ArticleFrontiers in public health2026
Barriers to hand hygiene practices and improvement expectations among awake ICU patients: a qualitative study.
Article in Frontiers in public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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8 authors.
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Abstract
Background: Awake patients in intensive care units (ICUs) retain partial self-care ability and may contribute to pathogen transmission through contaminated hands. However, patient hand hygiene is insufficiently emphasized, and adherence remains low. A deeper understanding of patients' behavioral challenges and support needs remains lacking. Objectives: This qualitative study aimed to explore the barriers to hand hygiene practices among awake ICU patients and identify their improvement expectations. Methods: A qualitative descriptive study was conducted in a tertiary hospital in Henan Province, China. Fifteen awake ICU patients participated in semi-structured interviews between December 2024 and April 2025. Data were analyzed using deductive content analysis informed by the Capability-Opportunity-Motivation Behavior (COM-B) framework. Results: Fifteen awake ICU patients were interviewed. Two overarching themes emerged with 17 subcategories: (1) barriers to hand hygiene practices, including incomplete knowledge, physical burden, cognitive fluctuations, limited resource accessibility, environmental constraints, lack of social support, insufficient health education, low perceived infection risk, emotional burden, diminished self-efficacy, unclear role perception, and insufficient emphasis from healthcare providers; and (2) improvement expectations for hand hygiene practices, including clear behavioral boundaries, ability-adapted health education, sustainable behavioral prompts, improved accessibility, role clarification with positive feedback, and respectful communication and care practices. Conclusion: Awake ICU patients experience multiple barriers to hand hygiene related to physical condition, environmental support, and motivation to engage during critical illness. Promoting patient participation in hand hygiene may therefore require not only education, but also individualized support, accessible resources, and respectful communication. These findings may inform future efforts to improve patient hand hygiene in ICU settings.
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