Human difficulties influence adherence of healthcare workers to infection control practices: psychology matters in the ICU: Psychology and adherence in the ICU.

Abstract Background Most bloodstream infections related to vascular catheters can be avoided if evidence-based practices are applied during insertion and maintenance. In practice, adherence by healthcare workers (HCW) is unsatisfactory and is the main current challenge. The objective of this study is to investigate associations between adherence to infection control practices and performance in psychological tests. Methods: We conducted a prospective observational study in 4 intensive care units involving health care workers. Physicians were observed for adherence to hand hygiene (HH). Nurses were observed during central venous catheter (CVC) dressing and handling. HCW were then evaluated psychologically. Results There were 7,572 observations of 248 HCW. Adherence to different steps of CVC manipulation ranged widely: from 13% for HH before procedure to 95% regarding the use of gloves. Adherence to HH ranged from 14% before to 99% after dressing. For physicians, HH ranged from 10% before touching patients to 98% after touching body fluids, and adherence was associated with age, self-esteem, and aggression. For nurses, adherence was positively associated with deference, and negatively associated with nurturance. Conclusions Psychosocial variables affect the quality of care that HCW provide. The next step would be to define what type of psychological interventions could be effective.