Phase 1 Interview

OMB control number: 0720-AAUC

Expiration date: XX-XX-XXXX

B1: Interview guide on institutional systems, supports, and barriers for hand hygiene

Specific objectives:

1. To explore current institutional systems for hospital infection control and hand hygiene

2. To understand institutional experiences and actions regarding infection control and hand hygiene during the Ebola epidemic

3. To explore institutional supports and barriers to change

Framework: Integrated Behavioural Model for Water, Sanitation, and Hygiene (IBM-WASH)

Levels	Contextual factors	Psychosocial factors	Technology factors
1) Societal/Structural
2) Community
3) Interpersonal
4) Individual
5) Habitual

Steps:

1. Provide privacy advisory statement:

“Information is being collected for this survey under the authority of 10 U.S.C. 2358, Research and Development Projects; DoDI2000.30, Global Health Engagement (GHE) Activities; the Fiscal Year (FY) 2013 National Defense Authorization Act (NDAA); and E.O. 13747, Advancing the GlobalHealth Security Agenda to Achieve a World Safe and Secure from Infectious Disease Threats; and will be used to help the DoD Center for Global Health Engagement to understand and evaluate hospital hand hygiene policies and practices. No personally identifiable information (PII) is being collected from you, and all information will be de-identified prior to being reported. Completing the survey is voluntary; you may stop the survey at any time and skip any questions you choose. There is no penalty if you choose not to respond, although maximum participation is encouraged so the data will be complete and representative.”

2. Record date and time of interview, hospital ID, participant ID, type of administrator/health worker, age, sex, education, and duration of working in this hospital.

3. Use the guiding questions below. Not all questions are necessary for all participants depending on individual participant characteristics as well as information already obtained from other interviews. Questions can be asked in any order.

AGENCY DISCLOSURE NOTICE

The public reporting burden for this collection of information, 0720-AAUC, is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or burden reduction suggestions to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-information-collections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.

Contextual factors	Guiding questions
Societal/Structural level	What are national policies, guidelines, and/or regulations surrounding hospital infection control and hand hygiene? What are your local hospital guidelines for hospital infection control and hand hygiene? Any awareness and/or use of international guidelines? Please give examples. What about glove use?
Community level	What is your hospital’s water source? Type? Continuous? What hand hygiene materials are used currently in the hospital? Availability? For health workers? For patients and family caregivers?
Interpersonal level	Is there a committee or person in charge of infection control or hand hygiene at your hospital?
Individual level	Do staff receive any training or education about infection control or hand hygiene? How often? Who is trainer? Information source? Do patients and family members receive any training or education about infection control or hand hygiene?
Habitual level	What is usual practice of hand hygiene in hospital? Among doctors? Nurses? Other hospital staff? Among patients and family caregivers? Please give examples. What happens on rounds? What happens in the clinic? What happens around starting ivs and giving injections? What is patient volume? Staff to patient ratio? Family caregiver contribution to patient care?

Psychosocial factors	Guiding questions
Societal/Structural level	Do you think hospital infection control/hand hygiene is a priority among the leadership? Why or why not?
Community level	Do you think hospital infection control/hand hygiene is a priority among the staff? Why or why not?
Interpersonal level	What is expected hand hygiene for doctors? Nurses? Other hospital staff? For patients and family caregivers? Any specific cultural norms surrounding hand hygiene? Gender? Caring for children? Please give examples.
Individual level	Why do you think health workers wash/cleanse hands? Patient care? Self-protection? What if there is no visible dirt? Why do you think patients and family caregivers wash/cleanse hands? Patient care? Self-protection? What if there is no visible dirt? What about glove use?
Habitual level	What reminds people to wash or clean their hands? Why do you think people do not wash or clean their hands when they are supposed to?

Technology factors	Guiding questions
Societal/Structural level	Who /where are the local suppliers of soap? Alcohol? Chlorine / hypochlorite / dilute bleach? Other cleansing materials used in the hospital? Are these products made locally or foreign? Are there specific brands that are preferred? If so, why? What about gloves and hand hygiene?
Community level	Where is water accessible inside the hospital? On the wards? Clinics? Latrines? What type of water sources? Functionality? Who is responsible for maintaining the water source? Who is responsible for ordering, stocking and maintaining hand hygiene materials?
Interpersonal level	What is the availability of water and hand hygiene materials for doctors? Nurses? Other hospital staff? Designated rooms or sinks? For patients and family caregivers?
Individual level	What do you think about soap as a hand cleansing material? Alcohol? Chlorine / hypochlorite / dilute bleach? Advantages? Disadvantages Smell? Effect on skin? Effectiveness? Convenience? Cost?
Habitual level	What do you think about soap as a hand cleansing material for routine and daily use in the hospital? Alcohol? Chlorine / hypochlorite / dilute bleach? Which do you think is most effective? Why? Which do you think is easiest/ most convenient? Why?

Experiences and actions during the Ebola epidemic	Guiding questions
What was your local hospital infection control and hand hygiene system before Ebola?	Hospital guidelines? Prioritization of infection control? Infrastructure? Water? Hand hygiene materials? Training and education? Health workers? Patient and family caregivers? Actual practices/behavior?
What changes did your hospital make during Ebola?	Hospital guidelines? Prioritization of infection control? Infrastructure? Water? Hand hygiene materials? Training and education? Health workers? Patient and family caregivers? Actual practices/behavior?
What changes did your hospital make after the Ebola crisis was over?	Hospital guidelines? Prioritization of infection control? Infrastructure? Water? Hand hygiene materials? Training and education? Health workers? Patient and family caregivers? Actual practices/behavior?

Institutional supports and barriers to change	Guiding questions
Perspective on current system	Do you think the current infection control and hand hygiene system in your hospital is appropriate and adequate? Why or why not?
Supports for change	What are the greatest supports for change?
Barriers against change	What are the greatest challenges or barriers against change?
Recommendations for change	How do you think the current system of infection control and hand hygiene can be improved?

Record any additional notes or comments on the interview itself: