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Infection Control Attitudes behaviors

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  • pg 1
         Secretary General,
Egyptian Society of Infection Control
How does one affect change?

 • Changing H.C. worker behaviors is a challenge
 • Before beginning any program to change
       the planning process should be undertaken
 • The cornerstone of this process is assessment

                                        Attitudes & behaviors

• Until you understand “who, what, when & why”,
   you cannot design a program that will be successful
• Assessment helps the ICP understand both individual
      & organizational factors that lead to a behavior
• It helps the ICP determine the priorities for change
• It provides the baseline against which change can
      be measured

                                        Attitudes & behaviors
Components of the Assessment

 I. Factors related to the individual H.C.Worker:
      • Sociodemographic characteristics
      • Knowledge & educational level
      • Attitudes
      • Beliefs

                                  Attitudes & behaviors
Components of the Assessment

 II. Organizational Factors
      • Resources
      • Staffing
      • Local & regional laws
      • Organizational support for a behavior

                                  Attitudes & behaviors
Strategies for change

 • Are based on the assessment & prioritization
       of the factors found
 • Once a plan is implemented, re-assessment
      can show success or failure in the program

                                  Attitudes & behaviors
Hints for success

 • Involve the target audience
 • Work at all levels of the org. to get support
 • Use positive reinforcements

 • Acknowledge the inclusion of IC professionals
    as persons who may need to change

                                    Attitudes & behaviors
Assessment of attitudes & behaviors

 Assessment is the cornerstone of program planning
   (Include programs to change HCW behaviors)
   •Systematic evaluation
   • Identification of places to intervene

   • Establishment of a baseline against which
      to evaluate change

                                     Attitudes & behaviors
Epidemiol. approach to behavior assessment

 • Who is doing?
 • What are the attributes & behaviors?

 • Where does it happen? In what context?

 • When does the behavior happen?

 • Why (what are the reasons for the behavior?)

                                 Attitudes & behaviors
Who: The Target Audience

   • Physicians
   • Nurses

   • Family members

   • Lay health workers & aides

   • Infection control personnel

                                   Attitudes & behaviors
What are the behaviors?

 • Handwashing
 • Use of barriers or isolation procedures

 • Antibiotic prescribing

 • Equipment handling procedures

 • Procedures to protect worker safety

                                   Attitudes & behaviors
Look at the behavior

     • Is it right?
     •Is it important
     •Is there a standard?
     • Is it effective?
     •Is it realistic?

                             Attitudes & behaviors
Where is it happening?

   • What type of facility?
   • During which activity?
   • What are the characteristics of the place
       in which it occurs?
When is it happening?
   • In emergencies or during normal care
   • Time of day, day of week, or season

                                   Attitudes & behaviors
Why: Individual reasons for behavior

  • Age                   • Beliefs
  • Education             • Attitudes
  • Profession            • Cues to action
  • Gender                • Reinforcement
  • Geographic location   • Self-efficacy
  • Knowledge

                                Attitudes & behaviors
Why: Individual reasons for behavior
     {It is rarely the only reason for behavior}

  • Perceived susceptibility to health threat
  • Perceived severity of the threat
  • Belief that the behavior will be beneficial

                                   Attitudes & behaviors
Why: Individual reasons for behavior
     • Time
     • Convenience
     • Opinion of the behavior & its importance
Cues to action
     • “Triggers”
     • Reminders
     • Presence of IC personnel
     • Social pressure
                                  Attitudes & behaviors
Why: Individual reasons for behavior
     • Positive or negative
     • Performance feedback

     • Perceived ability to do the desired behavior
     • Perceived control

                                  Attitudes & behaviors
Why: Organiz. reasons for behavior

  • Resources

  • Engineering

  • Staffing

  • Administrative leadership

  • Administrative sanctions

                                Attitudes & behaviors
Planning for behavior change
(should be based on assessment)
Example: Hand Hygiene
   to illustrate the many factors that influence behavior
   • Who:   HC workers
   • What: compliance with H.W. standards
   • Where: a H.C. facility (type?)
   • When: - In emergency or during normal care
           - Time …?

                                        Attitudes & behaviors
Hand Hygiene Reasons for noncompliance

I. Individuals:
• Knowledge:       Lack of scientific info; wearing gloves
• Beliefs:         (that interfere with HCW-patient
• Attitudes:       Too busy
• Cues:            Lack of role model
• Reinforcements: Lacking
• Self-efficacy:   Lack of time: Pt needs priority
                                        Attitudes & behaviors
Hand Hygiene Reasons for noncompliance

II. Organization:
  • Inaccessible supplies
  • Staffing
  • Lack of institutional priority
  • Lack of administrative sanctions or rewards

                                     Attitudes & behaviors
Planning strategies for behavior change

  Type of strategy: not always education

    • Too busy: time mgt

    • Peer pressure: assertiveness training

    • Knowledge: education

    • Resources: administrative commitment

                                   Attitudes & behaviors
Strategies for behavior change

  • Begin with OUR behavior
  • Not proscriptive, but collegial
  • Appeal to people’s knowledge & logic
  • Involvement leads to ownership
  • Empowerment leads to self-efficacy
  • Change social norms to maintain
     behavior change
                                      Attitudes & behaviors
Strategies for behavior change

  • Involve the leaders & influential persons
        (formal & informal leaders)
  • Work at every level of the org. to make
        change happen
  • Apply the basic concepts
  • Keep it simple, applicable, achievable
       & affordable

                                  Attitudes & behaviors
Strategies for behavior change

  • Use reinforcements & cues
     - Positive reinforcements

     - Negative reinforcements
          (when all else fails)
     - Repeat over time

                                  Attitudes & behaviors
Strategies for behavior change

  • Celebrate success, review failure
     - Communicate results: share successes
       & failures with staff
     - Repeat assessment & planning process
     - Include yourself in the change process
     - Trust in yourself & others!

                                     Attitudes & behaviors

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