Why do staff comply? A study to determine factors influencing staff adherence to PPE and hand hygiene policy and standards within an acute healthcare setting.

Background: Hand hygiene is commonly regarded as being the single most important method in preventing various healthcare-associated infections which cause an estimated 37,000 deaths in Europe and 100,000 deaths in the United States annually. Despite this, infection prevention and control audits regularly demonstrate that staff are missing hand hygiene opportunities, and that personal protective equipment (PPE) is being used inappropriately, clearly highlighting that policies are not being conformed to.

Aim: The aim of this was to identify factors that facilitate and hinder staff in their compliance with hand hygiene and PPE standards and policies.

Methods: A mixed methods approach sequential explanatory design was used to investigate levels of compliance and staff identified barriers and facilitators. Quantitative data was obtained regarding COVID-19 cases, hand hygiene, and PPE compliance over a 10-month period in all inpatient wards (approximately 750 beds) across an acute Trust. Following a review of this data, two wards were selected. Four participants on each ward, covering various grades of staff, were interviewed to explore their perceptions of compliance (qualitative data), and a thematic analysis was conducted to determine themes of facilitators and barriers.

Results: When compared to COVID-19 cases, hand hygiene and PPE compliance showed a downward trend over the study period. Barriers and facilitators to compliance identified by staff were time, information, training, safety, and accessibility. Time was the most common theme, with compliance to policy being deemed as too time consuming.

Conclusion: Patient safety was identified as the most influential aspect on staff being compliant with time being the one aspect that would contribute most to non-compliance.