Purpose: Hand hygiene (HH) is a cost-effective public health intervention to prevent infectious disease transmission, including COVID-19. Health care professionals have shown poor adherence to HH best practices, and little is known about athletic trainer (AT) HH. ATs typically work in dynamic, unpredictable environments, creating barriers to HH compliance. The purpose of this study was to understand the self-reported behaviors and challenges with adherence to HH of secondary school ATs, particularly related to mitigating infection transmission during the COVID-19 pandemic. Methods: In this qualitative study, we conducted 11 semi-structured interviews with secondary school ATs actively engaged in direct patient care (age=31±9 years; experience=9±8 years). A 2-person data analysis team used a multi-phase inductive coding process to identify emerging domains and themes to create a codebook. Trustworthiness and credibility were established with member checking, multi-researcher analysis, and internal auditing. Results: We identified four themes: 1) best practices awareness, 2) impact of COVID-19, 3) resources, and 4) community-based prevention. Participants indicated HH training was included during on-boarding, but lacked contextual knowledge for HH in clinical practice, despite identifying ATs as health care providers. Participants expressed increased HH frequency due to the COVID-19 pandemic and concern for transmission. Participants noted an overall positive perception of access to physical resources, like hand sanitizer, sinks, and soap, as well as financial support to provide those resources. Participants noted decreased perceived risk and lack of formal policy or enforcement of HH expectations for facility users. Conclusion: ATs have general knowledge and resources but lack contextual knowledge and behaviors to employ HH best practices. The COVID-19 pandemic increased awareness, but HH by athletic training facility users remains poor. ATs should engage in HH based on best practice recommendations consistent with a traditional healthcare facility. Policies should be developed and enforced to limit disease transmission.

Author Bio(s)

Olivia Jackson, DAT, LAT, ATC is an athletic trainer practicing with the Cleveland Clinic in Cleveland Ohio. She is a graduate of the DAT program from Indiana State University.

Matthew J. Rivera, DAT, LAT, ATC, is an Assistant Professor and athletic trainer and core faculty member in the Doctor of Athletic Training Program at Indiana State University.

Kenneth E. Games, PhD, LAT, ATC, is a Professor and Director of Clinical Education with the Doctor of Athletic Training program at Indiana State University.

Lindsey E Eberman, PhD, LAT, ATC, is a Professor and Program Director for the Doctor of Athletic Training Program at Indiana State University.





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