Personnel from 70 ICUs in 39 U.S. hospitals were included. A total of 1,995 surveys were distributed and 1,359 were returned (68.2%). Respondents included 1,003 nurses (74%), 228 physicians (17%), and 128 others (e.g. phlebotomist, radiologist, respiratory therapist, dieticians, 10%). Staff participants were predominantly female and white with a mean age of 37 years. The mean number of active beds of the 39 hospitals visited was 417. Almost three-fourths (70.9%) of the respondents were in the eastern region of the United States, and 60.6% were affiliated with an academic health center, .
Characteristics of ICU staff
Attitudes regarding clinical practice guidelines in general
While most respondents reported that they were familiar with the practice guidelines in their field, 10.2% stated that they were not. The mean score for the scale measuring general attitudes regarding clinical practice guidelines was 44.1 out of a possible 60 (95% confidence intervals: 43.7-45.1). While attitude scores of nurses and other staff members (phlebotomist, radiologist, respiratory therapist, dietician) did not differ significantly from each other, both groups scored significantly higher than physicians (p<0.001). In the univariate analyses, female staff scored higher than male staff members (p<0.001) and older respondents had significantly more positive attitudes than did younger staff (p=0.004). Among the hospital characteristics examined, number of active beds and type of ICU were significantly correlated with attitudes toward guidelines. Attitude scores were significantly lower in larger hospitals (p=0.007), and staff in the pediatric units scored significantly higher than staff in other ICUs (p<0.001). Scores of staff in the medical, surgical, and medical-surgical ICUs did not significantly differ. Neither affiliation with an academic health center nor geographic region was correlated with attitudes. In the regression analyses, each of those variables significant in univariate analyses was also found to be significant when the effects of other variables were controlled, .
Attitude scores by staff and hospital characteristics (Univariate analysis)
Attitudes specifically regarding the Hand Hygiene Guideline
The majority of respondents (90.4%) noted that they were familiar with the Hand Hygiene Guideline. The mean score for the scale measuring attitudes regarding the Hand Hygiene Guideline was 38.3 (95% CI: 38.0- 38.6) out of a possible 50. There were two characteristics correlated with attitudes toward the Hand Hygiene Guideline: type of ICU and age. Staff in the pediatric units scored significantly higher than staff in other units (p=.05), and older staff members had higher scores than younger (p<0.001). In the regression analysis, older age and working on a pediatric unit continued to be significantly associated with more positive attitudes, .
Relationship between attitudes and reported Guideline implementation
About half of respondents (52%) stated that following the Hand Hygiene Guideline would result in worsened skin condition. These individuals reported using alcohol products significantly less frequently than individuals who did not feel that the risk of skin damage would increase (63.7% versus 72.3%, p=0.002). The majority of respondents (96.9%) stated that following the Hand Hygiene Guideline would reduce the risk of healthcare-associated infections. There was no significant difference in the reported frequency of alcohol use for hand hygiene among those who reported that following the Guideline would reduce risk of infection or not (p=0.85). Almost all (92.7%) staff members reported that they personally implemented the recommendations of the Hand Hygiene Guideline and 67.2 % reported using an alcohol based product for hand hygiene. In the logistic regression models, staff members who scored higher on the attitude survey were more likely to report that they implemented the Guideline recommendations (OR: 1.11; CI: 1.06-1.16; p<0.001) and used alcohol for hand hygiene (OR: 1.05; CI: 1.02-1.08 p=0.002), .
Relationship between attitudes toward Hand Hygiene Guideline and self-reported implementation of the Guideline and use of alcohol for hand hygiene (Logistic regression)