Date of Award

Summer 2015

Document Type


Degree Name

Doctor of Philosophy (PhD)


Health Services Research

Committee Director

Holly Gaff

Committee Member

Ginger Watson

Committee Member

Scott Sechrist

Committee Member

Eli Perencevich


Problem Statement. The high rate of healthcare worker-patient contact provides many opportunities for exposure to pathogens, which creates challenges in assessing healthcare workers' success at preventing healthcare associated infections caused by these dangerous pathogens.

Methods. This study explored the effects of a simulated infectious disease on healthcare workers' hand hygiene knowledge, attitudes, performance, and reactions using Kirkpatrick's Four levels of Evaluation. The study utilized a mixed method pre-test – 2 post-test design. The dependent variables were hand hygiene knowledge, attitudes toward hand hygiene guidelines, hand hygiene performance, and reaction to the overall experience. Data was collected three times over a six-week study period. The simulation group completed a simulation experience using a clinical scenario with a simulated infectious disease, while the control group completed the same clinical scenario on paper during the same time period.

Results. Kirkpatrick Level I reaction findings revealed that all participants had a very positive reaction with the overall experience. Level II knowledge findings indicated, as expected, that using SID resulted in no new knowledge gain. Level II attitude findings revealed no significant changes in total attitude changes, but there was a significant change for the attitude sub-scale relevance, and a near significant change for the attitude sub-scale motivation. Level III performance findings revealed no changes in self-reported hand hygiene performance, but the findings did suggest that participants showed an increase in personal intention to comply with hand hygiene guidelines and to sequence of care from clean to dirty. The qualitative data revealed healthcare workers' hand hygiene influences as scientific evidence and patient safety and it revealed hand hygiene barriers as supply accessibility and time constraints.

Conclusion. The simulation findings suggest that visualizing spread during clinical scenarios may have an immediate positive effect on attitudes and self-reported intentions to increase hand hygiene performance. Recommendations include utilizing SID with existing hand hygiene training protocols to demonstrate hand hygiene lapses during job and specialty appropriate hand hygiene and skills training.