Adherence to hygiene routines in community care : the perspective of medically responsible nurses in Sweden

Abstract: Care for the elderly in Sweden is a community responsibility and one of the future challenges for municipality care is infection control. Medically Responsible Nurses (MRNs) and Registered Nurses (RNs) have an important role in keeping a high hygiene standard in community care.The first study´s aim was to investigating MRNs perception of factors influencing basal hygiene routines in community care. A web-based questionnaire was sent to all available MRNs in Sweden. Open questions were analyzed with content analysis. Four categories were found: Resources were referring to consultations of external specialist competence and time given for educational opportunities in basic hygiene routines. Resources could also mean access and availability to material as gloves, aprons, hand rub, and work clothing, and also equipment for proper cleaning as decontaminates. Management interest in putting hygiene on the agenda was important. The importance of hygiene was made by clear and consistent communication from the management. Staff: The MRNs experienced a general influence on adherence to hygiene routines in relation to the educational level. External factors: media focus on epidemic outbreaks was helpful to the MRNs when claiming for resources. The home like environment was mentioned as one of the obstacles to infection control.The second study aim was to explore the perceived impact of different Theory of Planned Behaviour (TPB) related factors in enhancing compliance to hygiene routines in community care. Data was analysed with descriptive and inferential statistics.The two question areas to the study aim were items related to the TPB and factors known to influence hygiene in hospital settings. The main result was a final ranking list of what to preferable pay attention to if wanting to enhance compliance to hygiene routines. The list contained four factors: 1) Knowledge and interest factors among staff. 2) Access and availability to material and equipment and encouragement from management. 3) Influence by work mates, interest and workload 4) Influence by patients and significant others. The results also showed that the MRNs work under different contextual conditions and guidelines suitable for hospitals sometimes must be made applicable for community care.