Healthcare Worker On Hand Hygiene In Healthcare Setting

KNOWLEDGE AND PRACTICE OF
HEALTHCARE WORKER ON HAND
HYGIENE IN HEALTHCARE SETTING

TABLE OF CONTENTS
INTRODUCTION...........................................................................................................................1
SYSTEMATIC REVIEW OF ARTCLES.......................................................................................1
Article 1.......................................................................................................................................1
Article 2.......................................................................................................................................3
Article 3.......................................................................................................................................5
Article 4.......................................................................................................................................7
Article 5.......................................................................................................................................9
Article 6.....................................................................................................................................11
Article 7.....................................................................................................................................14
Article 8.....................................................................................................................................16
Article 9.....................................................................................................................................18
Article10....................................................................................................................................20
CONCLUSION..............................................................................................................................21

INTRODUCTION
Hand hygiene (HH) practices are considered as essential prevention method for cross
transmission of microorganisms. Healthcare workers have little knowledge about HH practices
and most of them have poor attitude towards these activities. It is very important for nursing staff
to have good knowledge about these practices, so that they can maintain effectiveness in care
services. Present study will outline systematically reviewed articles related to level of
knowledge, pattern of practices of medical professionals on hand hygiene in health care setting.
SYSTEMATIC REVIEW OF ARTCLES
Article 1
Year 2018
Author
Aledeilah, R.D.I., El-Fetoh, N.M.A., Albaker,
A., Aljabbab, A.A., Alkhannani, S.J.,
Almahroos, T.S. and Ali, A.M.B.,
Title
Assessment of Knowledge, Attitude and
Practice of Hand Hygiene among Health Care
Workers in Arar City, Saudi Arabia
Research aim/ questions The major aim of the study is to assess
knowledge, attitude and practices of hand
washing among health care workers in Arar
city, Northern Saudi Arabia.
Design method Quantitative
Randomized Controlled Trial
Questionnaire Methodology
Population and sampling 116 respondents have been selected in which
32 were residents, 92 were nurses and 37
nursing assistants.
An inclusion technique was used.
Data Collection Hand Hygiene knowledge questionnaire 2009
1

was revised and edited for collecting data.
Questionnaire was designed by considering
age, gender, profession of persons.
Researcher has assessed attitude and practices
of respondents by using self-structured
questionnaire method.
There were many questions that contain yes or
no options.
Routine information has been asked through
questionnaire and therefore participants have
clearly shared their experiences about level of
pain and anxiety. Many information have been
asked to make them aware with importance of
wellbeing.
Ethical consideration Written consent has been taken from all
participants.
Approval has been taken from ethical board of
Northern Border University.
Confidentiality and anonymity of data were
taken into consideration on priority.
Data Analysis The entire study has been done by using
statistical analysis tool SPSS.
It is descriptive cross sectional study,
Chi square, and t- test have been applied
Main findings It is found that P value is less than 0.05.
Maximum nurses have answered that jewellery
and accessories are major source of infection.
Mean score of residents, nurses and assistant
nurses regarding hand hygiene (HH) knowledge
was 18 whereas mean score of practice was 4.
It is found that level of HH practices is high in
2

23.3% and moderate in 75.9% participants.
Strength Research has involved people with same
profession to assess knowledge and attitude
level of professionals in health care unit
Limitation One sample distribution was not uniform.
Difference in opinion of staff members was the
major limitation.
Conclusion The study has highlighted significance of
implementing training sessions in order to raise
knowledge of health care workers regarding
HH. HCWs have moderate knowledge about
Hand hygiene practices; if they improve their
understanding then they can prevent
themselves and patients as well.
Article 2
Year 2017
Author Khanal, G. and Thapa, S.,
Title Awareness of Hand Hygiene Among
Health Care Workers of Chitwan, Nepal
Research aim/ questions To describe knowledge and practices of health
care workers (HCWs) regarding HH in three
hospitals of Chitwan, Nepal.
Design method Cross- sectional
Self-administered
Questionnaire method
Randomised trial control
Population and sampling 132 health care workers have been selected as
sample in this investigation. These were
selected from three different levels: doctors,
sisters and staff nurses of Bharatpur Hospital
3

(BHC) of Chitwan, Koirala Memorial Cancer
hospital and Chitwan Medical College (CMC).
All participants were selected by using lottery
method randomly.
Convenience sampling technique was applied
to select the correct respondents.
Data Collection Questionnaire method was used to collect data
from respondents. 16 questions were prepared
and all the respondents filled this form and
shared their views. This questionnaire was
distributed to seven different wards.
N= 132
Ethical consideration Researcher has taken approval from
Institutional review committee board of CMC.
Written consent was also taken from
participants.
Data Analysis Statistical analysis technique was used in
which scholar has used SPSS 16 software.
Correlation, ANOVA tests have been applied
to find out relationship between variables.
Main findings It is found that 113 HCW said that they
perform HH more than three times in a single
day. It is identified that there is significant
relationship between practice and knowledge
as P value was resulted .004, r2 = .247.
Mean difference in HH knowledge is 0.003.
CMC workers follow HH practices quickly as
compare to other two hospitals.
Strength This study has explored good knowledge about
HH practices. There are limited articles which
have been published in Nepal on this topic.
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Thus, this has become the standard research
for those scholar who want to conduct
investigation on this topic.
Limitation Less discussion about important components of
HH such as infection control measures, verbal
reminders etc.
No financial support has been received by
scholar.
Conclusion It can be concluded that half of the medical
professionals are unaware with the importance
of HH practices in health care unit; most of
them have no knowledge about it.
This denotes the necessity of organising
training and educational programs to increase
awareness about HH practices.
Article 3
Year 2015
Author Nabavi, M., Alavi-Moghaddam, M., Gachkar,
L. and Moeinian, M.,
Title
Knowledge, Attitudes, and Practices Study on
Hand Hygiene Among Imam Hossein
Hospital’s Residents in 2013
Research aim/ questions To identify significance of knowledge, attitude,
practices (KAP)on hand hygiene among
medical residents at Imam Hossein hospital,
Tehran, Iran.
Design method Questionnaire method was used
Observational check list technique has been
applied
5

Quantitative method
Population and sampling Total participants were 270.
Volunteers were 256 and they were divided
into group of 15 members.
Data Collection Data collection was done through questionnaire
method. All participants were from different
residency period, age and sex. Involvement of
respondents was done on voluntary basis.
People who wanted to participate willingly in
research were involved.
Entire study was divided in three phases that is
evaluation, training and direct observation.
Ethical consideration Informed consent was obtained from
participants. Respondents were allowed to quit
at any level without any restriction.
Questionnaire was approved by ethics
committee of Shahid Beheshti university of
medical science. Official letter has been
received by Imam Hossein hospital.
Data Analysis Statistical analysis method was applied in this
study.
X2 test and fisher exact test were used
Main findings Mean score of resident’s knowledge about HH
was 14.2 +/-2.6. 12.1% participants wash their
hands for 20-30 seconds. There were only 2
participants those were having knowledge of
hand hygiene. Further, it has been identified
that no professional wash their hands in
morning visit hours.
Strength The study has involved large number people
from wards and therefore many of the things
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were very general
Limitation Financial support from concern authority and
critical revision of important contents were
major limitations.
Iranian medical residents those who have
participated in this research were having
moderate knowledge about HH.
Conclusion It can be concluded that residents have poor
attitude for HH practices and also have
moderate knowledge over hygiene practices.
Thus, it can be said that there is need to
implement some training programs so that
professionals can develop knowledge over HH
practices.
Article 4
Year 2014
Author Shinde, M. B. and Mohite, V. R.,
Title A Study to Assess Knowledge, Attitude and
Practices of Five Moments of Hand Hygiene
among Nursing Staff and Students at a Tertiary
Care Hospital at Karad
Research aim/ questions To assess knowledge, attitude and practices of
five moments of HH among nursing staff and
students at Tertiary care hospital at Karad.
Design method Cross sectional design has been used.
Qualitative and quantitative approach
Inclusion criteria- people those who were
available at the time of research and also the
individuals who were willing to participate
7

were involved.
Population and sampling Staff and student nurses of Krishna institute of
medical science and medical research centre
Karad were respondents of this study.
100 staff nurse and 100 student nurses were
major participants.
Convenient sampling technique was applied in
this study.
Data Collection Questionnaire technique for gathering data was
applied.
25 questions were asked with multiple choice
options.
For assessing attitude ad practice self-
structured questionnaire was prepared.
Likert scale method was applied in
questionnaire.
Ethical consideration Written consent from participants has been
taken.
Approval was taken from committee.
Data Analysis Data analysis has been done by using SPSS,
descriptive study has been done. Z test has
been applied in order to compare difference in
percentage.
Main findings It was found that majority of student nurses
have poor attitude towards HH practices.
P<0.05.
P value for knowledge of hand hygiene among
nursing staff and student was .023.
Knowledge of respondents is moderate and
most of the student have poor attitude, hence
P<0.05.
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Strength Staff has willingly participated in research.
Limitation Only selected staff and student nurses were
included, there was requirement to involve
doctors and other health care workers.
Conclusion It can be concluded that there is urgent need to
implement strategies in order to improve
knowledge, attitude and practices of medical
professionals towards HH. If they improve
their knowledge, then they can prevent
themselves from infection. There is a
relationship between knowledge and practice
of healthcare worker on hand hygiene. If
people have knowledge about significance of
HH practices, then they implement it in their
practices.
Article 5
Year 2014
Author Nair, S.S., Hanumantappa, R., Hiremath, S.G.,
Siraj, M.A. and Raghunath, P.,
Title Knowledge, Attitude, and Practice of Hand
Hygiene among Medical and Nursing Students
at a Tertiary
Health Care Centre in Raichur, India
Research aim/ questions To identify knowledge, attitude and practice of
hand hygiene among health care units at
Tertiary health care unit in Raichur, India.
Design method Cross – sectional study
Questionnaire technique.
Population and sampling Medical students= 98 and nursing students =
9

46.
Random sampling was applied.
Data Collection Questions were asked regarding knowledge,
attitude of people towards HH. Their routine
details have been taken through questionnaire.
Likert scale method was used. Options were
given as 1-7-point scale where respondents had
to choose one option.
In order to find out data about attitude of
nursing staff, self-structured questionnaire was
used which was based on 10 questions.
Ethical consideration Verbal consent was obtained from all
respondents. Approval was taken from ethical
review committee of Navodaya Medical
college.
Data Analysis SPSS software used for statistically analysis of
information. Z test has been applied in order to
compare responses of all participants.
Main findings 79% respondents have said that they have
received formal training in hand washing.
Maximum people are aware with this technique
and its benefit. There is significant mean
difference between attitude of medical students
and nursing staff, as P value if < 0.05.
It is found that nursing students use correct
practices as compare to medical students, as
value of P is <0.05.
Strength Involved persons have shared their real
experience and they were involved in
10

investigation properly.
Limitation There was no involvement of patients and their
experience has not been included in this study.
Conclusion From the above study, it can be articulated that
knowledge of nursing students is better as
compared to medical students. They have
moderate knowledge about hand hygiene
practice and are able to implement it properly.
Article 6
Year 2016
Author ALSofiani, A.M., AlOmari, F. and AlQarny,
M.,
Title Knowledge and practice of hand hygiene
among healthcare workers at Armed Forces
Military Hospitals, Taif, Saudi Arabia
Research aim/ questions To evaluate knowledge of HCW regarding
hand hygiene and identify obstacles among
them at armed force military hospitals in Taif.
Design method Cross sectional study
Randomized controlled trial
Quantitative approach
Population and sampling Random sampling method was used by using
Raosoft sample size calculator.
347 is sample size.
Systematic random sampling has been applied.
11

Data Collection Two questionnaires method were used to
gather data.
Questions were designed to meet the objectives
of research.
Self-administered questionnaire was prepared
which was based on 24 points about HH
knowledge and demographic features.
Second questionnaire has been given to
infectious control staff in order to analyse their
knowledge and practices.
Ethical consideration Researcher has taken permission from Joint
Program of Family medicine.
Furthermore, individual consent has been taken
from participants by sending them ethical
approval form. Data has been stored in
password protected computer and
confidentiality aspect has been taken into
consideration seriously.
All respondents were given rights to skip any
question if they do not want to answer.
Data Analysis The analysis has been done by using SPSS
version 20.0 software. Descriptive analysis
was done by calculating frequency and
percentage. Moreover, mean, mode, median
was calculated.
Kolmogrov- Smirnov (K-S) test was performed
for measuring total knowledge and practices of
health care workers.
Mann- Whitney Test was also performed.
Main findings Response rate of participants was 96.4%, It is
found that workers were getting formal training
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of HH thus, people over there have awareness
about hand hygiene practices. 59.1%
respondents have relevant information that if
they do not clean their hands then can face the
issue of cross transmission of potentially
harmful germs. It is found that only 28%
HCWs knew that germs are already present
within patients. Most of the health care
workers have good knowledge that they have
to wash their hands before touching these
persons and can prevent from transmission of
germs.
It is found that only 8.1% staff nurses have
knowledge that alcohol- based hand rubbing is
not that much effective as compare to soap and
water. 58.8% have replied that alcohol based
rubbing is the process that need to be adopted
by them before palpation of the abdomen.
Results of this study have declared that HCW
in Al-Hada Armed forces hospitals has high
hand hygiene knowledge score.
Strength This research paper has used systematic
sampling method and people are not included
as voluntary basis thus, there is no selection
bias.
Information has been gathered by observation
which was suitable method and has helped in
minimising issue of over scoring. Otherwise,
respondents could give unrealistic details to the
scholar.
Limitation Structured observation method has not been
13

used, that is why hand washing skills have not
been observed clearly.
Researcher has used cross sectional design
which has limited the direction of association.
Conclusion From the above study, it can be concluded that
hand hygiene score of HCWs in Taif Armed
Forces Hospitals is good. People are well
aware with the significance of washing their
hands properly. Health care workers of hospital
use alcohol based rubbing for maintaining
hygiene.
Article 7
Year
2016
Author Arthi, E., Abarna, V., Bagyalakshmi, R.,
Anitharaj, M. and Vijayasree, S.,
Title
Assessment of Knowledge, Attitude and
Practice of Hand Hygiene among Nursing and
Medical Students in a Tertiary Care Hospital in
Puducherry, India
Research aim/ questions The aim of the study is to assess knowledge,
attitude and practice of hand hygiene among
nursing and medical students in a Tertiary care
hospital in Puducherry, India.
Design method Self administrated questionnaire
Cross sectional study
Randomized controlled trial
Population and sampling 140 participants were included in this research,
74 nurses and 66 medical students were
14

enrolled in it.
All the respondents were included by using
random sampling technique.
Mixed population of trainees and trained
nurses were taken into consideration in order to
gather in-depth information about topic.
Data Collection All the participants were informed about
objective of research. The questionnaire was
having questions related to knowledge and
attitude of medical and nursing staff about HH.
There were 8 questions that have assessed
knowledge of HCWs. 10 statement questions
were there to measure attitude of health care
workers. Scoring system was used to identify
their understanding, knowledge and practices.
Ethical consideration Researcher has taken ethical approval from
institutional ethical review committee.
Verbal consent has been taken from all
respondents in order to minimise
complications.
All participants were having rights to skip
question, if they do not want to answer these
questions.
Data Analysis Analysis of the study has been done by using
statistical tools.
Chi Square test was performed.
SPSS 16 software was used to analysis data.
Main findings It has been found that knowledge of staff
members towards hand hygiene is moderate..
There were only few participants those who
have good knowledge about HH. There is
15

significance difference in mean value of nurses
and medical students, as P is .001. Nurses have
better knowledge and positive attitude towards
the HH practices as compare to medical
students in the hospitals.
It has been found that attitude of participants or
health care workers are not satisfactory.
85% of medical students have admitted that
they do not follow hand hygiene practices
properly. There are 36.4& medical learners
and 63.5% nurses believe that wearing gloves
is sufficient to practice hand hygiene.
Strength The study has focused on nursing and medical
both students. It has involved people from
different department so that valid answers can
be collected.
Limitation There should be use of purposive sampling
method because random selection some time
restricts involvement of right participants.
Conclusion From the above study, it is found that there is
gap in knowledge and practices of HH among
HCWs. Thus, authorities are required to
organise training sessions to make them aware
with the significance of this practice in health
care sector.
Article 8
Year 2016
Author Mu’taz, M.D., Alrimawi, I., Saifan, A.R. and
Batiha, A.M.,
Title Hand Hygiene knowledge, practices and
16

attitude among nurses and physicians
Research aim/ questions To assess HH knowledge, practices and
attitude of nurses and physicians.
Design method Cross sectional descriptive design
Quantitative approach
Population and sampling Convenience sampling technique
N =176
Palestinian nurses and physicians were
involved in this investigation, they are working
in government and private hospitals
Data Collection Questionnaire technique was used to collect
data. 225 questionnaires were distributed and
200 were received withal answers. Response
rate is 89%/.
Questions related to HH practise implemented
by them were involved init.
Ethical consideration Researcher has taken approval from Birzeit
University and permission has been given by
Palestinian MOH. Apart from this, ethical
committee of each hospital has given
permission to ask questions with their staff
members.
Confidentiality and privacy aspects have been
taken into consideration properly.
Data Analysis Analysis has been done by using SPSS version
19, researcher has prepared scoring system.
Zero score for wrong and one is for right
answer has been given.
Descriptive analysis has been done in which
mean, median, range, standard deviation has
been calculated.
17

Furthermore, inferential statistics has been
performed.
T- Test, Manova also been applied to find out
answers of research questions.
Main findings From the results it is found that staff is
receiving training for HH practices. There are
57% people those who have replied regarding
training aspect positively whereas 43% have
reported that they are not receiving training.
Standard deviation is found1.7 that means
people have moderate knowledge about these
practices.
P=0.015, that means there is no significant
difference between physicians and nurses
knowledge regarding HH. There is statistically
difference in experience in compliance as P
=0.015. Attitude score= .003.
It is found that students of nursing have good
knowledge as compare to medical students.
Strength The major strength of this study is that this has
given clues about clinical practices.
Limitation Experiences of patients have not been taken
into consideration.
Conclusion It can be concluded that Palestinian nurses and
physicians have moderate knowledge about
HH practise. There is significant relationship
between knowledge and practices of HCWs,
because of moderate understanding and
improper implementation chain of infection is
taking place.
18

Article 9
Year 2015
Author Sharif, A., Arbabisarjou, A., Balouchi, A.,
Ahmadidarrehsima, S. and Kashani, H.H.,
Title Knowledge, Attitude, and Performance of
Nurses toward Hand Hygiene in Hospitals
Research aim/ questions To assess knowledge, Attitude, and
Performance of Nurses toward Hand Hygiene
in Hospitals
Design method Cross sectional study
Population and sampling N=200
Nurses in hospitals of Kerman city have been
selected as sample.
Accessible sampling technique was used.
Inclusion criteria
All the nurses need to have three month
working experience in hospital
Data Collection Questionnaire technique has been applied in
order to collect data. First section was for
gathering information about demographic
features and second section was for knowing
knowledge of nurses about HH.
Third section was related with performance of
nurses in order to measure their practices.
Ethical consideration Written consent have been taken from all
participants and researcher has given them
rights to skip question or exit from the study
any time.
Data Analysis SPSS was used to analyse data.
Descriptive test
19

Chi- square
Main findings Mean score of nurses about knowledge of HH
was found 8.1+/- 1.04.74.5% nurses were there
who have good knowledge about it. 70.5%
participants have good attitude for HH. Mean
score for the performance of nurses has been
found 44.12+/- 3.41, that reflect that they are
performing well and applying in their
practices.
Strength Staff involvement was high
Limitation Only one department nurses were included.
Conclusion It can be concluded that nurses have positive
attitude and they apply HH practices in their
working. They want to learn more about these
practices so that they can serve patients well
and can minimise issues of infection..
Article10
Year 2013
Author
Ekwere, T.A. and Okafor, I.P.,
Title
Hand hygiene knowledge and practices among
healthcare providers in a tertiary hospital,
South West Nigeria
Research aim/ questions To access hand hygiene knowledge and
practices among healthcare providers in a
tertiary hospital, South West Nigeria
Design method Cross sectional study
Randomised trial
Population and sampling Simple random sampling
20