Infection Control:

1. Infection Control: Attitudes & Behaviors By Prof. OSSAMA RASSLAN Secretary General, Egyptian Society of Infection Control

2. 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

3. Assessment • 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

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

5. Components of the Assessment • II. Organizational Factors • Resources • Staffing • Local & regional laws • Organizational support for a behavior Attitudes & behaviors

6. 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

7. 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

8. 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

9. 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

10. Who: The Target Audience • Physicians • Nurses • Family members • Lay health workers & aides • Infection control personnel Attitudes & behaviors

11. What are the behaviors? • Handwashing • Use of barriers or isolation procedures • Antibiotic prescribing • Equipment handling procedures • Procedures to protect worker safety Attitudes & behaviors

12. Look at the behavior • Is it right? • Is it important • Is there a standard? • Is it effective? • Is it realistic? • Prioritize Attitudes & behaviors

13. 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

14. Why: Individual reasons for behavior • Age • Beliefs • Education • Attitudes • Profession • Cues to action • Gender • Reinforcement • Geographic location • Self-efficacy • Knowledge Attitudes & behaviors

15. Why: Individual reasons for behavior • Knowledge • {It is rarely the only reason for behavior} • Beliefs • Perceived susceptibility to health threat • Perceived severity of the threat • Belief that the behavior will be beneficial Attitudes & behaviors

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

17. Why: Individual reasons for behavior • Reinforcement • Positive or negative • Performance feedback • Self-efficacy • Perceived ability to do the desired behavior • Perceived control Attitudes & behaviors

18. Why: Organiz. reasons for behavior • Resources • Engineering • Staffing • Administrative leadership • Administrative sanctions Attitudes & behaviors

19. 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

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

21. Hand Hygiene Reasons for noncompliance • II. Organization: • Inaccessible supplies • Staffing • Lack of institutional priority • Lack of administrative sanctions or rewards Attitudes & behaviors

22. 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

23. 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

24. 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

25. Strategies for behavior change • Use reinforcements & cues • - Positive reinforcements • - Negative reinforcements • (when all else fails) • - Repeat over time Attitudes & behaviors

26. 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

27. Thank You