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="st1"><title>Background</title><p>Hand hygiene is one of the essential means to prevent the spread of infections. The aim of this study was to assess the knowledge, attitudes, and practice (KAP) of hand hygiene in primary care settings.</p></sec><sec id="st2"><title>Methods</title><p>A cross-sectional study using a self-reported questionnaire was conducted in primary care settings located in Riyadh, Kingdom of Saudi Arabia, under the service of King Abdulaziz Medical City (KAMC). The Institutional Review Board of KAMC Research Centre approved the study. Data were analyzed using IBM SPSS software.</p></sec><sec id="st3"><title>Results</title><p>A total of 237 participants were included in the analysis. Participants who received hand hygiene training within the last 3 years (2012–2014) scored higher on a knowledge scale. Generally, there was an overall positive attitude from participants toward hand hygiene practice. In total, 87.54% acknowledged that they routinely used alcohol-based hand rub, 87.4% had sufficiently decontaminated hands even under high work pressure, and 78.6% addressed that this practice was not affected by less compliant colleagues.</p></sec><sec id="st4"><title>Conclusion</title><p>Practicing hand hygiene was suggested to be influenced by variables related to the environmental context, social pressure, and individual attitudes toward hand hygiene. We believe that addressing beliefs, attitudes, capacity, and supportive infrastructures to sustain hand-hygiene routine behaviors are important components of an implementation strategy in enhancing health care workers’ KAP of hand hygiene.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Mauldin, Pd" uniqKey="Mauldin P">PD Mauldin</name></author><author><name sortKey="Salgado, Cd" uniqKey="Salgado C">CD Salgado</name></author><author><name sortKey="Hansen, Is" uniqKey="Hansen I">IS Hansen</name></author><author><name sortKey="Durup, Dt" uniqKey="Durup D">DT Durup</name></author><author><name sortKey="Bosso, Ja" uniqKey="Bosso J">JA Bosso</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Defez, C" uniqKey="Defez C">C Defez</name></author><author><name sortKey="Fabbro Peray, P" uniqKey="Fabbro Peray P">P Fabbro-Peray</name></author><author><name sortKey="Cazaban, M" uniqKey="Cazaban M">M Cazaban</name></author><author><name sortKey="Boudemaghe, T" uniqKey="Boudemaghe T">T Boudemaghe</name></author><author><name sortKey="Sotto, A" uniqKey="Sotto A">A Sotto</name></author><author><name sortKey="Daures, J" uniqKey="Daures J">J Daurès</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Llata, E" uniqKey="Llata E">E Llata</name></author><author><name sortKey="Gaynes, Rp" uniqKey="Gaynes R">RP Gaynes</name></author><author><name sortKey="Fridkin, S" uniqKey="Fridkin S">S Fridkin</name></author><author><name sortKey="Weinstein, Ra" uniqKey="Weinstein R">RA Weinstein</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Semmelweis, I" uniqKey="Semmelweis I">I Semmelweis</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Garner, Js" uniqKey="Garner J">JS Garner</name></author><author><name sortKey="Favero, Ms" uniqKey="Favero M">MS Favero</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Larson, El" uniqKey="Larson E">EL Larson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Larson, El" uniqKey="Larson E">EL Larson</name></author><author><name sortKey="Early, E" uniqKey="Early E">E Early</name></author><author><name sortKey="Cloonan, P" uniqKey="Cloonan P">P Cloonan</name></author><author><name sortKey="Sugrue, S" uniqKey="Sugrue S">S Sugrue</name></author><author><name sortKey="Parides, M" uniqKey="Parides M">M Parides</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Pittet, D" uniqKey="Pittet D">D Pittet</name></author><author><name sortKey="Simon, A" uniqKey="Simon A">A Simon</name></author><author><name sortKey="Hugonnet, S" uniqKey="Hugonnet S">S Hugonnet</name></author><author><name sortKey="Pessoa Silva, Cl" uniqKey="Pessoa Silva C">CL Pessoa-Silva</name></author><author><name sortKey="Sauvan, V" uniqKey="Sauvan V">V Sauvan</name></author><author><name sortKey="Perneger, Tv" uniqKey="Perneger T">TV Perneger</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Harbarth, S" uniqKey="Harbarth S">S Harbarth</name></author><author><name sortKey="Pittet, D" uniqKey="Pittet D">D Pittet</name></author><author><name sortKey="Grady, L" uniqKey="Grady L">L Grady</name></author><author><name sortKey="Goldmann, Da" uniqKey="Goldmann D">DA Goldmann</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Arenas, Md" uniqKey="Arenas M">MD Arenas</name></author><author><name sortKey="Sanchez Paya, J" uniqKey="Sanchez Paya J">J Sánchez-Payá</name></author><author><name sortKey="Barril, G" uniqKey="Barril G">G Barril</name></author><author><name sortKey="Garcia Valdecasas, J" uniqKey="Garcia Valdecasas J">J García-Valdecasas</name></author><author><name sortKey="Gorriz, Jl" uniqKey="Gorriz J">JL Gorriz</name></author><author><name sortKey="Soriano, A" uniqKey="Soriano A">A Soriano</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Assiri, A" uniqKey="Assiri A">A Assiri</name></author><author><name sortKey="Al Tawfiq, Ja" uniqKey="Al Tawfiq J">JA Al-Tawfiq</name></author><author><name sortKey="Al Rabeeah, Aa" uniqKey="Al Rabeeah A">AA Al-Rabeeah</name></author><author><name sortKey="Al Rabiah, Fa" uniqKey="Al Rabiah F">FA Al-Rabiah</name></author><author><name sortKey="Al Hajjar, S" uniqKey="Al Hajjar S">S Al-Hajjar</name></author><author><name sortKey="Al Barrak, A" uniqKey="Al Barrak A">A Al-Barrak</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="De Wandel, D" uniqKey="De Wandel D">D De Wandel</name></author><author><name sortKey="Maes, L" uniqKey="Maes L">L Maes</name></author><author><name sortKey="Labeau, S" uniqKey="Labeau S">S Labeau</name></author><author><name sortKey="Vereecken, C" uniqKey="Vereecken C">C Vereecken</name></author><author><name sortKey="Blot, S" uniqKey="Blot S">S Blot</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Borghesi, A" uniqKey="Borghesi A">A Borghesi</name></author><author><name sortKey="Stronati, M" uniqKey="Stronati M">M Stronati</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sax, H" uniqKey="Sax H">H Sax</name></author><author><name sortKey="Uckay, I" uniqKey="Uckay I">I Uçkay</name></author><author><name sortKey="Richet, H" uniqKey="Richet H">H Richet</name></author><author><name sortKey="Allegranzi, B" uniqKey="Allegranzi B">B Allegranzi</name></author><author><name sortKey="Pittet, D" uniqKey="Pittet D">D Pittet</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Boyce, Jm" uniqKey="Boyce J">JM Boyce</name></author><author><name sortKey="Pittet, D" uniqKey="Pittet D">D Pittet</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Pittet, D" uniqKey="Pittet D">D Pittet</name></author><author><name sortKey="Boyce, Jm" uniqKey="Boyce J">JM Boyce</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Memish, Za" uniqKey="Memish Z">ZA Memish</name></author><author><name sortKey="Zumla, Ai" uniqKey="Zumla A">AI Zumla</name></author><author><name sortKey="Assiri, A" uniqKey="Assiri A">A Assiri</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Grube, Jw" uniqKey="Grube J">JW Grube</name></author><author><name sortKey="Morgan, M" uniqKey="Morgan M">M Morgan</name></author><author><name sortKey="Mcgree, St" uniqKey="Mcgree S">ST McGree</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Godin, G" uniqKey="Godin G">G Godin</name></author><author><name sortKey="Belanger Gravel, A" uniqKey="Belanger Gravel A">A Bélanger-Gravel</name></author><author><name sortKey="Eccles, M" uniqKey="Eccles M">M Eccles</name></author><author><name sortKey="Grimshaw, J" uniqKey="Grimshaw J">J Grimshaw</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="O Boyle, Ca" uniqKey="O Boyle C">CA O'Boyle</name></author><author><name sortKey="Henly, Sj" uniqKey="Henly S">SJ Henly</name></author><author><name sortKey="Larson, E" uniqKey="Larson E">E Larson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Conner, M" uniqKey="Conner M">M Conner</name></author><author><name sortKey="Armitage, Cj" uniqKey="Armitage C">CJ Armitage</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ajzen, I" uniqKey="Ajzen I">I Ajzen</name></author><author><name sortKey="Driver, Bl" uniqKey="Driver B">BL Driver</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Pittet, D" uniqKey="Pittet D">D Pittet</name></author><author><name sortKey="Hugonnet, S" uniqKey="Hugonnet S">S Hugonnet</name></author><author><name sortKey="Harbarth, S" uniqKey="Harbarth S">S Harbarth</name></author><author><name sortKey="Mourouga, P" uniqKey="Mourouga P">P Mourouga</name></author><author><name sortKey="Sauvan, V" uniqKey="Sauvan V">V Sauvan</name></author><author><name sortKey="Touveneau, S" uniqKey="Touveneau S">S Touveneau</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Grol, R" uniqKey="Grol R">R Grol</name></author><author><name sortKey="Grimshaw, J" uniqKey="Grimshaw J">J Grimshaw</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Van Achterberg, T" uniqKey="Van Achterberg T">T Van Achterberg</name></author><author><name sortKey="Schoonhoven, L" uniqKey="Schoonhoven L">L Schoonhoven</name></author><author><name sortKey="Grol, R" uniqKey="Grol R">R Grol</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Grimshaw, Jm" uniqKey="Grimshaw J">JM Grimshaw</name></author><author><name sortKey="Eccles, Mp" uniqKey="Eccles M">MP Eccles</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mcguckin, M" uniqKey="Mcguckin M">M McGuckin</name></author><author><name sortKey="Taylor, A" uniqKey="Taylor A">A Taylor</name></author><author><name sortKey="Martin, V" uniqKey="Martin V">V Martin</name></author><author><name sortKey="Porten, L" uniqKey="Porten L">L Porten</name></author><author><name sortKey="Salcido, R" uniqKey="Salcido R">R Salcido</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">J Community Hosp Intern Med Perspect</journal-id><journal-id journal-id-type="iso-abbrev">J Community Hosp Intern Med Perspect</journal-id><journal-id journal-id-type="publisher-id">JCHIMP</journal-id><journal-title-group><journal-title>Journal of Community Hospital Internal Medicine Perspectives</journal-title></journal-title-group><issn pub-type="epub">2000-9666</issn><publisher><publisher-name>Co-Action Publishing</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">27609728</article-id><article-id pub-id-type="pmc">5016750</article-id><article-id pub-id-type="publisher-id">32151</article-id><article-id pub-id-type="doi">10.3402/jchimp.v6.32151</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group></article-categories><title-group><article-title>In the era of corona virus: health care professionals’ knowledge, attitudes, and practice of hand hygiene in Saudi primary care centers: a cross-sectional study</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Alfahan</surname><given-names>Ali</given-names></name><degrees>MD, FMD</degrees><xref ref-type="aff" rid="AF0001">1</xref></contrib><contrib contrib-type="author"><name><surname>Alhabib</surname><given-names>Samia</given-names></name><degrees>MPH, PhD</degrees><xref ref-type="aff" rid="AF0002">2</xref></contrib><contrib contrib-type="author"><name><surname>Abdulmajeed</surname><given-names>Imad</given-names></name><degrees>MBBS, MPH</degrees><xref ref-type="aff" rid="AF0003">3</xref><xref ref-type="corresp" rid="cor1">*</xref></contrib><contrib contrib-type="author"><name><surname>Rahman</surname><given-names>Saeed</given-names></name><degrees>MD, MPH</degrees><xref ref-type="aff" rid="AF0003">3</xref></contrib><contrib contrib-type="author"><name><surname>Bamuhair</surname><given-names>Samira</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="AF0004">4</xref></contrib></contrib-group><aff id="AF0001"><label>1</label>Department of Family Medicine and Primary Health Care, National Guard Health Affairs (NGHA), Riyadh, Kingdom of Saudi Arabia</aff><aff id="AF0002"><label>2</label>Department of Family & Community Medicine, King Abdullah bin Abdulaziz University Hospital, Riyadh, Kingdom of Saudi Arabia</aff><aff id="AF0003"><label>3</label>Department of Community Medicine, National Guard Health Affairs (NGHA), Riyadh, Kingdom of Saudi Arabia</aff><aff id="AF0004"><label>4</label>Department of Medical Microbiology, College of Medicine, King Saud University for Health Science (KSAU-HS), National Guard Health Affairs (NGHA), Riyadh, Kingdom of Saudi Arabia</aff><author-notes><corresp id="cor1"><label>*</label>Correspondence to: Imad Abdulmajeed, Department of Community Medicine, National Guard Health Affairs (NGHA), P.O. Box: 22490, Riyadh 11426, Kingdom of Saudi Arabia, Email: <email xlink:href="dr.imadyaseen@gmail.com">dr.imadyaseen@gmail.com</email></corresp></author-notes><pub-date pub-type="epub"><day>07</day><month>9</month><year>2016</year></pub-date><pub-date pub-type="collection"><year>2016</year></pub-date><volume>6</volume><issue>4</issue><elocation-id content-type="doi">10.3402/jchimp.v6.32151</elocation-id><history><date date-type="received"><day>05</day><month>5</month><year>2016</year></date><date date-type="rev-recd"><day>01</day><month>8</month><year>2016</year></date><date date-type="accepted"><day>05</day><month>8</month><year>2016</year></date></history><permissions><copyright-statement>© 2016 Ali Alfahan et al.</copyright-statement><copyright-year>2016</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc/4.0/"><license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License, permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><sec id="st1"><title>Background</title><p>Hand hygiene is one of the essential means to prevent the spread of infections. The aim of this study was to assess the knowledge, attitudes, and practice (KAP) of hand hygiene in primary care settings.</p></sec><sec id="st2"><title>Methods</title><p>A cross-sectional study using a self-reported questionnaire was conducted in primary care settings located in Riyadh, Kingdom of Saudi Arabia, under the service of King Abdulaziz Medical City (KAMC). The Institutional Review Board of KAMC Research Centre approved the study. Data were analyzed using IBM SPSS software.</p></sec><sec id="st3"><title>Results</title><p>A total of 237 participants were included in the analysis. Participants who received hand hygiene training within the last 3 years (2012–2014) scored higher on a knowledge scale. Generally, there was an overall positive attitude from participants toward hand hygiene practice. In total, 87.54% acknowledged that they routinely used alcohol-based hand rub, 87.4% had sufficiently decontaminated hands even under high work pressure, and 78.6% addressed that this practice was not affected by less compliant colleagues.</p></sec><sec id="st4"><title>Conclusion</title><p>Practicing hand hygiene was suggested to be influenced by variables related to the environmental context, social pressure, and individual attitudes toward hand hygiene. We believe that addressing beliefs, attitudes, capacity, and supportive infrastructures to sustain hand-hygiene routine behaviors are important components of an implementation strategy in enhancing health care workers’ KAP of hand hygiene.</p></sec></abstract><kwd-group><kwd>hand hygiene</kwd><kwd>KAP</kwd><kwd>primary health care</kwd></kwd-group></article-meta></front><body><p>Health care-associated infections are one of the most important public health problems in many countries, resulting in an increase in the morbidity, mortality, and additional costs in health care settings (<xref rid="CIT0001" ref-type="bibr">1</xref>–<xref rid="CIT0003" ref-type="bibr">3</xref>). Hand hygiene is one of the essential means to prevent the spread of such infections. In 1983, Semmelweis highlighted that cleansing contaminated hands with antiseptic products before and after contact with patients may reduce health care-associated infections (<xref rid="CIT0004" ref-type="bibr">4</xref>). Thereafter, CDC published the first formal guidelines on handwashing practices in hospitals (<xref rid="CIT0005" ref-type="bibr">5</xref>), followed by guidelines from the Association for Professionals in Infection Control and Epidemiology (APIC) (<xref rid="CIT0006" ref-type="bibr">6</xref>).</p><p>Understanding the knowledge, attitudes, and practice (KAP) of handwashing among health care professionals is essential to bring forth a sustained change in behaviors of individuals and institutions and to improve such practices when designing interventions. Several factors are involved in hand hygiene behavior such as attitude, perceived social norm, perceived behavioral control, perceived risk for infection, hand hygiene practices, perceived role model, perceived knowledge, and motivation (<xref rid="CIT0007" ref-type="bibr">7</xref>). Despite the number of published studies on hand hygiene, many questions concerning attitudes and knowledge of health care workers (HCWs) remain unanswered. This is particularly true in primary care settings where the volume of patients and complexities of cultural, institutional, and health policy factors can influence the practice of handwashing. Various studies have confirmed an inverse relation between intensity of patient care and adherence to hand hygiene practice (<xref rid="CIT0008" ref-type="bibr">8</xref>–<xref rid="CIT0010" ref-type="bibr">10</xref>). Additionally, the current burden of the spreading Middle East respiratory syndrome coronavirus (MERS-CoV) implied an action to review our basic strategies in hand hygiene practice. In a descriptive study (47 cases), MERS-CoV was found to be associated with substantial mortality in admitted patients who have medical comorbidities (<xref rid="CIT0011" ref-type="bibr">11</xref>). This calls for effective infection control measures in health care settings, in particular hand hygiene. Hence, KAP of hand hygiene will continue to be a concern and are essential to explore to bridge the theory–practice gap. Thus, the aim of this study was to assess the KAP of hand hygiene among primary care health workers.</p><sec sec-type="methods" id="S0002"><title>Methods</title><p>This was a cross-sectional study using a self-reported questionnaire conducted between February and June 2014. The questionnaire was composed of two instruments that were adapted to be consistent with the context of primary care settings. This was done because all the instruments in the literature were designed and worded according to a hospital setting. The first instrument was developed by expert groups from the World Health Organization as a knowledge and perception questionnaire (<xref rid="CIT0012" ref-type="bibr">12</xref>). The second one was adapted because of its wider contextual factors compared with the WHO instrument, such as the social support and norms that could influence the attitudes of HCWs toward hand hygiene practice (<xref rid="CIT0013" ref-type="bibr">13</xref>). Questions related to hospital settings, such as questions about hospital bed contact and peripheral catheter insertion, were excluded. Additional questions were included to gather participants characteristics (<xref ref-type="table" rid="T0001">Table 1</xref>).</p><table-wrap id="T0001" position="float"><label>Table 1</label><caption><p>Socio-demographic characteristics</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Item</th><th align="center" rowspan="1" colspan="1"></th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Age, mean (SD)</td><td align="center" rowspan="1" colspan="1">40.1 (9.25)</td></tr><tr><td align="left" rowspan="1" colspan="1">Years of experience, mean (SD)</td><td align="center" rowspan="1" colspan="1">12.85 (8.6)</td></tr><tr><td align="left" rowspan="1" colspan="1">Gender, <italic>n</italic> (%)</td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"> Male</td><td align="center" rowspan="1" colspan="1">45 (19)</td></tr><tr><td align="left" rowspan="1" colspan="1"> Female</td><td align="center" rowspan="1" colspan="1">192 (81)</td></tr><tr><td align="left" rowspan="1" colspan="1"> Total</td><td align="center" rowspan="1" colspan="1">237</td></tr><tr><td align="left" rowspan="1" colspan="1">Received hand hygiene training, <italic>n</italic> (%)</td><td align="center" rowspan="1" colspan="1">159 (67.1)</td></tr><tr><td align="left" rowspan="1" colspan="1">Occupation, <italic>n</italic> (%)</td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"> Nurses</td><td align="center" rowspan="1" colspan="1">189 (79.7)</td></tr><tr><td align="left" rowspan="1" colspan="1"> Physicians</td><td align="center" rowspan="1" colspan="1">48 (20.3)</td></tr><tr><td align="left" rowspan="1" colspan="1"> Total</td><td align="center" rowspan="1" colspan="1">237</td></tr></tbody></table></table-wrap><p>The questionnaire was accompanied by an information sheet explaining the objectives of the study. It was administered in English, without any translation. Two experts in the field of infection control assessed content and face validity of the modified questionnaire. The tool was pilot tested through 30 interviews (not including the sample) to ensure clarity of questions and to eliminate ambiguity.</p><p>In the knowledge section, the total score was calculated by adding up 28 questions assessing the participant's knowledge, and each correct answer was awarded with 1 point and unanswered questions and wrong answers were awarded 0 points. The maximum achievable score was 28. In the attitude section, all items (nine questions) were scored on a 5-point scale: 1 (fully agree) to 5 (fully disagree), with a maximum score of 45. In the practice section, answers were reported on either “Yes” or “No” options (two questions) or a 5-point numeric scale (four questions), ranging from 0 to 100%.</p><p>The study was conducted in primary care settings located in the central region of Riyadh, Kingdom of Saudi Arabia, under the service of King Abdulaziz Medical City (KAMC). Participants were included if they were physicians or nurses working in the targeted primary care centers.</p><p>Based on the published literature we used a precision estimate of 10% and anticipated hand hygiene knowledge of 50% (the most conservative value). Using a 95% confidence interval, 277 completed survey forms would be sufficient to accurately assess knowledge, attitude and practice about hand hygiene. Assuming a response rate of 70% and a completion rate of 80%, 400 questionnaires were distributed. 100 participants from each of the four primary care centers were randomly selected using electronic random number generator. The questionnaires were sent in sealed envelopes and placed in pigeonholes of the randomly selected participants in each practice.</p><p>Data were entered into SPSS v.20 by a professional data entry clerk and revised and cleaned by another clerk. The data were then analyzed using IBM SPSS software (v.20). Categorical variables were described using frequency and percentages. Continuous variables were summarized using mean±standard deviation. Chi-square test was used for comparing proportions. Student t-test/ANOVA was used for comparing means. Statistical significance was set to 0.05 or less and a confidence interval of 95%.</p><sec id="S0002-S20001"><title>Ethical considerations</title><p>Verbal consent was obtained from all subjects before they participated in the study. To keep their confidentiality, the returned questionnaires were kept anonymous and an identification code was assigned to each questionnaire in order to send a reminder to those who did not return the questionnaire. Participant details were kept in a password-protected computer that was accessible only to the researchers. Additionally, Institutional Review Board of King Abdullah International Medical Research Centre (KAIMRC) approved the project and ensured proper ethical conduct throughout the study.</p></sec></sec><sec sec-type="results" id="S0003"><title>Results</title><p>A total of 237 participants from five primary health care centers were included in the study (response rate = 59%). Female participants represented 81% (191) of the sample. The majority of respondents were nurses: 79.7% (189). The remaining 20.3% (48) were physicians. The age of participants ranged from 24 to 66 years, with a mean age of 40 years (SD±9.25). Participants’ experiences as HCWs ranged from 1 to 38 years, with a mean of 12.85 years (SD±8.59). In total, 67.1% (159) of participants acknowledged that they received training in hand hygiene within the last 3 years (2012–2014).</p><sec id="S0003-S20001"><title></title><sec><title>Participants’ knowledge</title><p>In the <italic>knowledge</italic> section of the questionnaire, the minimum knowledge score achieved was 5 and the maximum was 21 (<xref ref-type="fig" rid="F0001">Fig. 1</xref>), with a mean of 14 (SD±2.85). Nurses scored higher (14.1) than physicians (13.8) on knowledge scale; however, this was not statistically significant (<italic>p</italic> = 0.58). Moreover, the participants who received hand hygiene training within the last 3 years generally scored higher on knowledge scale (14.2) than those who did not have such a training (13.5); nevertheless, the difference was not statistically significant (<italic>p</italic> = 0.09). Knowledge score was not affected by the years of the participants’ work experience (<italic>p</italic> = 0.4). Those who reported using the alcohol-based hand rub routinely had significantly higher knowledge score (14.3) than those who did not use the hand rub routinely (12.5) (<italic>p</italic>=0.01)</p><fig id="F0001" position="float"><label>Fig. 1</label><caption><p>Percent of correct answers of knowledge questions.</p></caption><graphic xlink:href="JCHIMP-6-32151-g001"></graphic></fig></sec><sec><title>Participants’ attitude</title><p>In the <italic>attitude</italic> section of the questionnaire, only 218 (92%) participants completed the questions. Generally, there was an overall positive attitude from participants toward hand hygiene practice (<xref ref-type="fig" rid="F0002">Fig. 2</xref>). Participants agreed fully that hand hygiene is important, possible, and not time consuming; believed it saves lives; and would feel bad if they were not able to wash their hands. However, half the participants believed that their attention to proper hand hygiene practices is negatively affected by their workload.</p><fig id="F0002" position="float"><label>Fig. 2</label><caption><p>Answers to attitude questions.</p></caption><graphic xlink:href="JCHIMP-6-32151-g002"></graphic></fig><p>Attitude toward hand hygiene was not correlated with the participants’ gender, years of experience, or training. However, nurses were found to exhibit a better attitude toward hand hygiene than physicians (<italic>p</italic>=0.02). Also, age was positively correlated with a positive attitude toward hand hygiene (Spearman's rho = 0.14, <italic>p</italic>=0.04)</p></sec><sec><title>Participants’ practice of hand hygiene</title><p>In the <italic>practice</italic> section of the questionnaire, 81.9% (194) acknowledged that they routinely make use of alcohol-based hand rub, 86.5% (205) had sufficiently decontaminated hands even under high work pressure, and 77.6% (184) addressed that their hand hygiene practice was not affected by less compliant colleagues. Also, 55.3% (131) confirmed that their hand hygiene practice would improve if skin moisturizers were made available to them.</p><p>There was no correlation between the frequency of practicing hand hygiene and the participants’ gender, age, and years of experience. However, there was a significant correlation between such practices and participants’ training in hand hygiene in the last 3 years (<italic>p</italic>=0.02). Also, nurses were found to be more compliant with using alcohol-based hand rub than physicians (<italic>p</italic>=0.03).</p><p>There was a significant correlation between the level of practicing hand rubbing with alcohol and higher score of knowledge (<italic>p</italic>≤0.01). Also those who stated that their practice was not affected by workload were found to have a significantly higher knowledge score (<italic>p</italic>≤0.01). Participants who stated they were able to resist peer pressure had slightly higher mean knowledge score, but the difference was not statistically significant (<italic>p</italic>=0.7). Moreover, those whose practice was affected by the availability of skin moisturizers scored significantly lower on attitude score (<italic>p</italic>≤0.01).</p></sec></sec></sec><sec sec-type="discussion" id="S0004"><title>Discussion</title><p>This study highlighted very important aspects of KAP of hand hygiene among various health workers in primary care settings. Most of the studies of hand hygiene have measured knowledge (cognitive domain) and general practices (behavioral domain) rather than affective factors (values, beliefs, perceptions, motivation). Our study measured all of these domains. This is essential, in particular, with the current epidemics of MERS in the Arab countries, when all HCWs need to be vigilant to prevent and control such infections in the community. In addition to the fact that hand hygiene has been considered the leading measure to prevent health care-associated infections (<xref rid="CIT0014" ref-type="bibr">14</xref>), we found a statistically significant correlation between participants’ practice of hand hygiene and their previous training and their profession, in particular being a nurse. This finding is in line with other studies, which showed that training and campaign exposure increased the likelihood of a positive attitude and increased compliance with hand hygiene (<xref rid="CIT0015" ref-type="bibr">15</xref>).</p><p>In our survey, those whose practice was affected by the availability of skin moisturizers scored significantly lower on attitude score (<italic>p</italic>≤0.01). The implemented method of hand hygiene also influences practice, and the use of an alcohol-based hand rub preparation for hand hygiene, recently defined as the standard of care, has been associated with striking enhancement of compliance (<xref rid="CIT0016" ref-type="bibr">16</xref>). Studies have shown that adherence to hand hygiene recommendations is influenced by knowledge; awareness of personal and group performance; workload; and type, tolerance, and accessibility of hand hygiene products (<xref rid="CIT0016" ref-type="bibr">16</xref>, <xref rid="CIT0017" ref-type="bibr">17</xref>).</p><p>Practicing hand hygiene among HCWs was suggested to be influenced by variables related to the environmental context, social pressure, and the actual and perceived risk for cross-transmission and to a positive individual attitude toward hand hygiene (<xref rid="CIT0008" ref-type="bibr">8</xref>). This is particularly true in the current surge of MERS-CoV in Saudi Arabia at the national level and Middle East at large, where HCWs have to be vigilant to strict infection control procedures such as hand hygiene practice. In Saudi Arabia, it has been found that some of the nurses did not follow infection control procedures fully and therefore had maximal exposure to MERS-CoV (<xref rid="CIT0018" ref-type="bibr">18</xref>).</p><p>Social cognitive and psychological determinants (i.e., knowledge, intention, beliefs and perceptions) might provide some insight into hand hygiene behavior. This has been explained by the social cognitive theory, which is widely used to explain behaviors and behavioral intentions in different social situations. Social Cognitive theory has also been used to explain adherence to hand hygiene practice among nurses (<xref rid="CIT0019" ref-type="bibr">19</xref>–<xref rid="CIT0021" ref-type="bibr">21</xref>). This theory postulated that behavior (practice) could be anticipated from intention, which, in turn, is molded by personal attitudes, perceived behavioral control, and subjective norms (<xref rid="CIT0022" ref-type="bibr">22</xref>). Hence, intention is assumed to be the most instant factor to determine behavior.</p><p>Our participants’ intentions were positive in terms of willingness, perceived importance, realistic insight, and belief that hand hygiene will save lives.</p><p>This intention might explain the participants’ high level performance of hand hygiene practice. They acknowledged that they routinely make use of alcohol-based hand rub (87.54%), had sufficiently decontaminate hands even under high work pressure (87.4%), and addressed that their hand hygiene practice was not affected by less compliant colleagues (78.6%). Ajzen proposed that past experiences shape social cognitive factors, which, in turn, determine behavior (<xref rid="CIT0023" ref-type="bibr">23</xref>). Therefore, it can be assumed that once good working conditions are guaranteed, the real and perceived individual control over hand hygiene might improve, with a positive succeeding effect on hand hygiene behavior.</p><p>Barriers to appropriate hand hygiene practice have been studied and reported extensively, but even in settings with optimal environmental conditions, compliance appears to range from 50 to 60% at most (<xref rid="CIT0024" ref-type="bibr">24</xref>). However, our participants showed a higher level of hand hygiene practice (>78%). This could be explained by the high level of awareness program, policy, and procedures that are in place in our institution (KAMC). The Kingdom of Saudi Arabia is one of the 42 countries actively participating in a WHO-sponsored hygiene promotion campaign targeting HCWs (<xref rid="CIT0016" ref-type="bibr">16</xref>). Following the ministerial pledge to the First Global Patient Safety Challenge and the launch of a national campaign, a hand hygiene campaign was undertaken in 2005.</p><p>Our findings highlighted an alarming challenge in identifying unique opportunities for targeted quality improvement programs on hand hygiene at the primary care settings, where an excess of patients has been a particular characteristic compared to hospital settings. Hence, use of theory and evidence from implementation science can assist evidence-based implementation. Furthermore, adoption of previously tested models could be suggested, such as the stepwise approach model for effective implementation that takes the user through a series of rational and deliberate steps to accomplish practice improvement (<xref rid="CIT0025" ref-type="bibr">25</xref>).</p><p>Implementation project leaders tend to prefer voluntary, intrinsic motivation-focused strategies (<xref rid="CIT0026" ref-type="bibr">26</xref>). For example, supportive strategies such as reminders, decision support, and rewards were mostly effective. Moreover, combined strategies were recognized as more effective than were single strategies (<xref rid="CIT0027" ref-type="bibr">27</xref>).</p><sec id="S0004-S20001"><title>Study limitations</title><p>Although the English language is the official language of communication in the work environment in KAMC, English is a second language to most HCWs, and this might affect how participants responded to the survey tool. We did not identify any language barriers during the pilot testing of the data collection tool.</p></sec></sec><sec id="S0005"><title>Conclusion</title><p>We conclude with a suggestion for innovation by instructing patients to remind HCWs to perform hand hygiene, which proved to have a positive effect on HCWs’ compliance with hand hygiene practice (<xref rid="CIT0028" ref-type="bibr">28</xref>). However, a disadvantage of this strategy was that a substantial number of patients reported reluctance or uneasiness in reminding health care professionals. Such approaches should be tested and evidence of their effectiveness in various health care settings must be also explored in further research in order to be implemented to enhance the KAP of hand hygiene among HCWs.</p></sec></body><back><ack><title>Acknowledgment</title><p>We thank Ms Hind AL Shatry, as well as all the health care workers who made time in their busy schedules to complete the questionnaire, and Ms Cora Passive for her practical contributions to this study. We also thank KAIMRC for funding this project.</p></ack><sec id="S0006"><title>Conflict of interest and funding</title><p>Authors declare no conflicting interests.</p></sec><ref-list><title>References</title><ref id="CIT0001"><label>1</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Mauldin</surname><given-names>PD</given-names></name><name><surname>Salgado</surname><given-names>CD</given-names></name><name><surname>Hansen</surname><given-names>IS</given-names></name><name><surname>Durup</surname><given-names>DT</given-names></name><name><surname>Bosso</surname><given-names>JA</given-names></name></person-group><article-title>Attributable hospital cost and length of stay associated with health care-associated infections caused by antibiotic-resistant gram-negative bacteria</article-title><source>Antimicrob Agents Chemother</source><year>2010</year><volume>54</volume><issue>1</issue><fpage>109</fpage><lpage>15</lpage><pub-id pub-id-type="pmid">19841152</pub-id></element-citation></ref><ref id="CIT0002"><label>2</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Defez</surname><given-names>C</given-names></name><name><surname>Fabbro-Peray</surname><given-names>P</given-names></name><name><surname>Cazaban</surname><given-names>M</given-names></name><name><surname>Boudemaghe</surname><given-names>T</given-names></name><name><surname>Sotto</surname><given-names>A</given-names></name><name><surname>Daurès</surname><given-names>J</given-names></name></person-group><article-title>Additional direct medical costs of nosocomial infections: An estimation from a cohort of patients in a French university hospital</article-title><source>J Hosp Infect</source><year>2008</year><volume>68</volume><issue>2</issue><fpage>130</fpage><lpage>6</lpage><pub-id pub-id-type="pmid">18201796</pub-id></element-citation></ref><ref id="CIT0003"><label>3</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Llata</surname><given-names>E</given-names></name><name><surname>Gaynes</surname><given-names>RP</given-names></name><name><surname>Fridkin</surname><given-names>S</given-names></name><name><surname>Weinstein</surname><given-names>RA</given-names></name></person-group><article-title>Measuring the scope and magnitude of hospital-associated infection in the United States: The value of prevalence surveys</article-title><source>Clin Infect Dis</source><year>2009</year><volume>48</volume><issue>10</issue><fpage>1434</fpage><lpage>40</lpage><pub-id pub-id-type="pmid">19351269</pub-id></element-citation></ref><ref id="CIT0004"><label>4</label><element-citation publication-type="book"><person-group person-group-type="author"><name><surname>Semmelweis</surname><given-names>I</given-names></name></person-group><person-group person-group-type="editor"><name><surname>Buck</surname><given-names>C</given-names></name><name><surname>Llopis</surname><given-names>A</given-names></name><name><surname>Najera</surname><given-names>E</given-names></name><name><surname>Terris</surname><given-names>M</given-names></name></person-group><article-title>The etiology, concept and prophylaxis of childbed fever [excerpts]</article-title><source><italic>The challenge of epidemiology—issues and selected readings</italic></source><year>1988</year><publisher-loc>Washington</publisher-loc><publisher-name>PAHO Scientific Publication</publisher-name><fpage>46</fpage><lpage>59</lpage></element-citation></ref><ref id="CIT0005"><label>5</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Garner</surname><given-names>JS</given-names></name><name><surname>Favero</surname><given-names>MS</given-names></name></person-group><article-title>CDC Guideline for Handwashing and Hospital Environmental Control, 1985</article-title><source>Infection Control</source><year>1986</year><volume>7</volume><issue>4</issue><fpage>231</fpage><lpage>43</lpage><pub-id pub-id-type="pmid">3009347</pub-id></element-citation></ref><ref id="CIT0006"><label>6</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Larson</surname><given-names>EL</given-names></name></person-group><article-title>APIC guidelines for handwashing and hand antisepsis in health care settings</article-title><source>Am J Infect Contr</source><year>1995</year><volume>23</volume><issue>4</issue><fpage>251</fpage><lpage>69</lpage></element-citation></ref><ref id="CIT0007"><label>7</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Larson</surname><given-names>EL</given-names></name><name><surname>Early</surname><given-names>E</given-names></name><name><surname>Cloonan</surname><given-names>P</given-names></name><name><surname>Sugrue</surname><given-names>S</given-names></name><name><surname>Parides</surname><given-names>M</given-names></name></person-group><article-title>An organizational climate intervention associated with increased handwashing and decreased nosocomial infections</article-title><source>Behav Med</source><year>2000</year><volume>26</volume><issue>1</issue><fpage>14</fpage><lpage>22</lpage><pub-id pub-id-type="pmid">10971880</pub-id></element-citation></ref><ref id="CIT0008"><label>8</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Pittet</surname><given-names>D</given-names></name><name><surname>Simon</surname><given-names>A</given-names></name><name><surname>Hugonnet</surname><given-names>S</given-names></name><name><surname>Pessoa-Silva</surname><given-names>CL</given-names></name><name><surname>Sauvan</surname><given-names>V</given-names></name><name><surname>Perneger</surname><given-names>TV</given-names></name></person-group><article-title>Hand hygiene among physicians: Performance, beliefs, and perceptions</article-title><source>Ann Intern Med</source><year>2004</year><volume>141</volume><issue>1</issue><fpage>1</fpage><lpage>8</lpage><pub-id pub-id-type="pmid">15238364</pub-id></element-citation></ref><ref id="CIT0009"><label>9</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Harbarth</surname><given-names>S</given-names></name><name><surname>Pittet</surname><given-names>D</given-names></name><name><surname>Grady</surname><given-names>L</given-names></name><name><surname>Goldmann</surname><given-names>DA</given-names></name></person-group><article-title>Compliance with hand hygiene practice in pediatric intensive care</article-title><source>Pediatr Crit Care Med</source><year>2001</year><volume>2</volume><issue>4</issue><fpage>311</fpage><lpage>4</lpage><pub-id pub-id-type="pmid">12793932</pub-id></element-citation></ref><ref id="CIT0010"><label>10</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Arenas</surname><given-names>MD</given-names></name><name><surname>Sánchez-Payá</surname><given-names>J</given-names></name><name><surname>Barril</surname><given-names>G</given-names></name><name><surname>García-Valdecasas</surname><given-names>J</given-names></name><name><surname>Gorriz</surname><given-names>JL</given-names></name><name><surname>Soriano</surname><given-names>A</given-names></name><etal></etal></person-group><article-title>A multicentric survey of the practice of hand hygiene in haemodialysis units: Factors affecting compliance</article-title><source>Nephrol Dial Transplant</source><year>2005</year><volume>20</volume><issue>6</issue><fpage>1164</fpage><lpage>71</lpage><pub-id pub-id-type="pmid">15769816</pub-id></element-citation></ref><ref id="CIT0011"><label>11</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Assiri</surname><given-names>A</given-names></name><name><surname>Al-Tawfiq</surname><given-names>JA</given-names></name><name><surname>Al-Rabeeah</surname><given-names>AA</given-names></name><name><surname>Al-Rabiah</surname><given-names>FA</given-names></name><name><surname>Al-Hajjar</surname><given-names>S</given-names></name><name><surname>Al-Barrak</surname><given-names>A</given-names></name><etal></etal></person-group><article-title>Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: A descriptive study</article-title><source>Lancet Infect Dis</source><year>2013</year><volume>13</volume><issue>9</issue><fpage>752</fpage><lpage>61</lpage><pub-id pub-id-type="pmid">23891402</pub-id></element-citation></ref><ref id="CIT0012"><label>12</label><element-citation publication-type="webpage"><collab>WHO</collab><source>Hand hygiene knowledge questionnaire for health-care workers</source><year>2009</year><comment>Available from: <ext-link ext-link-type="uri" xlink:href="http://www.who.int/gpsc/5may/tools/evaluation_feedback/en/">http://www.who.int/gpsc/5may/tools/evaluation_feedback/en/</ext-link> [cited 21 October 2012]</comment></element-citation></ref><ref id="CIT0013"><label>13</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>De Wandel</surname><given-names>D</given-names></name><name><surname>Maes</surname><given-names>L</given-names></name><name><surname>Labeau</surname><given-names>S</given-names></name><name><surname>Vereecken</surname><given-names>C</given-names></name><name><surname>Blot</surname><given-names>S</given-names></name></person-group><article-title>Behavioral determinants of hand hygiene compliance in intensive care units</article-title><source>Am J Crit Care</source><year>2010</year><volume>19</volume><issue>3</issue><fpage>230</fpage><lpage>9</lpage><pub-id pub-id-type="pmid">20436062</pub-id></element-citation></ref><ref id="CIT0014"><label>14</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Borghesi</surname><given-names>A</given-names></name><name><surname>Stronati</surname><given-names>M</given-names></name></person-group><article-title>Strategies for the prevention of hospital-acquired infections in the neonatal intensive care unit</article-title><source>J Hosp Infect</source><year>2008</year><volume>68</volume><issue>4</issue><fpage>293</fpage><lpage>300</lpage><pub-id pub-id-type="pmid">18329134</pub-id></element-citation></ref><ref id="CIT0015"><label>15</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Sax</surname><given-names>H</given-names></name><name><surname>Uçkay</surname><given-names>I</given-names></name><name><surname>Richet</surname><given-names>H</given-names></name><name><surname>Allegranzi</surname><given-names>B</given-names></name><name><surname>Pittet</surname><given-names>D</given-names></name></person-group><article-title>Determinants of good adherence to hand hygiene among healthcare workers who have extensive exposure to hand hygiene campaigns</article-title><source>Infect Control Hosp Epidemiol</source><year>2007</year><volume>28</volume><issue>11</issue><fpage>1267</fpage><lpage>74</lpage><pub-id pub-id-type="pmid">17926278</pub-id></element-citation></ref><ref id="CIT0016"><label>16</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Boyce</surname><given-names>JM</given-names></name><name><surname>Pittet</surname><given-names>D</given-names></name></person-group><article-title>Guideline for hand hygiene in health-care settings: Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force</article-title><source>Am J Infect Control</source><year>2002</year><volume>30</volume><issue>8</issue><fpage>S1</fpage><lpage>46</lpage><pub-id pub-id-type="pmid">12461507</pub-id></element-citation></ref><ref id="CIT0017"><label>17</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Pittet</surname><given-names>D</given-names></name><name><surname>Boyce</surname><given-names>JM</given-names></name></person-group><article-title>Hand hygiene and patient care: Pursuing the Semmelweis legacy</article-title><source>Lancet Infect Dis</source><year>2001</year><volume>1</volume><fpage>9</fpage><lpage>20</lpage><pub-id pub-id-type="pmid">11871420</pub-id></element-citation></ref><ref id="CIT0018"><label>18</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Memish</surname><given-names>ZA</given-names></name><name><surname>Zumla</surname><given-names>AI</given-names></name><name><surname>Assiri</surname><given-names>A</given-names></name></person-group><article-title>Middle East respiratory syndrome coronavirus infections in health care workers</article-title><source>N Engl J Med</source><year>2013</year><volume>369</volume><issue>9</issue><fpage>884</fpage><lpage>6</lpage><pub-id pub-id-type="pmid">23923992</pub-id></element-citation></ref><ref id="CIT0019"><label>19</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Grube</surname><given-names>JW</given-names></name><name><surname>Morgan</surname><given-names>M</given-names></name><name><surname>McGree</surname><given-names>ST</given-names></name></person-group><article-title>Attitudes and normative beliefs as predictors of smoking intentions and behaviours: A test of three models</article-title><source>Br J Soc Psychol</source><year>1986</year><volume>25</volume><issue>2</issue><fpage>81</fpage><lpage>93</lpage><pub-id pub-id-type="pmid">3719241</pub-id></element-citation></ref><ref id="CIT0020"><label>20</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Godin</surname><given-names>G</given-names></name><name><surname>Bélanger-Gravel</surname><given-names>A</given-names></name><name><surname>Eccles</surname><given-names>M</given-names></name><name><surname>Grimshaw</surname><given-names>J</given-names></name></person-group><article-title>Healthcare professionals’ intentions and behaviours: A systematic review of studies based on social cognitive theories</article-title><source>Implement Sci</source><year>2008</year><volume>3</volume><issue>36</issue><fpage>1</fpage><lpage>12</lpage><pub-id pub-id-type="pmid">18179688</pub-id></element-citation></ref><ref id="CIT0021"><label>21</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>O'Boyle</surname><given-names>CA</given-names></name><name><surname>Henly</surname><given-names>SJ</given-names></name><name><surname>Larson</surname><given-names>E</given-names></name></person-group><article-title>Understanding adherence to hand hygiene recommendations: The theory of planned behavior</article-title><source>Am J Infect Contr</source><year>2001</year><volume>29</volume><issue>6</issue><fpage>352</fpage><lpage>60</lpage></element-citation></ref><ref id="CIT0022"><label>22</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Conner</surname><given-names>M</given-names></name><name><surname>Armitage</surname><given-names>CJ</given-names></name></person-group><article-title>Extending the theory of planned behavior: A review and avenues for further research</article-title><source>J Appl Soc Psychol</source><year>1998</year><volume>28</volume><issue>15</issue><fpage>1429</fpage><lpage>64</lpage></element-citation></ref><ref id="CIT0023"><label>23</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ajzen</surname><given-names>I</given-names></name><name><surname>Driver</surname><given-names>BL</given-names></name></person-group><article-title>Prediction of leisure participation from behavioral, normative, and control beliefs: An application of the theory of planned behavior</article-title><source>Leisure Sci</source><year>1991</year><volume>13</volume><issue>3</issue><fpage>185</fpage><lpage>204</lpage></element-citation></ref><ref id="CIT0024"><label>24</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Pittet</surname><given-names>D</given-names></name><name><surname>Hugonnet</surname><given-names>S</given-names></name><name><surname>Harbarth</surname><given-names>S</given-names></name><name><surname>Mourouga</surname><given-names>P</given-names></name><name><surname>Sauvan</surname><given-names>V</given-names></name><name><surname>Touveneau</surname><given-names>S</given-names></name><etal></etal></person-group><article-title>Effectiveness of a hospital-wide programme to improve compliance with hand hygiene</article-title><source>Lancet</source><year>2000</year><volume>356</volume><issue>9238</issue><fpage>1307</fpage><lpage>12</lpage><pub-id pub-id-type="pmid">11073019</pub-id></element-citation></ref><ref id="CIT0025"><label>25</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Grol</surname><given-names>R</given-names></name><name><surname>Grimshaw</surname><given-names>J</given-names></name></person-group><article-title>From best evidence to best practice: Effective implementation of change in patients’ care</article-title><source>Lancet</source><year>2003</year><volume>362</volume><issue>9391</issue><fpage>1225</fpage><lpage>30</lpage><pub-id pub-id-type="pmid">14568747</pub-id></element-citation></ref><ref id="CIT0026"><label>26</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Van Achterberg</surname><given-names>T</given-names></name><name><surname>Schoonhoven</surname><given-names>L</given-names></name><name><surname>Grol</surname><given-names>R</given-names></name></person-group><article-title>Nursing implementation science: How evidence-based nursing requires evidence-based implementation</article-title><source>J Nurs Scholarsh</source><year>2008</year><volume>40</volume><issue>4</issue><fpage>302</fpage><lpage>10</lpage><pub-id pub-id-type="pmid">19094144</pub-id></element-citation></ref><ref id="CIT0027"><label>27</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Grimshaw</surname><given-names>JM</given-names></name><name><surname>Eccles</surname><given-names>MP</given-names></name></person-group><article-title>Is evidence-based implementation of evidence-based care possible?</article-title><source>Med J Aust</source><year>2004</year><volume>180</volume><issue>6 Suppl</issue><fpage>S50</fpage><lpage>1</lpage><pub-id pub-id-type="pmid">15012580</pub-id></element-citation></ref><ref id="CIT0028"><label>28</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>McGuckin</surname><given-names>M</given-names></name><name><surname>Taylor</surname><given-names>A</given-names></name><name><surname>Martin</surname><given-names>V</given-names></name><name><surname>Porten</surname><given-names>L</given-names></name><name><surname>Salcido</surname><given-names>R</given-names></name></person-group><article-title>Evaluation of a patient education model for increasing hand hygiene compliance in an inpatient rehabilitation unit</article-title><source>Am J Infect Control</source><year>2004</year><volume>32</volume><issue>4</issue><fpage>235</fpage><lpage>8</lpage><pub-id pub-id-type="pmid">15175621</pub-id></element-citation></ref></ref-list></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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