Understanding hand hygiene behavior in a pediatric oncology unit in a low- to mid-income country

Background/Objective: A qualitative method study identified perceived barriers and motivations for hand hygiene (HH) practice in a pediatric oncology unit in Guatemala, with the aim of targeting these factors to improve HH compliance. Methods: Data collection included systematic observation, and focus groups with participants grouped by job type. Focus group responses were assessed using content analysis. Participants included nurse supervisors, registered nurses, auxiliary nurses, physicians, and auxiliary and support staff and volunteers (n=55). Results: Themes emerged from participant responses, providing a framework to develop and implement targeted interventions to improve HH. Perceived barriers to HH included the following themes: inconsistent HH supplies, time pressures related to workload, lack of HH training for some healthcare workers and patients’ families; negative social reactions after reminding others to practice HH; and cultural traditions shaping patients’ families’ hygiene. Motivations for HH practice included two themes: patient protection and self-protection. Some of these themes were unique to this culture and clinical setting. Recommendations included a preference for visual aids rather than verbal reminders (e.g. HH promotion signage, demonstrations of HH), and disclosure of compliance rates. Conclusions: The research team concluded that the main barriers and motivations for HH, including culturally-unique and site-specific factors, were identified and used for subsequent HH compliance improvement such as education.  Intervention post focus group concentrated in HH education of healthcare providers using e-learning methodology.