Introduction of New Theory for Hand Hygiene Surveillance: Healthcare Environment Theory

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Background and Purpose:

The purpose of this article is to introduce a theoretical foundation, the healthcare environment theory (HET), tested in a quantitative, cross-sectional, overt observational study measuring the association of demographic variables with consistent hand hygiene compliance of the ICU nurse.


Six environments found in a hospital ICU setting (family, church, work, administration, community, and culture) work bi-directionally to influence and be influenced by the nurse, simultaneously influencing each of the other environments in a multidirectional manner. The HET was used as the theoretical foundation for a study, which included a convenience sample of registered nurses (RNs) from five ICUs (64 participating RNs) in four hospitals in Texas who were observed for a total of 18 days (144 hours). The desired sample size of 613 hand hygiene opportunities for each ICU was obtained in 3 days of observation at 3 ICUs, 4 days in one ICU, and 5 days in one ICU. The six environments were used to support the results observed.


Through the variables of age and having children, hand hygiene rates were influenced by the family environment. Community environment was associated with a change in hand hygiene behavior in hospital hand hygiene rates in regards to age of the nurse. Younger nurses had higher hand hygiene compliance rates than older nurses.

Implications for Practice:

The different hospital environments surrounding the nurse can be used to explain hand hygiene compliance rates in association with demographic variables.

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