By Prof. OSSAMA RASSLAN Secretary General, Egyptian Society

By Prof. OSSAMA RASSLAN Secretary General, Egyptian Society

By Prof. OSSAMA RASSLAN Secretary General, Egyptian Society of Infection Control 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 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 Components of the Assessment I. Factors related to the individual H.C.Worker: Sociodemographic characteristics

Knowledge & educational level Attitudes Beliefs Attitudes & behaviors Components of the Assessment II. Organizational Factors Resources Staffing Local & regional laws

Organizational support for a behavior Attitudes & behaviors 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 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

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

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 Who: The Target Audience Physicians Nurses

Family members Lay health workers & aides Infection control personnel Attitudes & behaviors What are the behaviors? Handwashing Use of barriers or isolation procedures Antibiotic prescribing Equipment handling procedures Procedures to protect worker safety

Attitudes & behaviors Look at the behavior Is it right? Is it important Is there a standard? Is it effective? Is it realistic? Prioritize Attitudes & behaviors

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

Why: Individual reasons for behavior Age Beliefs Education Attitudes Profession

Cues to action Gender Reinforcement Geographic location Self-efficacy Knowledge

Attitudes & behaviors 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 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 Why: Individual reasons for behavior Reinforcement Positive or negative Performance feedback

Self-efficacy Perceived ability to do the desired behavior Perceived control Attitudes & behaviors Why: Organiz. reasons for behavior Resources Engineering Staffing Administrative leadership Administrative sanctions

Attitudes & behaviors 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 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 Hand Hygiene Reasons for noncompliance

II. Organization: Inaccessible supplies Staffing Lack of institutional priority Lack of administrative sanctions or rewards Attitudes & behaviors 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 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 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 Strategies for behavior change Use reinforcements & cues - Positive reinforcements - Negative reinforcements (when all else fails) - Repeat over time Attitudes & behaviors

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

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