A comparative study of hand hygiene and alcohol-based hand rub use among Irish nursing and medical students

Impact of an educational intervention on hand hygiene practice among nursing students, with a focus on hand drying efficacy

Background

Hand hygiene and its significance for reducing the spread of infection is well evidenced and has been brought into sharp focus following the COVID-19 pandemic. Although a crucial clinical skill in ensuring safe healthcare, little is known regarding nursing students' effectiveness of hand hygiene practice.

Aim

The aim of this study was to evaluate the impact of an educational intervention on hand hygiene practice, designed by the research team for first year pre-registration nursing students. Particular emphasis was placed upon hand drying technique and time.

Methodology

825 nursing students were observed and assessed for their hand hygiene practice in a clinical suite at a university setting. Nursing students were observed for compliance against set outcome measures involving hand hygiene preparation, hand and wrist washing technique, hand drying technique and time. Data were analysed quantitatively using SPSS.

Results

The educational intervention had a significant impact on the clinical skills learning of nursing students. 779 students passed the assessment at the first attempt (94.4%). Of the 46 students that failed to meet the necessary criteria, 45 satisfied the criteria at the second attempt; giving an overall optimal compliance of 99.9%. 99.6% of students complied with recommended hand drying standards.

Conclusion

This study offers an important contribution to the development and delivery of nursing education programmes. The educational intervention improved compliance with recommended hand hygiene technique and practice. Lack of attention to hand drying may negate effective hand hygiene in healthcare.

Clean hands, safe care: how knowledge, attitude, and practice impact hand hygiene among nurses in Najran, Saudi Arabia

Introduction

Healthcare-acquired infections are infections that patients acquire while receiving treatment for a medical or surgical condition and can occur in all care facilities. Hospital-acquired infections and the spread of antimicrobial resistance can be reduced by implementing proper preventive measures, including hand hygiene.

Aim

This study aimed to assess nurses' knowledge and attitudes toward hand hygiene guidelines in Najran city, determine compliance levels, identify factors contributing to non-compliance, and provide recommendations for interventions to improve hand hygiene practices and reduce healthcare-associated infections risk.

Subject and methods

This cross-sectional study was conducted among nurses working in the selected government hospitals in Najran City, Saudi Arabia. A self-administered questionnaire was distributed among the targeted nurses using an online survey. The questionnaire includes socio-demographic characteristics such as age, gender, and marital status. The questionnaire had 25 items to measure knowledge, 10 to measure attitude, 6 to measure practices, and 4 to measure the impact of COVID-19 on hand hygiene practices.

Results

Among the 386 nurses recruited, 88.3% were females, and 25.6% were aged between 31 to 35 years old. Overall, good knowledge, positive attitude, and good practice levels were found in 42.5, 48.4, and 94%, respectively. The common factor influencing hand hygiene practice was the prevention of cross-infection (88.1%). The total knowledge score mean was 18 ± 3.4 (highest possible score: 25). The total attitude score mean was 37.5 ± 6.1 (highest possible score: 50). The total practice score mean was 26.9 ± 2.8 (highest possible score: 30). A higher score indicates higher KAP of hand hygiene. Factors associated with increased KAP were being older in age (Z = 6.446; p < 0.001), gender female (Z = 9.869; p < 0.001), being a Filipino nurse (H = 117.8; p < 0.001), working in a surgery department (H = 28.37; p < 0.001), having more than 10 years of experience (Z = 6.903; p < 0.001), living in shared accommodation (H = 87.22; p < 0.001), having associated chronic disease (Z = 4.495; p < 0.001), and receiving formal training in hand hygiene (Z = 2.381; p = 0.017). There was a positive highly statistically significant correlation between knowledge score and attitude score (r = 0.556), between knowledge score and practices score (r = 0.303), and between attitude score and practices score (r = 0.481).

Conclusion

In light of the results, we can say that the nurses' knowledge, attitude, and practice in regards to hand hygiene were deemed acceptable. We noticed that female nurses who were older and had more experience, as well as those who had received formal hand hygiene training, displayed better KAP compared to their counterparts. Moreover, we found a significant and positive correlation between the scores for knowledge, attitude, and practice. Nonetheless, additional research is necessary to establish the extent of KAP concerning hand hygiene.

Effect of Optimal Alcohol-Based Hand Rub among Nurse Students Compared with Everyday Practice among Random Adults; Can Water-Based Hand Rub Combined with a Hand Dryer Machine Be an Alternative to Remove E. coli Contamination from Hands?

Efficient hand hygiene is essential for preventing the transmission of microorganisms. Alcohol-based hand rub (ABHR) is a recommended method. We compared health personnel (skilled nurse students) with random adults to study the effect of an ABHR procedure. A water-based hand rub (WBHR) procedure, using running tap water and a hand-drying machine, was also investigated. The study included 27 nurse students and 26 random adults. Hands were contaminated with Escherichia coli, and concentrations of colony forming units (CFU/mL) were determined before and after ABHR or WBHR. Concentrations after ABHR were 1537 CFU/mL (nurse students) and 13,508 CFU/mL (random adults) (p < 0.001). One-third of participants reported skin irritation from daily ABHR. Concentrations after WBHR were 41 CFU/mL (nurse students) and 115 CFU/mL (random adults) (p < 0.011). The majority of participants (88.5%) preferred the WBHR method. Results from 50 air samples from filtered air from the hand dryer outlet showed no CFU in 47 samples. A significant difference between the two groups was shown for the ABHR method, indicating that training skills are important for efficient hand hygiene. Surprisingly, the WBHR method seemed to have a significant effect in largely removing transient bacteria from hands.

Standard Precaution Knowledge and Behavioral Intentions Among Students in the Healthcare Field: A Cross-Sectional Study

BACKGROUND

Infectious diseases are a major threat to healthcare workers and patients alike. Standard precautions (SPs) are a pivotal element in controlling their spread. However, worldwide reported compliance with SP guidelines is suboptimal among workers and students in the healthcare field.

PURPOSE

The objective of this study was to identify the knowledge and behavioral intent patterns of students in the healthcare field as well as the relationship of these patterns to the students' study program, clinical exposure, and attitudes.

METHODS

This cross-sectional study employed a web-based structured questionnaire. Participants were students of nursing, emergency medicine for paramedics, physiotherapy, and medicine studying at a public university in Israel. The questionnaire assessed SP-related knowledge and behavioral intent, perceptions of personal responsibility, and the presence of mentors as role models. The K -means clustering method was used.

RESULTS

The 259 students (33% response rate) who completed the questionnaire were enrolled as participants and divided into two knowledge and behavioral intent clusters. Cluster 1 ( n = 156) had a higher proportion of nursing students and a lower proportion of medical students than Cluster 2 ( n = 103). Emergency medicine for paramedics and physiotherapy students were more evenly distributed between the clusters. Participants who were classified in Cluster 1 reported higher intent with regard to proper hand hygiene, use of personal protective equipment, and decontamination practices. In multivariable analysis, only three variables predicted belonging to Cluster 1: nursing students, perception of their mentors as role models, and perception of having higher personal responsibility for microbiological safety.

CONCLUSIONS

We observed clear patterns of knowledge and behavior among the students in the healthcare field examined in this study. These patterns were influenced by profession, role mentoring, and sense of responsibility. This use of cluster analysis may contribute to the development of better SP educational endeavors. The patterns identified highlight the need for improved training and the importance of role modeling for healthcare students in all areas of specialization.

Teaching health care students hand hygiene theory and skills: a systematic review

Hand hygiene is the cornerstone of infection prevention but is poorly undertaken and under-appreciated by medical, nursing, and other health care students. This systematic review aimed to identify and describe strategies used to teach the theory and practice of hand hygiene, determine impact on knowledge and practice, and identify need for future education and research. Ten studies met the criteria for review. Health care students' theoretical knowledge of hand hygiene and their ability to practise are suboptimal and should be improved before they have contact with vulnerable patients. Educational input can increase knowledge and practice but the methodological heterogeneity of the studies and lack of rigour make it impossible to determine which interventions are most likely to be successful. The literature provides little evidence upon which to base educational practice in this area. There is a need for multi-centred longitudinal studies to measure effectiveness of teaching methods over time.

Knowledge, attitudes, and self-reported practices (KAP) towards hand hygiene in medical students versus the public

Background

The COVID-19 pandemic and its associated morbidity, mortality, and economic disruption has reignited interest in simple protective and preventive measures.

Aims

The aim of this study was to assess the knowledge, attitudes, and practices (KAP) of hand hygiene in a sample of medical students in Ireland and members of the public to evaluate these within the context of the COVID-19 pandemic. We also explored any differences between the two groups.

Methods

A 35-question survey was formulated and circulated to potential participants comprising Irish medical students and members of the public. The data was analysed using Microsoft Excel with P-values being calculated using chi-squared goodness-of-fit analysis.

Results

There were 356 responses to the survey, categorised into medical students and general public populations. Incomplete surveys were removed leaving 303 responses. There was no statistical difference between the groups for attitudes and self-reported practices towards hand hygiene. Statistical differences were found between the two groups in terms of knowledge.

Conclusions

The study showed that medical students and the public had a good knowledge base and positive attitude in regards to hand hygiene. Both groups displayed consensus that the practices are essential, especially within the current pandemic context. However, larger studies, involving multiple universities and a larger portion of the public, may be useful to ascertain whether there is a true difference in the KAP between healthcare students and the general public.

Hand-hygiene-related clinical trials reported between 2014 and 2020: a comprehensive systematic review

Background

There is general consensus that hand hygiene is the most effective way to prevent healthcare-associated infections. However, low rates of compliance amongst healthcare workers have been reported globally. The coronavirus disease 2019 pandemic has further emphasized the need for global improvement in hand hygiene compliance by healthcare workers.

Aim

This comprehensive systematic review provides an up-to-date compilation of clinical trials, reported between 2014 and 2020, assessing hand hygiene interventions in order to inform healthcare leaders and practitioners regarding approaches to reduce healthcare-associated infections using hand hygiene.

Methods

CINAHL, Cochrane, EMbase, Medline, PubMed and Web of Science databases were searched for clinical trials published between March 2014 and December 2020 on the topic of hand hygiene compliance among healthcare workers. In total, 332 papers were identified from these searches, of which 57 studies met the inclusion criteria.

Findings

Forty-five of the 57 studies (79%) included in this review were conducted in Asia, Europe and the USA. The large majority of these clinical trials were conducted in acute care facilities, including hospital wards and intensive care facilities. Nurses represented the largest group of healthcare workers studied (44 studies, 77%), followed by physicians (41 studies, 72%). Thirty-six studies (63%) adopted the World Health Organization's multi-modal framework or a variation of this framework, and many of them recorded hand hygiene opportunities at each of the ‘Five Moments’. However, recording of hand hygiene technique was not common.

Conclusion

Both single intervention and multi-modal hand hygiene strategies can achieve modest-to-moderate improvements in hand hygiene compliance among healthcare workers.

Impact of the fluorescent concretization intervention on effectiveness of hand hygiene in nursing students: A randomized controlled study

BACKGROUND

Hand hygiene is the most effective and simplest infection control method but there is a considerable amount of evidence that shows hand hygiene skills of nursing students should be improved. Nursing education plays an important role in giving nursing students the necessary knowledge, beliefs and teaching and improving basic hand hygiene skills. An effective learning method that enables students to understand both the practical skills and the underlying theoretical principles should be used in teaching hand hygiene.

OBJECTIVES

The aim of this study was to compare the effects of a fluorescent concretization intervention and conventional education on improving the hand hygiene beliefs and skills of nursing students.

DESIGN AND SETTING

This double blinded pretest-posttest randomized controlled trial was carried out from January 1 to June 1, 2019 with the participation of 126 nursing students in a faculty of health science in a state university in Turkey.

METHODS

The participants were randomly assigned to an intervention group (n = 63), receiving education with a fluorescent concretization intervention, and a control group (n = 63) receiving conventional education.

RESULTS

There was a significant difference between the intervention and control groups in terms of the total post-test hand hygiene belief score (p = .016 effect size(r) = 0.214). The final handwashing skill score of the students in the intervention group increased significantly for the seven regions of hands (p < .001 effect size(r) = 0.863). In addition, final handwashing skill score in the intervention group (20.62 ± 4.07) was found to be significantly higher than that of the students in the control group (12.57 ± 2.85) (p < .001 effect size(r) = 0.805).

CONCLUSION

Hand hygiene training which includes visual concretization intervention with glo germ can be used as a useful strategy to improve nursing students' negative beliefs about hand hygiene and to gain students to effective handwashing behaviors.

[Discussion groups as an approach to assess knowledge, attitudes and practices of hand hygiene among the adult intensive care unit professionals from a referral hospital]

OBJECTIVES

The adherence to hand hygiene practices among the adult Intensive Care Unit (ICU) professionals in this hospital has not improved substantially in the last years, regardless of the theoretical training sessions conducted. A study was made of the knowledge, attitudes, and practices of the ICU personnel in this field.

METHODS

Several small discussion groups with ICU staff organised by preventive medicine professionals were scheduled in March 2018. Semi-structured questions on hand hygiene and use of gloves were included. The points discussed were listed into strengths and weaknesses. Knowledge was then assessed using an anonymous questionnaire, after the sessions.

RESULTS

Thirteen 60-minute sessions were carried out with 157 participants from all professional categories (82% from ICU, median=11 participants / session). The majority perceived hand hygiene as a priority issue of personal responsibility for patient safety. They identified factors that limit their ability to improve their adherence. Certain habits have more to do with personal preferences than with theoretical knowledge or technical indications.

CONCLUSIONS

The discussion groups have helped to make a diagnosis of the situation that will be useful to strengthen those areas of improvement that have been identified. If we aim for a cultural change, and eliminate incorrect habits, it seems more useful to carry out adequate continuing education as part of the daily routine of professionals.

Factors influencing hand hygiene practice of nursing students: A descriptive, mixed-methods study

Developing nursing students' knowledge and practice of infection prevention and control (IPC) is fundamental to safe healthcare. A two-phase descriptive, mixed-method study conducted within a Bachelor of Nursing program at an Australian university aimed to explore: (i) theoretical knowledge of IPC, highlighting hand hygiene, of nursing students and; (ii) nursing students' and clinical facilitators' perceptions of factors influencing these practices during clinical placement. Phase One utilised an anonymous validated questionnaire assessing students' knowledge; identifying variables influencing students' IPC practices, subjected to descriptive and inferential analysis. Phase Two were semi-structured interviews exploring clinical facilitators' experiences/perceptions of students during clinical placement, analysed thematically. Students' demonstrated satisfactory knowledge of IPC in their second and third year, but clinical facilitators perceived that. students lacked awareness of the importance of these practices. Five themes arose from the interviews: (i) understanding workplace culture; (ii) students' modelling local behaviour; (iii) enhancing and consolidating knowledge for practice; (iv) adjusting to practice reality and; (v) accessing additional hand hygiene resources. Factors specific to workplace setting and culture were perceived to influence nursing students' socialisation. Future practice/education strategies could address these factors by ensuring students receive adequate supervision during clinical placement, and having strong advocates/role models present in the workplace.

Students' observations of hand hygiene in nursing homes using the five moments of hand hygiene

AIMS AND OBJECTIVES

To use nursing students to observe hand hygiene adherence in nursing homes and to explore whether the students' reflections after observing hand hygiene practices gives them a deeper understanding of the subject matter.

BACKGROUND

Residents in nursing homes worldwide have low tolerance for healthcare-associated infections that require antibiotics, and hand hygiene is the single most effective action to reduce infections.

DESIGN

Observational study using (a) World Health Organization's (WHO) "Five moments for hand hygiene" validated tool to record indications and adherence and (b) an exploratory study of individual reflection notes from students conducted during and after observations.

METHODS

From February 12-15, 2018, 26 nursing students in their second semester of a 3-year bachelor programme participated as observers in five wards in four nursing homes in the Oslo metropolitan area. This study was performed according to the STROBE statement.

RESULTS

Hand hygiene was performed for 57.2% of the 2,393 indications observed and recorded. Adherence differed significantly by type of personnel and by location. Four thematic categories emerged from the reflection notes: (a) practical awareness and introspection; (b) visualisation and enhancement of understanding of practice learning; (c) incorrect hand hygiene practices; and (d) stimulation to increase essential knowledge.

CONCLUSION

Hand hygiene adherence was too low to prevent healthcare-associated infections and to reduce the use of antibiotics. The students' reflection notes indicated more "insight and understanding of the complexity of hand hygiene." We suggest using nursing students in clinical placement as a means of incorporating different interventions as part of their learning skills and become "living reminders" of the importance of hygiene and infection prevention.

RELEVANCE FOR CLINICAL PRACTICE

Improving the student's activity about hygiene and infection prevention in clinical placement may help to raise awareness by healthcare workers in nursing homes.

Knowledge and performance of nursing students of Kermanshah-Iran regarding the standards of nosocomial infections control: a cross-sectional study

Objectives

The aim of this study was to determine the level of knowledge and performance of nursing students in regard to the standards of nosocomial infections control.

Results

The average score of knowledge and performance of the subjects was 12.49 ± 2.3 from 18 and 43.07 ± 0.67 from 54, respectively. There was a direct and significant correlation between the knowledge and performance of students (r = 0.46, p < 0.0001). There was no statistically significant relationship between the knowledge of students and variables such as gender and academic year of the students, but there was a significant relationship between students’ performance, and gender (p = 0.014) and academic year (p = 0.015).