{"id":{"repo_id":"unsw","oai_identifier":"oai:unsworks.library.unsw.edu.au:1959.4/44959"},"canonical_url":"https://search.dev.ndltd.org/etd/unsw/oai:unsworks.library.unsw.edu.au:1959.4/44959","repository":{"repo_id":"unsw","name":"University of New South Wales","base_url":"https://unsworks.unsw.edu.au/oai/provider"},"display":{"title":"Why healthcare workers don't wash their hands: a behavioural explanation","abstract":"Hand-washing compliance was examined by thematic analysis of focus group discussions in nurses, mothers and children. Perceptions in these groups were identical, with the purpose of hand-cleansing seen as self-protection from infection. This assessment is not grounded in microbiology, but is strongly driven by emotion. Two types of hand-cleansing (“hand-hygiene”) behaviour were identified: (a) “inherent” hand-washing. This behaviour is taught by mothers to their children early in life. The behaviour occurs when hands have been visibly or “emotionally” soiled or feel sticky, and drives most hand-hygiene undertaken in the community; and (b) “elective” hand-hygiene, which occurs in the absence of perceived threat. As patient contact by healthcare workers is frequently assessed by healthcare workers as not posing risk, healthcare workers omit much elective hand-hygiene, leading to potential cross-infection. Modelling responses of 754 nurses on the Theory of Planned Behaviour for these two hand-hygiene behaviours in the healthcare setting explained 64% of elective hand-hygiene and 76% of inherent hand-washing intention. Translation of hand-washing behaviour patterns of the community into the healthcare setting is the predominant driver of all hand-hygiene in healthcare workers. In-hospital elective hand-hygiene behaviour is further significantly predicted by belief in the benefit from the activity, peer pressure and role modelling of senior physicians and administrators. For inherent hand-washing intent, only attitudes and peer behaviour are predictive. Time constraints, commonly implicated to explain poor compliance, are important mostly to elective hand-hygiene. Reduction in necessary effort by introducing an alcohol-based hand rub without a concomitant behavioural modification program will therefore have only minimal impact. Further components essential to hand-hygiene programs have been identified. These accord with the outcomes of the modelling and include the need for institutional recognition of hand-hygiene as a priority, overt clinician leadership support, and reinforcement of purpose by both education and performance feedback. In the long-term, society would be best served by altering the entire paradigm of hand-hygiene behaviour with nationwide campaigns based on principles of social marketing. Ideally, hand-hygiene should be taught by mothers and reinforced in early education programs as behaviour that is self-protective but with the defining theme: ����clean your hands, and protect others, not just yourself.”","abstract_html":"Hand-washing compliance was examined by thematic analysis of focus group discussions in nurses, mothers and children. Perceptions in these groups were identical, with the purpose of hand-cleansing seen as self-protection from infection. This assessment is not grounded in microbiology, but is strongly driven by emotion. Two types of hand-cleansing (“hand-hygiene”) behaviour were identified: (a) “inherent” hand-washing. This behaviour is taught by mothers to their children early in life. The behaviour occurs when hands have been visibly or “emotionally” soiled or feel sticky, and drives most hand-hygiene undertaken in the community; and (b) “elective” hand-hygiene, which occurs in the absence of perceived threat. As patient contact by healthcare workers is frequently assessed by healthcare workers as not posing risk, healthcare workers omit much elective hand-hygiene, leading to potential cross-infection. Modelling responses of 754 nurses on the Theory of Planned Behaviour for these two hand-hygiene behaviours in the healthcare setting explained 64% of elective hand-hygiene and 76% of inherent hand-washing intention. Translation of hand-washing behaviour patterns of the community into the healthcare setting is the predominant driver of all hand-hygiene in healthcare workers. In-hospital elective hand-hygiene behaviour is further significantly predicted by belief in the benefit from the activity, peer pressure and role modelling of senior physicians and administrators. For inherent hand-washing intent, only attitudes and peer behaviour are predictive. Time constraints, commonly implicated to explain poor compliance, are important mostly to elective hand-hygiene. Reduction in necessary effort by introducing an alcohol-based hand rub without a concomitant behavioural modification program will therefore have only minimal impact. Further components essential to hand-hygiene programs have been identified. These accord with the outcomes of the modelling and include the need for institutional recognition of hand-hygiene as a priority, overt clinician leadership support, and reinforcement of purpose by both education and performance feedback. In the long-term, society would be best served by altering the entire paradigm of hand-hygiene behaviour with nationwide campaigns based on principles of social marketing. Ideally, hand-hygiene should be taught by mothers and reinforced in early education programs as behaviour that is self-protective but with the defining theme: ����clean your hands, and protect others, not just yourself.”","abstract_has_math":false,"creators":["Whitby, Robert Michael"],"institution":"UNSW, Sydney","degree_name":null,"degree_level":null,"degree_discipline":null,"degree_department":null,"school":null,"contributors":[],"advisors":[],"committee_chairs":[],"committee_members":[],"year":2009,"date_issued":"2009","date_published":"2009","updated_at":"2026-07-24T05:32:40Z","subjects":["Hand-Hygiene","Healthcare Worker"],"languages":["EN"],"rights":["open access","CC BY-NC-ND 3.0","free_to_read"],"rights_urls":["https://purl.org/coar/access_right/c_abf2","https://creativecommons.org/licenses/by-nc-nd/3.0/au/"],"identifier_entries":[{"key":"dc:identifier","label":"Identifier","values":["https://doi.org/10.26190/unsworks/23032"],"render_values":[{"text":"https://doi.org/10.26190/unsworks/23032","href":"https://doi.org/10.26190/unsworks/23032","code":true}]}]},"links":{"outbound_url":"http://hdl.handle.net/1959.4/44959","outbound_label":"Handle","outbound_source":"dc:identifier"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:creator","label":"Author","values":["Whitby, Robert Michael"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date","label":"Dc Date","values":["2009"]},{"key":"dc:publisher","label":"Institution","values":["UNSW, Sydney"]},{"key":"dc:type","label":"Dc Type","values":["doctoral thesis","http://purl.org/coar/resource_type/c_db06"]}]},{"id":"subjects_keywords","label":"Subjects and Keywords","entries":[{"key":"dc:subject","label":"Dc Subject","values":["Hand-Hygiene","Healthcare Worker"]}]},{"id":"language_rights","label":"Language and Rights","entries":[{"key":"dc:language","label":"Dc Language","values":["EN"]},{"key":"dc:rights","label":"Dc Rights","values":["open access","https://purl.org/coar/access_right/c_abf2","CC BY-NC-ND 3.0","https://creativecommons.org/licenses/by-nc-nd/3.0/au/","free_to_read"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier","label":"Identifier","values":["http://hdl.handle.net/1959.4/44959","https://unsworks.unsw.edu.au/bitstreams/e914933c-59a3-4a8e-bf31-f538027f6921/download","https://doi.org/10.26190/unsworks/23032"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description","label":"Description","values":["Hand-washing compliance was examined by thematic analysis of focus group discussions in nurses, mothers and children. Perceptions in these groups were identical, with the purpose of hand-cleansing seen as self-protection from infection. This assessment is not grounded in microbiology, but is strongly driven by emotion. Two types of hand-cleansing (“hand-hygiene”) behaviour were identified: (a) “inherent” hand-washing. This behaviour is taught by mothers to their children early in life. The behaviour occurs when hands have been visibly or “emotionally” soiled or feel sticky, and drives most hand-hygiene undertaken in the community; and (b) “elective” hand-hygiene, which occurs in the absence of perceived threat. As patient contact by healthcare workers is frequently assessed by healthcare workers as not posing risk, healthcare workers omit much elective hand-hygiene, leading to potential cross-infection. Modelling responses of 754 nurses on the Theory of Planned Behaviour for these two hand-hygiene behaviours in the healthcare setting explained 64% of elective hand-hygiene and 76% of inherent hand-washing intention. Translation of hand-washing behaviour patterns of the community into the healthcare setting is the predominant driver of all hand-hygiene in healthcare workers. In-hospital elective hand-hygiene behaviour is further significantly predicted by belief in the benefit from the activity, peer pressure and role modelling of senior physicians and administrators. For inherent hand-washing intent, only attitudes and peer behaviour are predictive. Time constraints, commonly implicated to explain poor compliance, are important mostly to elective hand-hygiene. Reduction in necessary effort by introducing an alcohol-based hand rub without a concomitant behavioural modification program will therefore have only minimal impact. Further components essential to hand-hygiene programs have been identified. These accord with the outcomes of the modelling and include the need for institutional recognition of hand-hygiene as a priority, overt clinician leadership support, and reinforcement of purpose by both education and performance feedback. In the long-term, society would be best served by altering the entire paradigm of hand-hygiene behaviour with nationwide campaigns based on principles of social marketing. Ideally, hand-hygiene should be taught by mothers and reinforced in early education programs as behaviour that is self-protective but with the defining theme: ����clean your hands, and protect others, not just yourself.”"]},{"key":"dc:format","label":"Dc Format","values":["application/pdf"]},{"key":"dc:title","label":"Title","values":["Why healthcare workers don't wash their hands: a behavioural explanation"]}]}],"canonical_facts":{"dc:creator":["Whitby, Robert Michael"],"dc:date":["2009"],"dc:description":["Hand-washing compliance was examined by thematic analysis of focus group discussions in nurses, mothers and children. Perceptions in these groups were identical, with the purpose of hand-cleansing seen as self-protection from infection. This assessment is not grounded in microbiology, but is strongly driven by emotion. Two types of hand-cleansing (“hand-hygiene”) behaviour were identified: (a) “inherent” hand-washing. This behaviour is taught by mothers to their children early in life. The behaviour occurs when hands have been visibly or “emotionally” soiled or feel sticky, and drives most hand-hygiene undertaken in the community; and (b) “elective” hand-hygiene, which occurs in the absence of perceived threat. As patient contact by healthcare workers is frequently assessed by healthcare workers as not posing risk, healthcare workers omit much elective hand-hygiene, leading to potential cross-infection. Modelling responses of 754 nurses on the Theory of Planned Behaviour for these two hand-hygiene behaviours in the healthcare setting explained 64% of elective hand-hygiene and 76% of inherent hand-washing intention. Translation of hand-washing behaviour patterns of the community into the healthcare setting is the predominant driver of all hand-hygiene in healthcare workers. In-hospital elective hand-hygiene behaviour is further significantly predicted by belief in the benefit from the activity, peer pressure and role modelling of senior physicians and administrators. For inherent hand-washing intent, only attitudes and peer behaviour are predictive. Time constraints, commonly implicated to explain poor compliance, are important mostly to elective hand-hygiene. Reduction in necessary effort by introducing an alcohol-based hand rub without a concomitant behavioural modification program will therefore have only minimal impact. Further components essential to hand-hygiene programs have been identified. These accord with the outcomes of the modelling and include the need for institutional recognition of hand-hygiene as a priority, overt clinician leadership support, and reinforcement of purpose by both education and performance feedback. In the long-term, society would be best served by altering the entire paradigm of hand-hygiene behaviour with nationwide campaigns based on principles of social marketing. Ideally, hand-hygiene should be taught by mothers and reinforced in early education programs as behaviour that is self-protective but with the defining theme: ����clean your hands, and protect others, not just yourself.”"],"dc:format":["application/pdf"],"dc:identifier":["http://hdl.handle.net/1959.4/44959","https://unsworks.unsw.edu.au/bitstreams/e914933c-59a3-4a8e-bf31-f538027f6921/download","https://doi.org/10.26190/unsworks/23032"],"dc:language":["EN"],"dc:publisher":["UNSW, Sydney"],"dc:rights":["open access","https://purl.org/coar/access_right/c_abf2","CC BY-NC-ND 3.0","https://creativecommons.org/licenses/by-nc-nd/3.0/au/","free_to_read"],"dc:subject":["Hand-Hygiene","Healthcare Worker"],"dc:title":["Why healthcare workers don't wash their hands: a behavioural explanation"],"dc:type":["doctoral thesis","http://purl.org/coar/resource_type/c_db06"]},"updated_at":"2026-07-24T05:32:40Z"}