Theory of Planned Behavior and Nosocomial Infection Prevention
This paper applies the Theory of Planned Behavior (TPB) to the prevention of nosocomial, or hospital-acquired, infections (HAIs). It examines how attitudes, perceived behavioral control, and social norms shape clinicians' and patients' intentions to engage in hand hygiene practices. Drawing on CDC surveillance data and peer-reviewed research, the paper outlines evidence-based health promotion activities — including posters, bilingual educational videos, and brochures — designed to improve handwashing adherence among healthcare workers. The paper also addresses evaluation methods for measuring the efficacy of these interventions against baseline nosocomial infection rates.
- Introduction to the Theory of Planned Behavior: TPB applied to handwashing intent in hospitals
- Nosocomial Infections: Scope and Impact: CDC data on HAI prevalence and infection sites
- Evidence-Based Prevention and Health Promotion Activities: CDC resources and handwashing protocols as interventions
- Evaluation of Health Promotion Efficacy: Benchmark comparisons to measure intervention success
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What makes this paper effective
- Directly connects a behavioral theory to a concrete public health problem, demonstrating how abstract concepts like attitude, perceived behavioral control, and social norms translate into real clinical interventions.
- Supports claims with specific statistics — for example, the finding that clinicians wash their hands according to recommended protocols only about 40% of the time — which grounds the argument in measurable reality.
- Incorporates both clinician-facing and patient-facing dimensions of the theory, showing awareness that behavior change requires engagement from multiple actors in the healthcare setting.
Key academic technique demonstrated
The paper demonstrates applied theory integration: it does not merely describe the Theory of Planned Behavior in the abstract but consistently maps its components (attitude, subjective norms, perceived behavioral control) onto the specific problem of handwashing adherence and HAI reduction. This technique — selecting a theory and then systematically using its variables to frame intervention design and evaluation — is a hallmark of public health program planning at the undergraduate and early graduate level.
Structure breakdown
The paper follows a three-part prompt-driven structure: (1) theoretical justification, establishing the TPB and its relevance to HAIs; (2) intervention design, detailing evidence-based prevention activities using CDC resources; and (3) evaluation planning, explaining how benchmark infection-rate data will be used to assess outcomes. Each section builds logically on the previous one, moving from theory to practice to measurement.
Introduction to the Theory of Planned Behavior
According to the tenets of the Theory of Planned Behavior (TPB), individuals first think about a behavior — that is, they form an intent to act — and only then proceed to act (Chambers & Benibo, 2011). The dependent variables of intent to act in the TPB include individual attitudes, perceived behavioral control, self-efficacy, and behavioral norms, which are in turn antecedents to the actual behavior demonstrated (Chambers & Benibo, 2011). The theory has been applied in a number of different settings, including in the context of nosocomial infections (Hughes, 2008).
In this context, the TPB conceptualizes individuals' intent to engage in handwashing as involving three main factors: (1) attitude toward whether the behavior is beneficial to themselves, (2) perception of pressure from peers, and (3) perceived control over the ease or difficulty of performing the behavior (Hughes, 2008, p. 937). Further, the theory has also been used to evaluate patient perceptions of the benefit of participating in activities that can promote their health during inpatient stays.
For example, a study by Davis and Anderson (2012) used the TPB to identify the antecedents of safety-relevant behaviors among hospital inpatients. This study examined predictors of patients' intentions to engage in a safety behavior that could reduce nosocomial infections — specifically, reminding clinicians to wash their hands (Davis & Anderson, 2012). The findings indicated that the extent to which patients understand why a behavior is beneficial will determine the extent to which they perceive it as acceptable to engage in that activity (Davis & Anderson, 2012).
The TPB will therefore be employed in the implementation of prevention and health promotion activities related to nosocomial, or hospital-acquired, infections (HAIs). Nosocomial infections can result in adverse clinical outcomes such as central-line associated bloodstream infections, catheter-associated urinary tract infections, surgical site infections, and ventilator-associated pneumonia (Types of healthcare-associated infections, 2017).
Nosocomial Infections: Scope and Impact
Despite significant progress in addressing the problem in recent years, the proliferation of sophisticated medical devices has introduced additional sources of nosocomial infections, and the problem persists. The U.S. Centers for Disease Control and Prevention (CDC) estimates that on any given day, at least one in every 25 American hospitals will experience at least one nosocomial infection case (HAIs at a glance, 2017). According to the CDC's most recent nosocomial surveillance report, the major sites of infection are set forth in Table 1 below.
Table 1: Nosocomial Estimates in U.S. Acute Care Hospitals, 2011
Pneumonia — 157,500
Gastrointestinal Illness — 123,100
Urinary Tract Infections — 93,300
Primary Bloodstream Infections — 71,900
Surgical Site Infections (any inpatient surgery) — 157,500
Other Types of Infections — 118,500
Estimated Total — 721,800
Source: HAI Data and Statistics, CDC, 2017
Every tertiary healthcare facility will experience differing levels of nosocomial infections depending on its areas of specialization and the availability of resources (Bijari & Abassi, 2014). Moreover, a number of other variables can affect nosocomial infection rates in a given hospital, including patient characteristics and care requirements, nursing education and staffing levels, and differences in the use of aseptic techniques by clinicians (Hughes, 2008).
References
Bijari, R. & Abassi, A. (2014, January 1). Nosocomial infections and related factors in southern Khorasan hospitals. Iranian Journal of Public Health, 43(2), 197.
Chambers, V. & Benibo, B. R. (2011, October 1). Reactions to the 2008 economic crisis and the theory of planned behavior. Academy of Accounting and Financial Studies Journal, 15(4), 17–20.
Davis, R. & Anderson, O. (2012, April). Predictors of hospitalized patients' intentions to prevent healthcare harm: A cross-sectional survey. International Journal of Nursing Studies, 49(4), 407–415.
HAIs at a glance. (2017). U.S. Centers for Disease Control. Retrieved from https://www.cdc.gov/hai/surveillance/index.html.
HAI data and statistics. (2017). U.S. Centers for Disease Control. Retrieved from https://www.cdc.gov/hai/surveillance/index.html.
Hand hygiene in healthcare settings. (2017). U.S. Centers for Disease Control. Retrieved from https://www.cdc.gov/handhygiene/campaign/archive.html.
Hughes, R. G. (2008, April). Patient safety and quality: An evidence-based handbook for nurses. Rockville, MD: Agency for Healthcare Research and Quality.
Types of healthcare-associated infections. (2017). U.S. Centers for Disease Control. Retrieved from https://www.cdc.gov/hai/infectiontypes.html.
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