Obstetric Healthcare Workers' Adherence to Hand Hygiene Recommendations during the COVID-19 Pandemic: Observations and Social-Cognitive Determinants

Abstract

Background: Hand hygiene is crucial to avoid healthcare-associated infections and the transmission of COVID-19. Although the WHO has issued global hand hygiene recommendations for healthcare, adherence remains challenging. Considering social-cognitive theories such as the health action process approach (HAPA) can help to improve healthcare workers' adherence. This study aimed to observe adherence and to assess determinants in obstetric hospitals during and after the onset of the COVID-19 pandemic.

Methods: In all, 267 observations of behaviour were conducted in two German obstetric university hospitals over three time periods (pre-COVID-19 pandemic, heightened awareness, and strict precautions). In addition, 115 healthcare workers answered questionnaires regarding social-cognitive determinants of hand hygiene behaviour. Multiple regression and multiple mediation analyses were used to analyse associations.

Results: Adherence to hand hygiene recommendations increased from 47 per cent pre-COVID-19 pandemic to 95 per cent just before lockdown while simple measures against the pandemic were taken. Self-efficacy was associated with the intention to sanitise hands (β = .397, p < .001). Coping self-efficacy mediated the association of intention with hand hygiene adherence.

Conclusions: Obstetric healthcare workers seem to adapt their hand hygiene behaviour to prevent infections facing the global COVID-19 pandemic. To further improve interventions, social-cognitive determinants should be considered, especially intention and (coping) self-efficacy.

Keywords: COVID-19; hand hygiene behaviour; health action process approach; observations; obstetrics and gynaecology; social-cognitive determinants.

FIGURE 1

Observed adherence to hand hygiene recommendations over time. Note: The figure shows 148 observations from the first hospital during the pre‐COVID‐19 pandemic period, 98 observations from the second hospital in the heightened awareness period, and 21 observations from the first hospital in the last time period (strict precautions). Due to the low number of moments, the last period (strict precautions) needs to be interpreted with caution. There were no observed moments concerning after touching patient surroundings due to the lockdown on 16 March.

FIGURE 2

Mediation analysis between intention and hand hygiene behaviour. Note: The figure shows the multiple mediation analyses between self‐reported intention to wash or sanitise hands and handwashing behaviour. The figure does not show repeated measures panel data. Time period, hospital, sex, age, and profession were controlled for using dummy‐coded covariates for all variables. * significant at the .05 α‐level; ** significant at the .01 α‐level; *** significant at the .001 α‐level.