The experiences of nurses’ hand hygiene compliance in advanced recovery room care (ARRC): A descriptive phenomenological study

Authors

DOI:

https://doi.org/10.26550/2209-1092.1379

Keywords:

phenomenology, nurse, hand hygiene, compliance, advance recovery room care unit, post anaesthetic care unit

Abstract

Background: Hand hygiene is vital in preventing health care–associated infection, yet compliance rates remain suboptimal across different clinical settings. Limited research has focused on hand hygiene compliance within the Post Anaesthesia Care Unit (PACU). Hence, this study aimed to understand factors that hindered or promoted compliance within a specialised PACU unit, the advanced recovery room care (ARRC) unit in a major
tertiary hospital.
Methods: A descriptive phenomenological design was employed, and data was collected using the purposive sampling method through in-depth, semi-structured interviews conducted with ten registered nurses working in a major tertiary hospital ARRC unit. The data was analysed using Giorgi’s five-step phenomenological approach.
Results: Four major themes were identified in this study which encompassed the various challenges and opportunities faced by nurses in maintaining effective hand hygiene practices within the ARRC unit. The themes were: hand hygiene practice, education and compliance; leadership roles and functions; safety and compliance measures; and infrastructure and resources.
Conclusions: This study indicates that strong leadership, continuous education, improved infrastructure and regular audits are vital for reinforcing hand hygiene practices within the PACU unit. The findings emphasise an urgent need for continuous vigilance, innovation and improvements in leadership, training and  infrastructure to ensure that infection control standards are maintained within PACU units.

References

1. Australian Commission on Safety and Quality in Health Care (ACSQHC). National hand hygiene initiative implementation guide [Internet]. Sydney: ACSQHC; 2023 [cited 2023 Sep 2]. Available from: https://www.safetyandquality.gov.au/publications-and-resources/resource-library/national-hand-hygiene-initiative-implementation-guide.

2. Mitchell BG, Shaban RZ, MacBeth D, Wood C-J, Russo PL. The burden of healthcare-associated infection in Australian hospitals: A systematic review of the literature [Internet]. Infect Dis Health. 2017[cited 2023 Sep 2];22(3):117–28. DOI: 10.1016/j.idh.2017.07.001

3. World Health Organization (WHO). First-ever WHO research agenda on hand hygiene in health care to improve quality and safety of care [Internet]. Geneva: WHO; 2023 [cited 2023 Sep 2]. Available from: https://www.who.int/news/item/12-05-2023-first-ever-who-research-agenda-on-hand-hygiene-in-health-care-to-improve-quality-and-safety-of-care.

4. White KM, Starfelt LC, Jimmieson NL, Campbell M, Graves N, Barnett AG et al. Understanding the determinants of Australian hospital nurses’ hand hygiene decisions following the implementation of a national hand hygiene initiative [Internet]. Health Educ Res. 2015[cited 2023 Sep 2];30(6):959–70. DOI: 10.1093/her/cyv057

5. White KM, Jimmieson NL, Graves N, Barnett A, Cockshaw W, Gee P et al. Key beliefs of hospital nurses’ hand-hygiene behaviour: Protecting your peers and needing effective reminders [Internet]. Health Promot J Austr. 2015[cited 2023 Sep 2];26(1):74–8. DOI: 10.1071/HE14059

6. Jammali-Blasi A, McInnes E, Middleton S. A survey of acute care clinicians’ views on factors influencing hand hygiene practice and actions to improve hand hygiene compliance [Internet]. Infect Dis Health. 2016[cited 2023 Sep 2];21(1):16–25. DOI: 10.1016/j.idh.2016.01.004

7. Ghaffari M, Rakhshanderou S, Safari-Moradabadi A, Barkati H. Exploring determinants of hand hygiene among hospital nurses: A qualitative study [Internet]. BMC Nurs. 2020[cited 2023 Sep 2];19(1):109. DOI: 10.1186/s12912-020-00505-y

8. Ahmadipour M, Dehghan M, Ahmadinejad M, Jabarpour M, Shahrbabaki PM, Rigi ZE. Barriers to hand hygiene compliance in intensive care units during the COVID-19 pandemic: A qualitative study [Internet]. Front Public Health. 2022[cited 2023 Sep 2];10:968231. DOI: 10.3389/fpubh.2022.968231

9. Midturi JK, Narasimhan A, Barnett T, Sodek J, Schreier W, Barnett J et al. A successful multifaceted strategy to improve hand hygiene compliance rates [Internet]. Am J Infect Control. 2015[cited 2023 Sep 2];43(5):533–6. DOI: 10.1016/j.ajic.2015.01.024

10. Han C, Song Q, Meng X, Lv Y, Hu D, Jiang X et al. Effects of a 4-year intervention on hand hygiene compliance and incidence of healthcare-associated infections: A longitudinal study [Internet]. Infection. 2021[cited 2023 Sep 2];49(5):977–81. DOI: 10.1007/s15010-021-01626-5

11. Frödin M, Rogmark C, Nellgård B, Gillespie BM, Wikström E, Andersson AE. Interactive interventions can improve hand hygiene and aseptic techniques during perioperative care – experience from the ‘Safe Hands’ project [Internet]. J Perianesth Nurs. 2023[cited 2023 Sep 2];38(2):284–90. DOI: 10.1016/j.jopan.2022.07.006

12. Marques dos Santos C, Carvalho R, Toniolo AR, Kawagoe JY, Menezes FG, Silva CV, et al. Multiple interventions in a postanesthesia care unit: impact on hand hygiene compliance [Internet]. Am J Infect Control. 2017[cited 2023 Sep 2];45(10):1171–3.

13. Petty WC. Closing the hand hygiene gap in the postanesthesia care unit: A body-worn alcohol-based dispenser [Internet]. J Perianesth Nurs. 2013[cited 2023 Sep 2];28(2):87–93. DOI: 10.1016/j.jopan.2012.06.008

14. Borbasi S, Jackson D, East L. Navigating the maze of nursing research: Enhancing nursing and midwifery practice. 5th ed. Chatswood: Elsevier Australia; 2019.

15. Moran D. Introduction to phenomenology. 1st ed. Milton PArk: Routledge; 2000.

16. Rodriguez A, Smith J. Phenomenology as a healthcare research method [Internet]. Evid Based Nurs. 2018[cited 2023 Sep 2];21(4):96–8. DOI: 10.1136/eb-2018-102990

17. Whitehead D, Ferguson C, LoBiondo-Wood G, Haber J. Nursing and midwifery research: Methods and appraisal for evidence-based practice. 6th ed. Chatswood: Elsevier Australia; 2020.

18. Giorgi A. Giorgi B. Morley J. The descriptive phenomenological psychological method. In: Willig C, Rogers WS, editors. The Sage Handbook of Qualitative Research in Psychology. 2nd ed. Thousand Oaks: Sage; 2017.

19. Lincoln YS, Guba EG, Pilotta JJ. Naturalistic inquiry. Beverly Hills; Sage: 1985.

20. Pimentel MPT, Feng AY, Piszcz R, Urman RD, Lekowski RW, Nascimben L. Resident-driven quality improvement project in perioperative hand hygiene [Internet]. J Patient Saf. 2019[cited 2023 Sep 2];15(4)–e47. DOI: 10.1097/PTS.0000000000000282

21. Allegranzi B, Pittet D. Role of hand hygiene in healthcare-associated infection prevention [Internet]. J Hosp Infect. 2009[cited 2023 Sep 2];73(4):305–15. DOI: 10.1016/j.jhin.2009.04.019

22. Nwaokenye J, Lakoh S, Morgan J. Perceptions of Nigerian healthcare workers towards hand hygiene: A qualitative study [Internet]. Pan Afr Med J. 2020[cited 2023 Sep 2];36(204):204–204. DOI: 10.11604/pamj.2020.36.204.19869

23. Chakma SK, Hossen S, Rakib TM, Hoque S, Islam R, Biswas T et al. Effectiveness of a hand hygiene training intervention in improving knowledge and compliance rate among healthcare workers in a respiratory disease hospital [Internet]. Heliyon. 2024[cited 2023 Sep 2];10(5)–e27286. DOI: 10.1016/j.heliyon.2024.e27286

24. Kingston L, O’Connell NH, Dunne CP. Hand hygiene-related clinical trials reported since 2010: A systematic review [Internet]. J Hosp Infect. 2016[cited 2023 Sep 2];92(4):309–20. DOI: 10.1016/j.jhin.2015.11.012

25. Smiddy MP, Murphy OM, Savage E, Fitzgerald AP, O’ Sullivan B, Murphy C et al. Efficacy of observational hand hygiene audit with targeted feedback on doctors’ hand hygiene compliance: A retrospective time series analysis [Internet]. J Infect Prev. 2019[cited 2023 Sep 2];20(4):164–70. DOI: 10.1177/1757177419833165

26. Anguraj S, Ketan P, Sivaradjy M, Shanmugam L, Jamir I, Cherian A et al. The effect of hand hygiene audit in COVID intensive care units in a tertiary care hospital in South India [Internet]. Am J Infect Control. 2021[cited 2023 Sep 2];49(10):1247–51. DOI: 10.1016/j.ajic.2021.07.008

27. Lieber SR, Mantengoli E, Saint S, Fowler KE, Fumagalli C, Bartolozzi D et al. The effect of leadership on hand hygiene: Assessing hand hygiene adherence prior to patient contact in 2 infectious disease units in Tuscany [Internet]. Infect Control Hosp Epidemiol. 2014[cited 2023 Sep 2];35(3):313–6. DOI: 10.1086/675296

28. Bora MM, Zarghami A. The association between hand hygiene compliance and glove use: Still unknown? [Internet] AmJ Infect Control. 2018[cited 2023 Sep 2];46(1):118. DOI: 10.1016/j.ajic.2017.09.035

29. Picheansanthian W, Chotibang J. Glove utilization in the prevention of cross transmission: A systematic review [Internet]. JBI Database Syst Rev Implement Rep. 2015[cited 2023 Sep 2];13(4):188–230. DOI: 10.11124/jbisrir-2015-1817

30. Salmon S, McLaws M-L. Qualitative findings from focus group discussions on hand hygiene compliance among health care workers in Vietnam [Internet]. Am J Infect Control. 2015[cited 2023 Sep 2];43(10):1086–91.

31. Atif S, Lorcy A, Dubé E. Healthcare workers’ attitudes toward hand hygiene practices: Results of a multicentre qualitative study in Quebec [Internet]. Can J Infect Control. 2019[cited 2023 Sep 2];41–8. DOI: 10.36584/CJIC.2019.004

32. McLaws M-L, Farahangiz S, Palenik CJ, Askarian M. Iranian healthcare workers’ perspective on hand hygiene: A qualitative study [Internet]. J Infect Public Health. 2015[cited 2023 Sep 2];8(1):72–9. DOI: 10.1016/j.jiph.2014.05.004

Downloads

Published

06-07-2025

How to Cite

Xin, L., Smith, Z., & Salamon, Y. (2025). The experiences of nurses’ hand hygiene compliance in advanced recovery room care (ARRC): A descriptive phenomenological study. Journal of Perioperative Nursing, 38(2), 29–39. https://doi.org/10.26550/2209-1092.1379

Issue

Section

Articles