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      Barriers and facilitators in the implementation of recommendations for hand eczema prevention among healthcare workers

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          Summary

          Background

          Evidence‐based recommendations are available for the prevention of hand eczema among healthcare workers. However, the implementation of these recommendations is not always successful.

          Objectives

          To identify barriers and facilitators in the implementation of recommendations for the prevention of hand eczema among healthcare workers alongside a randomized controlled trial.

          Methods

          A qualitative study was performed in which 19 healthcare workers were interviewed. The interview transcripts were open coded and also coded by means of a template by two researchers to identify relevant barriers and facilitators.

          Results

          Most barriers and facilitators reported for the recommendations were found at the level of the innovation (e.g. the recommendations), whereas for the guideline as a whole, multiple levels (socio‐political, organization, user, and facilities) were identified.

          Conclusions

          To enhance the implementation of recommendations for the prevention of hand eczema in a healthcare setting, having knowledge about these recommendations seems to be an important first step. In addition, maintaining the attention of the subject, testing the products beforehand and close collaboration with the infection control department might enhance implementation. Furthermore, it is important that the recommendations fit in with the work of the healthcare workers. When the implementation of the recommendations is prepared, these points should be taken into account.

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          Most cited references20

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          The Health Belief Model: a decade later.

          Since the last comprehensive review in 1974, the Health Belief Model (HBM) has continued to be the focus of considerable theoretical and research attention. This article presents a critical review of 29 HBM-related investigations published during the period of 1974-1984, tabulates the findings from 17 studies conducted prior to 1974, and provides a summary of the total 46 HBM studies (18 prospective, 28 retrospective). Twenty-four studies examined preventive-health behaviors (PHB), 19 explored sick-role behaviors (SRB), and three addressed clinic utilization. A "significance ratio" was constructed which divides the number of positive, statistically-significant findings for an HBM dimension by the total number of studies reporting significance levels for that dimension. Summary results provide substantial empirical support for the HBM, with findings from prospective studies at least as favorable as those obtained from retrospective research. "Perceived barriers" proved to be the most powerful of the HBM dimensions across the various study designs and behaviors. While both were important overall, "perceived susceptibility" was a stronger contributor to understanding PHB than SRB, while the reverse was true for "perceived benefits." "Perceived severity" produced the lowest overall significance ratios; however, while only weakly associated with PHB, this dimension was strongly related to SRB. On the basis of the evidence compiled, it is recommended that consideration of HBM dimensions be a part of health education programming. Suggestions are offered for further research.
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            A qualitative exploration of reasons for poor hand hygiene among hospital workers: lack of positive role models and of convincing evidence that hand hygiene prevents cross-infection.

            To study potential determinants of hand hygiene compliance among healthcare workers in the hospital setting. A qualitative study based on structured-interview guidelines, consisting of 9 focus group interviews involving 58 persons and 7 individual interviews. Interview transcripts were subjected to content analysis. Intensive care units and surgical departments of 5 hospitals of varying size in The Netherlands. A total of 65 nurses, attending physicians, medical residents, and medical students. Nurses and medical students expressed the importance of hand hygiene for preventing of cross-infection among patients and themselves. Physicians expressed the importance of hand hygiene for self-protection, but they perceived that there is a lack of evidence that handwashing is effective in preventing cross-infection. All participants stated that personal beliefs about the efficacy of hand hygiene and examples and norms provided by senior hospital staff are of major importance for hand hygiene compliance. They further reported that hand hygiene is most often performed after tasks that they perceive to be dirty, and personal protection appeared to be more important for compliance that patient safety. Medical students explicitly mentioned that they copy the behavior of their superiors, which often leads to noncompliance during clinical practice. Physicians mentioned that their noncompliance arises from their belief that the evidence supporting the effectiveness of hand hygiene for prevention of hospital-acquired infections is not strong. The results indicate that beliefs about the importance of self-protection are the main reasons for performing hand hygiene. A lack of positive role models and social norms may hinder compliance.
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              Quality, morale and the new contract with GPs.

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                Author and article information

                Journal
                Contact Dermatitis
                Contact Derm
                10.1111/(ISSN)1600-0536
                COD
                Contact Dermatitis
                Blackwell Publishing Ltd (Oxford, UK )
                0105-1873
                1600-0536
                05 March 2015
                May 2015
                : 72
                : 5 ( doiID: 10.1111/cod.2015.72.issue-5 )
                : 325-336
                Affiliations
                [ 1 ] Department of Public and Occupational HealthEMGO Institute for Health and Care Research, VU University Medical Centre van der Boechorststraat 7 1007MB AmsterdamThe Netherlands
                [ 2 ] Department of Primary and Community CareCentre for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen Medical Centre Geert Grooteplein‐Zuid 10 6500 HB NijmegenThe Netherlands
                [ 3 ]Body@Work, Research Centre Physical Activity, Work and Health, TNO‐VU University Medical Centre van der Boechorststraat 7 1007MB AmsterdamThe Netherlands
                [ 4 ]Research Centre for Insurance Medicine AMC‐UMCG‐UWV‐VU University Medical Centre van der Boechorststraat 7 1007MB AmsterdamThe Netherlands
                Author notes
                [*] [* ] Correspondence: Johannes R. Anema, Van der Boechorststraat 7, room: C564, 1081 BT Amsterdam, The Netherlands. Tel: 31 20 4446495; Fax: 31 20 4448387. E‐mail: h.anema@ 123456vumc.nl
                Article
                COD12331
                10.1111/cod.12331
                5024051
                25739424
                4e292f8c-cdb8-4d76-a956-b7b787fca449
                © 2015 The Authors. Contact Dermatitis published by John Wiley & Sons Ltd

                This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                : 19 June 2014
                : 04 November 2014
                : 16 November 2014
                Page count
                Pages: 12
                Funding
                Funded by: The Netherlands Organization for Health Research and Development (ZONMW)
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                cod12331
                May 2015
                Converter:WILEY_ML3GV2_TO_NLMPMC version:4.9.4 mode:remove_FC converted:15.09.2016

                barriers,facilitators,guideline,hand eczema,healthcare workers,implementation

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