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 peoples 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