Understanding practice: factors that influence physician hand hygiene compliance.

Objective: To identify the behavioral determinants--both barriers and enablers--that may impact physician hand hygiene compliance.

Design: A qualitative study involving semistructured key informant interviews with staff physicians and residents.

Setting: An urban, 1,100-bed multisite tertiary care Canadian hospital.

Participants: A total of 42 staff physicians and residents in internal medicine and surgery.

Methods: Semistructured interviews were conducted using an interview guide that was based on the theoretical domains framework (TDF), a behavior change framework comprised of 14 theoretical domains that explain health-related behavior change. Interview transcripts were analyzed using thematic content analysis involving a systematic 3-step approach: coding, generation of specific beliefs, and identification of relevant TDF domains.

Results: Similar determinants were reported by staff physicians and residents and between medicine and surgery. A total of 53 specific beliefs from 9 theoretical domains were identified as relevant to physician hand hygiene compliance. The 9 relevant domains were knowledge; skills; beliefs about capabilities; beliefs about consequences; goals; memory, attention, and decision processes; environmental context and resources; social professional role and identity; and social influences.

Conclusions: We identified several key determinants that physicians believe influence whether and when they practice hand hygiene at work. These beliefs identify potential individual, team, and organization targets for behavior change interventions to improve physician hand hygiene compliance.