1. Valerie Ness In the patient zone: healthcare staff’s perceptions of the 5 th moment Funded by the Scottish Infection Research Network (SIRN) Project management group: Robin Creelman, Lesley Price, Lisa Ritchie, Jackie McIntyre, Donald Bunyan, Jon Godwin, Stefan Morton and Jacqui Reilly

2. Background Hand hygiene – one of the most effective measures in reducing & preventing avoidable illness WHO’s “5 moments for hand hygiene” Compliance less for 5th moment

3. Research aim & questions Aim: To evaluate healthcare staff’s perceptions of the WHO hand hygiene moment 5 relative to compliance with this moment Questions: 1.Do healthcare staff comply with moment 5 in practice? 2.Does compliance with moment 5 vary between professional groups or in different contexts? 3.What are healthcare staff’s perceptions of moment 5? 4.Do healthcare staff’s perceptions of moment 5 vary across the professional group? 5.Is there an association between healthcare staff’s hand hygiene behaviour and their perceptions of moment 5?

4. Mixed method design Focus groups Development of self-report questionnaire Purposive sample of healthcare staff from 3 Scottish Health Boards Non-participant observation Completion of self-report questionnaire

5. Clinical Area N/M/ AHP/ ANC-O N/M/ AHP/ ANC-O N/M/ AHP/ANC-O N/M/ AHP/ ANC-O N/M/ AHP/ ANC-O Participant number * Gr EventTalking to patients Drug round Ward round Catering Toileting Transferring Cleaning Observations Documentation Other: please specify SettingBed/Trolley/Chair Bathroom Dayroom Treatment room Sluice Other: please specify RoomSingle Shared ‘Patient zone’Locker Bed rail Bed/Trolley/Chair Door handle Curtains Bed linen Bed table Equipment: please specify Other: please specify Final actionUse alcohol rub Wash hands No hand hygiene Next moment1 2 3 4 5 Data Collection – observation tool

6. Self-report questionnaire Could you answer the following questions in relation to: “In the prevention of infection, the 5 th moment for hand hygiene (after touching the patient’s surroundings) is…” Clearly defined [ ] [ ] [ ] [ ] [ ] Not clearly defined Unachievable [ ] [ ] [ ] [ ] [ ] Achievable Essential [ ] [ ] [ ] [ ] [ ] Not essential Too time consuming [ ] [ ] [ ] [ ] [ ] Not too time consuming Encouraged [ ] [ ] [ ] [ ] [ ] Not encouraged Not valuable [ ] [ ] [ ] [ ] [ ] Valuable Not repetitive [ ] [ ] [ ] [ ] [ ] Repetitive Not widely known [ ] [ ] [ ] [ ] [ ] Widely known

7. Data analysis SPSS Mostly nonparametric tests 1 st stage: - distributions and frequencies 2 nd stage: - Chi-squared tests/Fisher’s Exact test - Mann-Whitney U test/Krustal-Wallis/t-tests

8. Results 410/484 returned questionnaires (response rate 84%) 404 could be matched to observation data 93% either washed their hands, used alcohol gel or did both at Moment 5 No significant differences across professionals regarding compliance with Moment 5 (Heterogeneity χ² 3 =5.3, 1p=0.2) Significant differences in relation to compliance with Moment 5 across the health boards (χ² 3 (2) =10.3, 1p=0.006)

9. Results – healthcare staff’s perceptions of the 5 th moment Overall positive 77% essential 71% clearly defined 70% encouraged 69% achievable 65% widely known 56% not too time- consuming Only negative 60% repetitive

10. Results – Group differences in healthcare staff’s views Significant difference between medical staff and ancillary staff, where medical staff felt it was “less essential” and “less encouraged” than ancillary staff Professional group StatisticDefinedAchievableEssential Time consuming EncouragedValuableRepetitive Widely known Medical staff mean0.920.790.810.520.420.90 0.85 Ancillary/ other mean1.221.251.560.821.181.45-1.071.07 t-test min.2p 0.10.02<0.001**0.2<0.001**0.0050.030.3

11. Results - relationship between staff perceptions & hand hygiene practice Only significant variable was “widely known” –those who performed hand hygiene scored “widely known” higher than those who did not (p=<0.001)

12. Discussion 93% compliance with Moment 5 is still less than the 96% national compliance level for all hand hygiene opportunities Differences between health boards Staff perceptions about being widely known No significant differences in health professionals compliance but differences in perceptions (encouraged, essential) Repetitive

13. Conclusion Although staff are positive about the 5 th Moment & compliance is high, it is not optimum Increased staff awareness & understanding of Moment 5 may enhance compliance

14. Thank you. Any questions?