O4   To Wash Or Not To Wash: Understanding Hand Washing Behaviour

G.MEYERS*, E.HENDERSON, D.MORALEJO, T.LOUIE, T.DALBY and K.DUREGON. Calgary Health Region (CHR), University of Calgary and Memorial University

Objective: To understand decision making processes associated with hand washing (hw) and identify factors that will affect change to hw behaviour in the CHR.

Methods: Qualitative methods were used in which unstructured, open-ended interviews were conducted, transcribed verbatim and entered into a computer software package (NUD.IST) to facilitate data organization and analysis. Interviews were analysed line by line and coded according to categories and themes that emerged which were then compared for similarities and differences. Informants (n=30) were selected to maximize variation and widen perspectives on hw and included individuals in a variety of roles and disciplines in CHR hospitals.

Results: Informants identified hw as formal or informal based on the context within which hw occurred. The culture within which an individual operates influences values, beliefs and norms that guide thinking, decisions and action. The decision to hw involves an interaction between a person's inner resources (e.g. beliefs and experiences), group culture and context. Hw decision making is "automatic" and / or "conscious". This decision making is strongly influenced by the type of hw education and degree to which the belief that hw is important is internalized. Internalization is influenced by pivotal personal experiences and affective learning. The decision making process is used to assess degree of risk (to self or others) which can vary in degree of accuracy. Once risk assessment has been made the decision of when, where and how to wash occurs. It is at this point that traditional barriers to hw can influence action. Informants identified "internal" and "external" motivations to wash or change behaviour. Barriers were often seen as hurdles to be over come rather than true barriers and varying degrees or types of non-compliance to hw were identified.

Conclusions: Hw behaviour is complex. Many hw initiatives focus their energy at the end of the decision making process after a series of factors have already influenced the decision to wash. Initiatives should be tailored to specific group cultures and address beliefs and attitudes to hw and risk assessment. The challenge for IPCs is literally and figuratively to make visible the invisible.