Additional File 1 - Interview Guide Explanation Thank you for agreeing to speak with me today about hand hygiene

practice. There may appear to be overlap between questions but each question is worded to obtain specific information and therefore you may find that answers are repeated. It is important to note that there are no right or wrong answers to the questions and that no one will know what your specific answers were. The interview should take approximately 15 to ! minutes and will be audio"recorded to ensure that all key points are accurately documented. #ny identifying information $for example the names of other individuals% that you use in the course of our discussion will be removed from the interview transcripts. If you wish to end the interview before I have asked all of the questions or if you wish to withdraw from the study you are free to do so.

&ackground 1% 'ale or (emale $to keep track of) won*t be asked% +onfirm if right campus documented $for staff physicians% #ge range" ,-!) -1".!) .1"5!) 51"/!) /10 1ow long have you been a physician2 3hat year of residency2 $if applies% 1ow long have you been at T412 1ave you done any of your training at T41 in the past 1! years $medical school) residency) fellowship%2

5nowledge #re you aware of any guidelines about hand hygiene2 i. If yes) what are they2 ii. #re you familiar with the . moments of hand hygiene2 #re you aware of any evidence that links hand hygiene to healthcare associated infections2 i. If yes) what are your thoughts about this evidence2 $prompt6 do you agree2 etc.% 7o you feel as though you have a sufficiently strong background in infection control training2 i. If yes) what is the training2 ii. If no) what would you like to know more about2 3hen do you think that you need to practice hand hygiene2 8kills 3ere you ever trained in the proper technique for hand hygiene2
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7o you think proper hand hygiene is a skill2

8ocial;9rofessional <ole and Identity Is hand hygiene a standard part of your patient consultations2 Is hand hygiene something specific to =residents> =staff physicians> =surgeons> =general medicine>2 3hat is your impression of the compliance of others in your profession with hand hygiene guidelines2 7o you feel as though your hand hygiene practice is in line with your peers2 &eliefs about +apabilities 1ow easy or difficult is it for you to practice hand hygiene2 3hat made it easy what made it difficult2 7o you believe that what you consider to be good hand hygiene fits with the current guidelines2 #re you confident that you are following the guidelines when practicing hand hygiene2 &eliefs about consequences 3hat are the benefits when good hand hygiene is practiced2 $prompts6 patients) yourself% 3hat are the negative aspects when good hand hygiene is practiced2 $prompts6 patients) yourself% In what situations do you think hand hygiene is necessary;unnecessary2 4ptimism 3hat do you think will happen if you are not able to practice hand hygiene $prompt6 the . moments%2 In your opinion) how likely is it that improper hand hygiene will lead to a healthcare associated infection2 Intentions 7o you intend to practice hand hygiene $prompt6 the . moments%2 i. If no) why2 ii. If yes) do you anticipate any problems2 3hat will make the process of hand hygiene easier2 'emory) #ttention and 7ecision 9rocesses Is hand hygiene automatic or do you need to remember or be reminded to do it2 Is practicing or not practicing hand hygiene ever a conscious decision2 7o you have any triggers for remembering to practice hand hygiene2 3hat would make it easier to remember hand hygiene2 #re there certain situations where you find yourself forgetting to practice hand hygiene more often than others2
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In what situations might you find it difficult to follow the hand hygiene guidelines2

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Anvironmental context and resources 1ave you found hand hygiene audits to be successful at promoting compliance2 If yes) what aspects of this intervention encourage hand hygiene2 If no) what could be done to improve this intervention2 3hat resources would make it easier for you to practice hand hygiene2 3hat aspects of your work environment influence whether you practice hand hygiene2 $9<4'9T6 any trigger or prompts in clinic2% #re there any competing tasks or time constraints that might influence whether or not you practice hand hygiene2 3hat would help you overcome these problems;difficulties2

1!% 8ocial influences 7o other team members influence your decision to practice hand hygiene2 i. If yes) how2 ii. If no) prompt $co"workers ; team lead ; department ; overall workplace% 7o the expectations of your patients and their families influence you to practice hand hygiene2 i. If yes) how2

11% Amotion 7o you have any strong feelings about current hand hygiene guidelines $prompt6 . moments%2 7o your emotions or mood ever influence whether you practice hand hygiene2 7oes not practicing hand hygiene evoke worry or concern in you2 1 % Goals 7o you want to practice hand hygiene $prompt6 the . moments%2 In what situations do you want to practice hand hygiene2 +onsidering your other priorities) on a scale of 1 to 1! with 1! being very important) how important do you think it is for you to practice hand hygiene $prompt6 the . moments%2 i. $If not 1!%) what is a higher priority2 1-% &ehavioural regulation 3hat could you personally do to increase your hand hygiene practice2 $prompt6 within your everyday practice% 3hat do you think is needed to ensure that you consistently practice hand hygiene2 3ithin your healthcare team #re there procedures or ways of working that encourage
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hand hygiene2 1.% <einforcement In the past) are there any personal or external incentives that you have experienced to be effective to improve hand hygiene2 $prompt6 yourself) or others% 1ave your views toward hand hygiene evolved from your time in medical school up until now2 i. If so) how2

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