Healthcare-associated infections are the most frequent adverse event in healthcare delivery worldwide. The theory of planned behavior has proven helpful in hospital hygiene interventions andmight be useful in community care. This study explored howmedically-responsible nurses in Swedish community care perceived and ranked the impact of factors related to the theory of planned behavior, the factors“ probability to change, enhancing the healthcare staff’s adherence to infection control guidelines, and identified which theory of planned behavior subquestions should be focused on to enhance adherence to infection control. Medically-responsible nurses (n = 268) in Swedish communities answered a Web-based questionnaire regarding impact and probability to change theory of planned behavior factors in relation to infection control. Four theory of planned behavior factor constructs were found: (i) knowledge and encouragement from management; (ii) access and availability to materials and equipment, and interest among staff; (iii) influence by colleagues; and (iv) workload, and influence by patients and significant others. The theory of planned behavior factors are relevant for infection control in a home-like environment, and findings could be used as a basis for interventions enhancing hygiene in community care.

Care for the elderly in Sweden is a community responsibility and one of the future challenges for municipality care is infection control. Medically Responsible Nurses (MRNs) and Registered Nurses (RNs) have an important role in keeping a high hygiene standard in community care.

The first study´s aim was to investigating MRNs perception of factors influencing basal hygiene routines in community care. A web-based questionnaire was sent to all available MRNs in Sweden. Open questions were analyzed with content analysis. Four categories were found: Resources were referring to consultations of external specialist competence and time given for educational opportunities in basic hygiene routines. Resources could also mean access and availability to material as gloves, aprons, hand rub, and work clothing, and also equipment for proper cleaning as decontaminates. Management interest in putting hygiene on the agenda was important. The importance of hygiene was made by clear and consistent communication from the management. Staff: The MRNs experienced a general influence on adherence to hygiene routines in relation to the educational level. External factors: media focus on epidemic outbreaks was helpful to the MRNs when claiming for resources. The home like environment was mentioned as one of the obstacles to infection control.

The second study aim was to explore the perceived impact of different Theory of Planned Behaviour (TPB) related factors in enhancing compliance to hygiene routines in community care. Data was analysed with descriptive and inferential statistics.The two question areas to the study aim were items related to the TPB and factors known to influence hygiene in hospital settings. The main result was a final ranking list of what to preferable pay attention to if wanting to enhance compliance to hygiene routines. The list contained four factors: 1) Knowledge and interest factors among staff. 2) Access and availability to material and equipment and encouragement from management. 3) Influence by work mates, interest and workload 4) Influence by patients and significant others. The results also showed that the MRNs work under different contextual conditions and guidelines suitable for hospitals sometimes must be made applicable for community care.

Aims and objectives:  The aim of the study was to describe factors influencing compliance to hygiene routines in community care in Swedish municipalities from the perspective of medically responsible nurses (MRN).

Method:  A web-based questionnaire was sent to all MRNs in Swedish municipalities, N = 268. Beside demographical background data, the questionnaire contained two core open-ended questions generating free text data. Data were analysed with descriptive statistics and qualitative content analysis.

Result:  Four categories of factors were found: resources, management, staff and external factors. All four categories contained subcategories.

Conclusion:  To some extent, the challenges to uphold adequate compliance to hygiene routines seem different in community care than in hospitals. Resources regarding equipment and supplies seem as an uncertain asset and uneven distributed among municipalities. Home likeness was seen as a major obstacle for upholding adequate hygiene routines. To uphold sufficient hygiene routines in a person’s home or in a home-like environment might be one of the major challenges for community health care in the future. The MRN’s narratives suggest that Registered Nurses have a key role in upholding sufficient hygiene in community care. This report might contribute in providing them with more knowledge to take on this urgent task.