Whitby et al. (2006) focused on determining the origin of the behavioral determinants of handwashing of nurses. According to the researchers, handwashing was perceived by the study subjects as a mechanism of self protection against harmful organisms. Handwashing behavior was also influenced by the appearance of their hands. Nurses recognized that handwashing played an integral role in the removal of microbes and the prevention of their transfer, and described the practice as unconscious and habitual, rather than as a thoughtful action associated with particular occasions. Whitby et al. (2006) reported that although nurses appeared to believe that they habitually washed their hands without thinking about it, a number of factors affected the importance they placed on handwashing, including the condition of their patients, the extent of patient contact, their assessment of the task involving a patient, and workload. They note, “Nurses assessed the risk of infection due to contact with patients on the basis of several criteria, including the patient’s diagnosis, physical appearance, and perceived general cleanliness; visibility of the patient’s body fluids; and the patient’s age. An assessment was made in terms of the degree of ‘dirtiness’ or the lack of ‘cleanliness’ of a patient. Handwashing was not always considered to be essential for certain types of physical contact with patients. Tasks that require non-intimate touching of a patient or use of inanimate objects were less likely to be considered important motivating factors for handwashing, compared with tasks involving more-prolonged physical contact. In parallel with the nurse’s assessment of the task involving a patient, nurses judged the level of ‘dirtiness’ of the actual task. This assessment resulted in nursing staff feeling compelled to wash their hands if their hands were visibly contaminated, moist or gritty, or touched axillae, genitals or the groin. Nurses reported that, when under time constraints, they used physical and task assessments to determine the necessity of handwashing. However, nurses always felt compelled to wash hands after performing tasks they considered to be ‘dirty.’”
Behavior is becoming key to understanding hand hygiene compliance, and a new train of thought has emerged that could assist infection preventionists’ efforts.