Figure 3: Correlation between the proportions of improving healthcare workers and the overall improvement in hand hygiene compliance per hospital HH, hand hygiene; pp, percentage points high workload on HH compliance has been reported before [25‐28]. Scheithauer et al. demonstrated an inverse relationship between the daily workload and HH [29], and Lee et al. found a positive association between nurse‐to‐patient ratio and HH compliance [16]. Data collected by Hansen et al. demonstrate a nurse to patient ratio of 0.5 during dayshifts to be typical for European ICUs, with national averages ranging from 0.3 to 0.9 [30]. Our study reveals considerable variability in HH compliance between individual HCWs, in some ICUs more than in others. The few previous studies that have employed individualized observation found similar between‐HCW variability [12‐17, 31]. However, these were either based on a small number of HCWs or did not perform an intervention. Estimating from Figure 1 and additional Figure 1, this between‐HCW variability seems to increase in some centres, suggesting differences in the individual response to the intervention. Personal perceptions, mental models, motivation, and work organisation can influence the individual HH behaviour of each HCW and, in consequence, also their response to promotional exposure [31‐34]. Early recognition of these individual factors could help in customizing HH improvement strategies to a range of typical behavioural profiles. Methods 0 5 10 15 20 25 30 35 0 20 40 60 80 100 Overall increase in HH (pp) % improving healthcare workers B C D E F G Spearman rank 0.82 (95% CI 0.18‐0.97; P‐value 0.02) A
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