Improving Hand Hygiene Adherence in Small Animal Hospitals: A Social Marketing Approach

Abstract

Background Good hand hygiene adherence is a key factor in the prevention of hospital-acquired infections. The guidelines offered by the World Health Organization for interventions to improve hand hygiene adherence in human health care can only in part be applied to veterinary medicine, and current observations of hygiene adherence in veterinary environments stress a need for decisive action. There is great potential for improvement, especially in situations in which people act habitually. Focus of the Article The focus of this article is to identify the barriers and benefits that influence hand hygiene habits in veterinary care facilities and to derive intervention strategies to promote hand hygiene habits informed by theory and formative research. Research Question This article examines two research questions. What contextual, social, and personal factors promote (benefits) and hinder (barriers) hand hygiene habits in veterinary care facilities? Which intervention strategies can be derived from the identified barriers and benefits to foster hand hygiene habits? Approach The identification of the target behavior and group was based on the literature, talks within the author team, and daily observations. Barriers and benefits were identified by means of qualitative focus groups. The focus group interview schedule was informed by the risks, attitudes, norms, abilities, and self-regulation (RANAS) approach. The intervention strategy was based on the elicited barriers and benefits and guided by the framework of habit formation. Importance to the Social Marketing Field For the first time, barriers and benefits regarding hand hygiene habits were systematically elicited in a small animal clinic in Switzerland. The article focuses on hand hygiene as a habit and offers evidence-based and behavior-oriented intervention strategies. Our findings can thus be used as a basis for developing a theoretically sound intervention to promote hand hygiene habits in veterinary clinics and practices and serve as a springboard for future social marketing research, especially with a focus on habit formation. Methods Primary data were gathered using eight structured in-depth focus group interviews (N = 32 participants) in a small animal clinic in Switzerland. Two focus groups each were conducted with the following professional groups: veterinary assistants, students, residents and interns, and senior clinicians. Results The overarching theme across the participants’ talk was that building habits is promising but challenging to implement. In examining the key barriers and benefits, five themes were discussed: (1) animal welfare as a reason to act, (2) not about the why but about the how, (3) clash of generations, (4) lack of feedback mechanisms, and (5) the invisible enemy. Strategies were derived based on these findings and the theoretical framework of a habit formation intervention. Recommendations for Practice and Research The themes that emerged in the focus groups are connected to the theoretical framework of habit formation to derive possible intervention strategies. The supplemental material delves into these strategies and provides implementation steps for practitioners facing a similar challenge. Further research is needed to experimentally test the effect of the intervention strategies and to validate the results for other clinics.