The knowledge of hand hygiene among the healthcare workers of two teaching hospitals in Mashhad

Hand hygiene knowledge among nurses and nursing students-a descriptive cross-sectional comparative survey using the WHO's "Hand Hygiene Knowledge Questionnaire"

Aim

To determine the level of knowledge and explore the difference of hand hygiene between nursing students and nurses.

Background

Annually, 3.8 million people in Europe acquire healthcare-associated infections, highlighting the importance of hand hygiene. Despite WHO's emphasis on the fact that greater hand hygiene knowledge correlates with improved hand hygiene compliance, several studies have shown knowledge gaps among nurses and nursing students regarding hand hygiene.

Design

Descriptive cross-sectional comparative survey.

Methods

A version of the WHO "Hand Hygiene Knowledge Questionnaire", translated into Swedish, was used for data collection among nursing students in the first and last semester, and registered nurses from a university and associated hospital. Data were analyzed by descriptive statistics, and comparison between groups with Fisher's exact test, one-way ANOVA, and post-hoc tests (Pairwise Z-Tests, Tukey HSD).

Results

The survey, conducted between December 2020 and January 2021, received responses from 201 participants, including 71 first semester students, 46 last semester students and 84 registered nurses, showing moderate (55.7% [50-74% correct answers]) to good (43.8% [75-100% correct answers]) knowledge levels. First-semester students scored lower (17.0 ± 2.1) than last-semester students (18.8 ± 1.8) and registered nurses (18.3 ± 2.1) out of 25 questions.

Discussion

It is necessary for all groups to receive proper education on hand hygiene knowledge and to have an educational program that does not separate the groups but combines them with continuing education, since the students will someday be influencing future hand hygiene knowledge as a peer, together with the nurse.

Hand hygiene during the spread of COVID-19: a cross-sectional study of awareness and practices among academic institutions in Lebanon

Introduction

During the pandemic, the World Health Organization has recommended hand hygiene as one of the effective preventive measures to limit the global spread of COVID-19. However, the awareness gap of hand hygiene protocols could increase the spread of COVID-19 and consequently increase the absenteeism rate among academic institutions. This study aims to assess hand hygiene awareness and practices levels among various university communities in Lebanon.

Methods

A cross-sectional study was conducted between December 2021 and June 2022 among 1,291 participants from academic settings in Lebanese universities. An online survey (score-based questionnaire) of hand hygiene was conducted to evaluate the awareness and practices among university communities (faculty, staff, and students). Mann-Whitney and Kruskal-Wallis tests were used to determine whether significant differences exist in the levels of awareness with regard to gender, age, provinces, educational level, and university status. Pearson's chi-squared test was applied to assess differences among the sample characteristics and participants' practice of hand hygiene.

Results

It was found that most of the participants showed a moderate level of awareness (76.4%) with a mean score of 7.59 out of 12 (SD = 1.68). The Mann-Whitney test indicated that females recorded higher levels of awareness than males with a significant difference of 102, 104: p < 0.05. Another notable variable was the educational level of the participants with university degrees holders recording higher scores of awareness than the ones with high school degrees as per the Kruskal-Wallis test (p < 0.05). Significant differences were also shown in awareness scores among the age groups and the university status (p < 0.05). The Pearson's chi-squared test results showed that females used alcohol-based hand rubs or soap and water more frequently than males (p < 0.05). However, males significantly preferred the frequent use of water alone compared to females (p < 0.05).

Conclusion

The study findings highlighted the necessity of awareness campaigns and health educational programs addressing the technical skills of hand hygiene among both genders (especially males) of the academic communities in Lebanon.

Hand Hygiene Knowledge and Perception Survey for Healthcare Workers in Government Hospitals (GHs) in Bahrain

Introduction and aim Healthcare-associated infections (HAIs) are a serious concern in all healthcare facilities as they may lead to many serious consequences, like prolonged hospitalization, increased mortality and morbidity, and extra costs. Effective hand hygiene (HH) is the primary proven measure known to be effective in reducing the risk of HAIs in all healthcare settings. This study aimed to measure the healthcare workers' (HCWs) knowledge and perception of HH at government hospitals (GHs) in Bahrain. Subjects and methods This cross-sectional study was conducted among HCWs working in GHs in the Kingdom of Bahrain. A self-administered questionnaire was distributed among the targeted population using a Google survey (Google LLC, California, USA). The questionnaire includes socio-demographic data (e.g., age, gender, nationality, etc.) and a validated WHO questionnaire measuring perceptions and knowledge toward HH. Results Of the 285 HCWs, 75.4% were females, and 48.1% were aged between 31 and 40 years old. The overall mean perception was 35.9 (SD 6.93) out of 42 points, with nearly 80% of HCWs considered to have good perception levels. The overall mean knowledge score was 11.4 (SD 1.37) out of 14 points. Accordingly, 75.4% were considered to have good knowledge levels. Factors associated with increased perception include increasing age, female gender, non-Bahraini, being a nurse with increasing years of working experience, and receiving formal training in HH. Being a nurse was the sole significant predictor of increased knowledge. Conclusion The knowledge and perception of HH among HCWs were sufficient. Being a nurse was a significant predictor of both knowledge and perception. Further, a significant positive correlation was noted between the knowledge and perception scores. Maintaining the level of knowledge and perception of HH could lead to improved HH compliance among HCWs.

Medical Students' and Radiology Technician Trainees' eHealth Literacy and Hygiene Awareness-Asynchronous and Synchronous Digital Hand Hygiene Training in a Single-Center Trial

Next to the known nosocomial infections, the COVID-19 pandemic was an example for the need for the immediate implementation of functioning hygiene concepts and knowledge transfer. The aim of this study was to evaluate the self-assessment of ehealth literacy in terms of finding, using and critically evaluating health information and theoretical and practical hygiene awareness on a voluntary participation basis at the Jena University Hospital in 2022. The well-established and validated eHEALS and WHO questionnaire on hand hygiene (HH) knowledge for healthcare workers was completely filled by 204 participants (191 medical students; 13 healthcare trainees). In a second step, after the questionnaire, 77 participants completed additional asynchronous, digitally guided self-training using DesiCoach 2Go. In the end, a synchronous hand disinfection was carried out in the hospital using Visirub, by separating it into a group without (n = 191; with and without HH questionnaire) and a group with (n = 31; with HH questionnaire) previously completed self-training. For the eHL, the respondents tended to have a positive self-assessment of finding, using and critically evaluating health information. The voluntary participants of the practical hand disinfection who had received self-training were able to achieve significantly better results (p = 0.0047), resulting in fewer wetting gaps in a subsequent performance with Visirub than those who had not received digital self-training. The survey showed that healthcare-related participants belonging to the "digital native" generation have above-average knowledge on HH and profit by digitally guided self-training.

Hand hygiene compliance and associated factor among nurses working in public hospitals of Hararghe zones, Oromia region, eastern Ethiopia

Background

Healthcare workers are in constant contact with a wide variety of materials and surfaces, including waste, body fluids, mucous membranes, food, their own bodies, and the skin of patients. As a result, their hands are colonized by different groups of pathogens. Hand hygiene of healthcare workers is recognized to be the main factor in reducing healthcare-associated infections. Therefore, this study aimed to assess hand hygiene adherence and related factors among nurses working in public hospitals in eastern Ethiopia.

Methods

An institutional based cross-sectional study was conducted in Hospital, Hararghe zone, Eastern Ethiopia from July 1 to 30, 2021. A total of 451 study participants were randomly selected, after the proportional allocation of study participants to each selected hospital. The data was collected using self-administered questionnaire and observation checklist. SPSS version 26 was used to analyze the data. Bivariable and multivariable analysis were employed to assess the association between outcome and independent variables. Finally, a p-value of < 0.05 was used as a cutoff point for statistical significance.

Results

Out of 436 eligible nurses, the overall hand hygiene compliance was 37.4% [95% CI (0.33, 0.42)]. The overall compliance among those working in medical, surgical, OR ward, OPD, Gynecology/obstetrics, emergency ward, Intensive care units, Pediatrics, and other wards/departments was 46.8, 44.8, 35.7, 28.2, 20.7, 45.1, 23.1, 40.5, and 29.4%, respectively. The mean knowledge score was 21.6% (SD: 2.08). Furthermore, there was a statistically significant association between hand hygiene compliance and gender, work experience, training in hand hygiene, availability of running water, and knowledge of hand hygiene.

Conclusion

The current study found overall compliance with hand hygiene accounted for 34.7%. Therefore, an exemplary worker may initiate others to do so, and strong managerial and leadership commitment may also help the workers stick to the rules and regulations to follow the multimodal hand hygiene practice as per WHO recommendation.

Application of the gold standard direct observation tool to estimate hand hygiene compliance among healthcare providers in Dessie referral hospital, Northeast Ethiopia

This study aims to assess hand hygiene compliance and associated factors among healthcare providers in Dessie referral hospital (Ethiopia) using the gold standard WHO's observational checklist and self-administered questionnaire. Hand hygiene practices of 230 healthcare providers from ten hospital wards were observed over 24 hours period. The required numbers of sample were proportionally allocated among the different professions and wards. The overall observed hand hygiene compliance was only 17.6%. Hand hygiene training , availability of functional sink , knowledge about hand hygiene , attitude towards hand hygiene , availability of water and soap , and availability of alcohol-based hand rub were positively associated with hand hygiene compliance. As lower levels of compliance were observed for indications that have potential risk for patients, healthcare providers need to follow the WHO's multimodal hand hygiene improvement strategies. This study also indicated the important prerequisites that could help improve hand hygiene.

Assessment of Anti-Bacterial Effectiveness of Hand Sanitizers Commonly Used in South Africa

Hand sanitizers are used as an alternative to hand washing to reduce the number of viable microorganisms when soap and water are not readily available. This study aimed to investigate the anti-bacterial effectiveness of commercially available hand sanitizers and those commonly used in healthcare and community settings. A mapping exercise was done to select and procure different hand sanitizers (n = 18) from retailers. Five microorganisms implicated in hospital-acquired infections were selected and tested against each hand sanitizer: Escherichia coli, Enterococcus faecalis, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Staphylococcus aureus. Twenty-one volunteers were recruited to do a handprint before and after applying the hand sanitizer. Only four out of eighteen hand sanitizers (22%) were effective against all tested bacterial species, and an equal number (22%) were completely ineffective. Seven hand sanitizers with a label claim of 99.99% were only effective against E. coli. Only five hand sanitizers (27%) effectively reduced bacteria on participants’ hands. This study showed that only a fifth of hand sanitizers were effective against selected microorganisms. The findings raise a concern about the effectiveness of hand sanitizers and their role in infection, prevention, and control if not well regulated.

Bacterial contamination of non-contact condensing lenses in National University of Malaysia Hospital isolated using BD BACTEC Peds Plus/F broth bottles versus conventional culture plates

Introduction. Non-contact condensing lenses (NCLL) are a requirement in ophthalmology examinations. To date, there have been no studies on the types of bacteria found on handheld lenses used to examine patients in an ophthalmology clinic.Hypothesis. The BD BACTEC Peds Plus broth (BACTEC-PP) culture method can isolate more organisms as compared to conventional culture plates (CCP) from NCLL.Aim. To evaluate the organism spectrum cultured from NCCL for fundus examination and to compare the results between BACTEC-PP and CCP. The isolation results were then related to the participant's knowledge and hand hygiene practices (HHP).Methodology. This is a comparative cross-sectional study involving consenting trainee ophthalmologists from a single centre, whose preferred NCCL was swabbed from January to December 2019. The respondents completed the adapted World Health Organization Hand Hygiene Knowledge and Perception Questionnaire, and their HHP were observed by Infective Control Unit nurses. Positive bacterial growth using both methods, in addition to hand hygiene practices, were compared.Results. All samples had positive yields by at least one method. BACTEC-PP had a higher yield of 47 (90.4%) isolates compared to CCP with 37 (71.2%) isolates, P=0.041. CoNS sp (38.9 %) was the most common isolate with both methods, followed by Bacillus sp (25.3 %). At the same time, three fungi were detected with CCP only (3.2 %). There was a significant correlation in bacterial isolation with years of training, with fewer isolates among seniors in both BACTEC-PP (P=0.049) and CCP (P=0.034). There were no significant correlations between HHP and positive yields from either culture method.Conclusions. NCCL used by trainee ophthalmologists are typically contaminated by at least one bacteria, with CoNS sp being the most commonly isolated. More positive cultures occurred in lenses from junior trainees. Contamination was not correlated with knowledge or HHP. BACTEC-PP has significantly higher yields than CCP for bacterial isolation from NCCL, but did not isolate any fungus.

Hand Hygiene Knowledge Among Eye Care Workers at an Eye Hospital in Nigeria

AIM

The aim of this article is to determine the knowledge of hand hygiene (HH) practices among eye care workers in a tertiary eye hospital in Nigeria.

MATERIALS AND METHODS

This was a cross-sectional study of eye care workers at a tertiary eye hospital in Nigeria. Eye care workers, involved with clinical duties, responded to the WHO Hand Hygiene Knowledge questionnaire containing 24 multiple choice questions on HH knowledge. Each correct answer earned one point; zero was given for a wrong answer. Overall scores were expressed in percentage. An overall score of ≥75% was considered as good; 50-74% moderate; and <50% poor knowledge. Data analysis was with SPSS version 23.

RESULTS

Fifty-eight workers participated. Thirty-nine (67.2%) were females and 19 (32.8%) were males; the age range was 25-68 years; mean 39.6 ± 7.4 years. The average work experience was 15.3 ± 8.9 years; range 1-40 years. The mean knowledge score was 12.0 ± 2.9 (50%) which is moderate knowledge; range 3-18. Workers who had received training in HH had a significantly higher mean knowledge score than those who did not receive training (12.8 ± 2.3 vs. 11.3 ± 3.2; P = 0.04). There was no statistically significant association between knowledge of HH and age, sex, work experience, and professional category (P > 0.05).

CONCLUSION

HH knowledge of the eye care workers studied is sub-optimal. This has negative implication for hospital infection control. Eye care workers' knowledge of HH can be improved through formal training and frequent rehearsals.

Spatial Distribution and Determinant Factors of Handwashing Practice With Essential Agents Among Households in Ethiopia

Objectives: This study aimed to assess the spatial distribution and determinant factors of handwashing practice using essential handwashing agents (soap and water) among households in Ethiopia.

Methods: A two-stage stratified cluster sampling technique was used. Mixed-effect logistic regression analysis was also used to identify determinants of handwashing practice with essential agents.

Results: In Ethiopia, household handwashing practices with essential agents had spatial variation (Moran’s Index 0.62, p < 0.001). The Amhara and Somali regions were identified as significant hotspots with low handwashing practice using essential agents.

Conclusion: In Ethiopia, handwashing practice with essential agents showed spatial variation across the country with a very low rate. Areas with low handwashing practice with essential agents need high priority in the allocation of resources to ensure communities’ access to fixed and portable handwashing facilities, soap, and reliable water supplies. Households with low access to improved sanitation facilities, low wealth status, and low educational status should be targeted for the intervention.

Impact of Infection Control Education on Gastrointestinal Endoscopy Procedural Staff

To date, minimal research has been conducted on proper use of personal protective equipment and hand hygiene within endoscopy. The American Society for Gastrointestinal Endoscopy has developed guidelines for infection control within the endoscopy suite. A practice change based upon these guidelines was implemented. Education was provided to endoscopy procedural staff within a Midwestern hospital based upon the World Health Organization 5 Moments for Hand Hygiene initiative and included personal protective equipment. Knowledge, skills, and attitudes of the participant group were compared from paired pre- to posteducation surveys pertaining to hand hygiene and personal protective equipment. Observation of personal protective equipment use and hand hygiene implementation during procedures was also documented pre- to posteducation. The project results revealed both willingness to implement proper donning and doffing of personal protective equipment and improved technique as evidenced by improved observed technique with the endoscopy suite and moderately improved hand hygiene questionnaire results. Although conducted as a quality improvement project, clinical significance was found via observation following education. These practices can aid in reduction of organism transmission from patients to staff.

Hand hygiene knowledge, perception, and self-reported performance among nurses in Kelantan, Malaysia: a cross-sectional study

Background

Nurses interact with patients 24 hours a day, and this connection has the potential to raise the risk of infection transmission to patients. Nursing plays a vital role in pre-venting healthcare-associated infections (HCAIs) by ensuring that hand hygiene (HH) practises are followed and maintained. The purpose of this study was to evaluate nurses’ knowledge, perceptions, and self-reported HH performance scores, as well as their correlation, in tertiary care hospitals in Kelantan, Malaysia.

Methods

A cross-sectional study was undertaken in all four Kelantan tertiary care hospitals from December 2019 to February 2020. A stratified random selection method was used to obtain a sample of 438 registered nurses. A validated WHO self-administered HH knowledge and perception questionnaire for healthcare personnel was used to measure HH knowledge, perception, and self-reported HH performance.

Results

The mean (SD) score of knowledge was 15.08 (1.96) out of the total 25. The score of perception participants towards HH was 68.02 (10.14) out of the total 81 and the average self-reported HH performance was 87.58 (12.03) out of 100. Pearson’s correlation analysis showed significant positive correlations between perception and knowledge scores; r (436) =0.17, p<0.001 and Perception and self-reported HH performance scores; r (436) =0.27, p<0.001.

Conclusions

There is a strong link between knowledge and perception scores. Lack of understanding of HH during patient care might lead to a negative perception, which can affect overall self-reported HH performance. The need of monitoring and maintaining HH knowledge among nurses was established in this study.

Microbial contamination of the hands of healthcare providers in the operating theatre of a central hospital

Background

Effort is invested in maintaining the sterility of the operating field, but less attention is paid to potential healthcare associated infection (HAI) sources through patient contact with non-scrubbed healthcare providers (HCPs). A single microbiological assessment of hands can provide a good assessment of the potential dynamic transmission of microorganisms. The aim of this study was to identify and quantify the microbial growth on the hands of HCPs in the operating theatres of Chris Hani Baragwanath Academic Hospital.

Methods

A prospective, contextual and descriptive study design was followed. Seventy-five samples were collected using convenience sampling from an equal number of surgeons, anaesthetists and nurses. Specimens were taken using agar plates and underwent semi-quantitative analysis.

Results

All the hands of the HCPs displayed growth; 95% grew commensals and 64% grew pathogens. Eighteen commensal microorganisms and 21 pathological microorganisms were noted. Comparisons of commensal, pathological and combined levels of contamination among the three groups were not statistically significant (p = 0.061, p = 0.481, p = 0.236). No significant difference between the growth of combined microorganisms (p = 0.634) and pathological microorganisms (p = 0.499) among the groups. Surgeons had significantly more commensal growth (p = 0.041). There was no statistically significant difference between sexes (p = 0.290).

Conclusion

It was concerning that 100% of the hands of HCPs who were about to commence with the surgical list had microbial growth. These HCPs could have already been in contact with patients and equipment in the theatre environment.

Hand hygiene behavior among Sri Lankan medical students during COVID-19 pandemic

BACKGROUND

Poor compliance with hand hygiene practices among medical students poses a risk for cross-infection. It has become more critical during the COVID-19 pandemic than ever before. This study aimed to determine the knowledge, attitudes, practices of hand hygiene among final-year medical students. It also explored reported hand hygiene behavior before the COVID-19 pandemic and the need for educational strategies to correct the deficiencies.

METHODS

A concurrent mixed-method approach was used. In the quantitative strand, a cross-sectional online survey was carried out via a Google form. Mann-Whitney U test and Chi-squared test were used for comparisons. In the qualitative strand, twelve participants were interviewed, based on a semi-structured interview guide and audio recorded. Transcribed data were evaluated with thematic content analysis.

RESULTS

A total of 225 final-year medical students were studied in the quantitative strand. Most were females. The mean score for knowledge was 3.35 ± 0.795 out of six. Of them, 31.6 % of participants scored below 3 points (< 50 % of the total). Most (78.9 %) had positive attitudes (score of > 80 %). Only 36.4 % reported "adequate" hand hygiene performance in all eight dimensions of the behavior domain. Noticeably, fewer participants reported to clean their hands after checking blood pressure (55.6 %), and only 66.2 % stated carrying a hand sanitizer in their pocket. Significant correlations were not found between reported behavior and attitudes (p = 0.821) or knowledge (p = 0.794). The qualitative strand with 12 respondents revealed the positive influence of both hierarchical and non-hierarchal role models. Time constraints, skin irritation, and workload pressures were the main barriers. Frequent reminders, supervision, and interactive teaching were suggested as methods to improve hand hygiene compliance. They also stated that increased enthusiasm was noted on hand hygiene during the COVID-19 pandemic compared to the pre-pandemic period.

CONCLUSIONS

Most of the participants had positive attitudes towards hand hygiene. Yet, a considerable gap between attitudes and knowledge and reported hand hygiene behavior was evident. Coupling educational programs that use cognitive and behavioral methods, including role modeling, supervision, and frequent reminders, is recommended to bridge the knowledge-attitude-behavior gap.

Impact of an Interventional Program on Improving Compliance of Hand Hygiene and Reducing Hospital-Acquired Infection in the Critical Care Unit

Introduction

This study aimed to determine the effect of a hand hygiene (HH) and awareness campaign on knowledge and compliance with HH practices among health-care workers working staff in the main intensive care units and also to evaluate the rates of hospital-acquired infection (HAI) before and after the intervention.

Methods

A prospective, interventional, pre-post design was utilized and carried out in three phases: the first stage was a 1-month preintervention stage to develop the foundation of the compliance rate of handwashing; the second stage was the interventional handwashing campaign; the third stage was the postintervention stage to improve the compliance rate of handwashing. Two instruments were used in this study: the HH Knowledge Questionnaire developed by the World Health Organization to assess HH knowledge and the Handwashing Questionnaire developed to evaluate HH washing.

Results

HH knowledge has been increased from preintervention (M = 11.84, standard deviation [SD] = 2.41) to postintervention (M = 18.80, SD = 2.93), and the effective compliance with HH practice was as low as 49% in June 2017 to 75% in February 2018. In addition, the HAI rate was dropped from 13.2% in June 2017 to 9% in February 2018. An inverse association was recognized between HH compliance and HAI rates.

Conclusions

These results recommend that reasonable approaches can decrease the HAI rate of intensive care units. A nationwide handwashing interventional program can be employed in all hospitals.

Predictors of Self-Reported Hand Hygiene Performance among Nurses at Tertiary Care Hospitals in East Coast Malaysia

Background: Hand hygiene (HH) is the simplest and most effective way to reduce the incidence of healthcare-associated infections (HCAIs). Methods: This cross-sectional study aimed to determine factors associated with self-reported HH performance among nurses at Kelantan tertiary care hospitals. A sample of 438 registered nurses was selected through a stratified random sampling method. Self-reported HH performance was assessed using a validated WHO self-administered HH knowledge and perception questionnaire for healthcare workers. Results: A multiple linear regression analysis was performed to identify the predictors. The factors that significantly predicted self-reported HH performance among nurses included perception score (beta coefficient (β) = 0.260; 95% CI: 0.200, 0.417; p < 0.001), pediatric department (β = −0.104; 95% CI: −9.335, −2.467; p < 0.001), and orthopedic department (β = −5.957; 95% CI: −9.539, −0.720; p < 0.023), adjusted R² = 0.102; p < 0.001. Nurses with a strong perception and belief in HH were more likely to have better HH performance. Compared to pediatric and orthopedic, surgical departments were associated with better self-reported HH performance. Conclusions: This study showed the importance of factors that could improve the intervention’s performance in HH strategy. Lack of perception and HH program intervention in departments engaged in patient care could lead to poor HH practices, thus increasing HCAIs and antimicrobial resistance (AMR).