Understanding hand hygiene adherence in neonatology: a qualitative study of behavioral determinants.

Background: Hand hygiene is effective to prevent transmission of pathogens and healthcare-associated infections. Despite efforts by hospitals to improve hand hygiene adherence among healthcare practitioners (HCP), adherence in neonatology wards is often limited.

Objective: Identifying determinants, i.e., facilitators and barriers, to hand hygiene adherence among frontline HCP in neonatology.

Design: Qualitative implementation research study.

Setting: Department of Neonatology of the University Hospital Zurich, Switzerland.

Methods: Semi-structured interviews with frontline HCP and Infection Prevention and Control (IPC) experts were conducted in November 2022. Interviews were coded deductively according to the Theoretical Domains Framework (TDF) and the Capability, Opportunity, Motivation and Behavior model (COM-B), and inductively to capture nuances in the data. Determinants whose addressing was perceived to likely improve hand hygiene adherence in the current setting were rated as "high priority".

Results: A total of 42 interviews were conducted, 27 (64%) with nurses, six (14%) with physicians, four (10%) with other professions, and five (12%) with IPC experts. Sixteen determinants were identified, twelve of which were high-priority, four in each COM-B domain. Knowledge, attention control, planning workflows, and habits & automatisms were found in "Capability," workload & emergencies, invisibility of germs, role models, and being observed in "Opportunity," and bad conscience, experience consequences of (non-) adherence, self-reflection, and intention to adhere to hand hygiene in "Motivation."

Discussion/conclusion: Facilitators from all COM-B domains and barriers from "Capability" and "Opportunity" influence hand hygiene behavior in neonatology settings. Our findings can now inform interventions to improving hand hygiene adherence in neonatal settings.