On Health Care-Associated Infection Control in the Presence of Health Care Workers’ Strategic Hand Hygiene Behaviour

Abstract

Every year, millions of patients in the world suffer from health care-associated infections (HCAIs) caused by antibiotic-resistant bacteria (ARB). ARB are transmitted to patients in a ward by temporarily contaminated hands of health care workers (HCWs) in patient-care activities. Therefore, hand hygiene of HCWs is an important and effective way to prevent ARB transmission among patients and ensure patient safety. However, HCWs wash their hands with high compliance in some situations, but with low compliance in other situations. Namely, they wash their hands strategically. HCWs’ strategic hand hygiene behaviour has been observed to lead to a generally low compliance. This research studies HCWs’ strategic hand hygiene behaviour and provides guidance to hospitals about intervention decision-making to improve compliance.

In particular, a strategic behaviour model is developed by using an evolutionary game to understand how HCWs adjust their hand washing behaviour because of peer influence in intensive interactions. This model suggests three contingent behaviours that depend heavily on peers’ choices: bandwagoning, free-riding, and prosocial hand hygiene behaviour. The conditions for how contingent behaviours appear are also identified. In addition, this study investigates the drivers for these contingent behaviours by conducting a discrete choice experiment (DCE) and best-worst scaling experiment (BWS). The DCE and BWS are also used to provide further insights on how hospitals can design effective interventions, from the perspective of a HCW. This study uses inspection policy as an example of an intervention in order to illustrate how to use a decision model that integrates an evolutionary game model and a transmission dynamics model for the allocation of resources for hand hygiene interventions.