Elsevier

Heart & Lung

Volume 36, Issue 4, July–August 2007, Pages 287-297
Heart & Lung

Issues in infection control
Attitudes toward practice guidelines among intensive care unit personnel: A cross-sectional anonymous survey

https://doi.org/10.1016/j.hrtlng.2006.08.005Get rights and content

Objectives

The study assessed attitudes of intensive care unit (ICU) staff members toward practice guidelines in general and toward a specific guideline, The Centers for Disease Control and Prevention’s Guideline for Hand Hygiene in Healthcare Settings; correlated these attitudes with staff and hospital characteristics; and examined the impact of staff attitudes toward the Hand Hygiene Guideline on self-reported implementation of the Guideline.

Methods

We performed a cross-sectional survey of staff in 70 ICUs in 39 U.S. hospitals, members of The National Nosocomial Infection Surveillance System. A survey, “Attitudes Regarding Practice Guidelines,” was administered anonymously to all willing staff during a site visit at each hospital. A total of 1359 ICU personnel responded: 1003 nurses (74%), 228 physicians (17%), and 128 others (10%).

Results

Significantly more positive attitudes toward practice guidelines were found among staff in pediatric compared with adult ICUs (P < .001). Nurses and other staff when compared with physicians had more positive attitudes toward guidelines in general but not toward the specific Hand Hygiene Guideline. Those with more positive attitudes were significantly more likely to report that they had implemented recommendations of the Guideline (P < .001) and used an alcohol product for hand hygiene (P = .002).

Conclusions

The majority of staff members were familiar with the Centers for Disease Control and Prevention Hand Hygiene Guideline. Staff attitudes toward practice guidelines varied by type of ICU and by profession, and more positive attitudes were associated with significantly better self-reported guideline implementation. Because differences in staff attitudes might hinder or facilitate their acceptance and adoption of evidence-based practice guidelines, these results may have important implications for the education and/or socialization of ICU staff.

Section snippets

Sample and setting

This cross-sectional, anonymous survey was a component of a larger study, “Effect of Hand Hygiene Guideline on Infections and Costs” (1 R01 NR008242, National Institute of Nursing Research). Hospitals were recruited from The National Nosocomial Infection Surveillance (NNIS) System, a voluntary CDC reporting network of acute care hospitals. Electronic messages were sent from the CDC to NNIS hospitals explaining the study and inviting them to contact the principal investigator if they were

Results

Personnel from 70 ICUs in 39 U.S. hospitals were included. A total of 1995 surveys were distributed, and 1359 were returned (68.2%). Respondents included 1003 nurses (74%), 228 physicians (17%), and 128 others (eg, 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. Approximately three-fourths (70.9%) of the respondents were in

Correlates of attitudes toward practice guidelines

This attitude survey regarding practice guidelines included the largest sample of critical care staff of any published to date, which allowed us to identify possible differences in attitudes by certain staff and hospital characteristics. Most of the research related to attitudes and beliefs about practice guidelines has been conducted among physicians in general11, 13, 14, 15, 16 and in various specialties including psychiatry,17 pediatrics,10 family medicine,18, 19 and intensivists.20, 21

Study Limitations

This study suffers from the same limitations as does any study using self-report data. Although self-report is one of the few ways to assess attitudes, there is concern about desirability bias (ie, participants provide responses they think the researcher wants or expects). We attempted to minimize this potential bias by ensuring respondent anonymity. Despite the fact that survey forms were collected in person, it is unlikely that this would have had a major impact on responses because the data

Summary and Implications

In this large survey of ICU personnel, significantly more positive attitudes toward practice guidelines were found among staff in pediatric compared with adult ICUs. Nurses and other staff when compared with physicians had more positive attitudes toward guidelines in general but not toward the specific Hand Hygiene Guideline. Older respondents had more positive attitudes, and respondents scored significantly higher on the specific Hand Hygiene Guideline compared with attitudes toward guidelines

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