Journal of Education and Health Promotion

An assessment of hand hygiene perception and practices among undergraduate nursing students in Lagos State: A pilot study

Document Type : Original Article

Authors

. Afolabi Oyapero
. Oyejoke Oyapero

Department of Paediatrics, Alimosho General Hospital, Lagos State, Nigeria

Abstract
BACKGROUND: The contaminated hands of health‑care professionals (HCPs) is an implicated
vector in the transmission of potentially pathogenic organisms to vulnerable patients. The aim of
this study was to derive baseline data on hand hygiene (HH) practices among a cohort of students
at the Lagos State School of Nursing and to determine their perception about the adequacy of
instructions they receive.
MATERIALS AND METHODS: A descriptive, cross‑sectional study was conducted on a probability
random sample of 69 nursing students at the Lagos State School of Nursing at the Alimosho
Igando General Hospital. The knowledge, attitude, and practice as well as the perception of
the respondents on the adequacy of their infection control instructions were obtained using an
interviewer‑administered questionnaire. Data entry and analysis were done using SPSS software
version 20 (IBM Corp., Armonk, NY, USA), P < 0.05 was considered statistically significant. Multivariate
linear and logistic regressions were done to assess which factors were truly significant predictors,
with odds ratios (ORs) and 95% confidence intervals (CIs) specified as the measures of association
between predictors and outcome variables.
RESULTS: Majority of participants were ≤20 years old (50.7%, n = 35) and were in their second year
of study (44.9%, n = 31). Participants were least knowledgeable about the importance of discarding
gloves and not washing or reusing them (16 [23.1%]). The mean score on the Hand Hygiene Beliefs
Scale was 86.2 ± 9.0, with scores ranging from 23 to 88 out of a possible high score of 115. The
most positive health beliefs were associated with being a role model for HH (3.57 ± 0.52), while the
worst was associated with imitating bad HH practices performed by senior colleagues (1.29 ± 1.20).
Caring for a wound (60 [87.0%]) was most associated with the need for HH, while demonstration
and clinical practice were rated as the most effective teaching methods. Results of the multivariate
logistic regression analysis, with the outcome variable of good self‑reported HH practices, revealed
that the odds of appropriate behavior were higher if the student nurses were in their third year of
study (OR = 1.59; 95% CI: 1.01–2.45). An appropriate behavior was also more likely in student
nurses with a higher risk perception (OR = 1.54; 95% CI: 1.03–2.51).
CONCLUSION: Despite the overwhelming evidence that HH is effective in the prevention of
hospital‑acquired infections, its performance among HCPs remains far less than optimal. Since
students will someday be influencing future HH compliance behaviors of other health‑care workers,
the importance of HH should be adequately incorporated into their school curriculum.

Keywords

Hand hygiene
nosocomial infections
nursing students
1. DucelG, FabryJ, NicolleL, editors. Prevention of Hospital‑Acquired
Infections: A Practical Guide. 2nd ed. Geneva, Switzerland: World
Health Organization; 2002. Available from: http://www.who.
int/iris/handle/10665/67350. [Last assessed on 2017 Mar 03].
2. Vincent JL. Nosocomial infections in adult Intensive‑Care Units.
Lancet 2003;361:2068‑77.
3. Klevens RM, Edwards JR, Richards CL Jr., Horan TC, Gaynes RP,
Pollock DA, et al. Estimating health care‑associated infections and
deaths in U.S. Hospitals, 2002. Public Health Rep 2007;122:160‑6.
4. Ryan C. Determinants of Hand Hygiene among Registered Nurses
Caring for Critically Ill Infants in the Neonatal Intensive Care Unit.
Electronic Theses and Dissertations. Paper 221; 2012. Available
from: http://www.scholar.uwindsor.ca/etd. [Last assessed on
2017 Jan 03].
5. Kampf G, Kramer A. Epidemiologic background of hand hygiene
and evaluation of the most important agents for scrubs and rubs.
Clin Microbiol Rev 2004;17:863‑93.
6. Hilburn J, Hammond BS, Fendler EJ, Groziak PA. Use of alcohol
hand sanitizer as an infection control strategy in an acute care
facility. Am J Infect Control 2003;31:109‑16.
7. Munoz‑Figueroa GP, Ojo O. The effectiveness of alcohol‑based gel
for hand sanitising in infection control. Br J Nurs 2018;27:382‑8.
8. Larson E. Skin hygiene and infection prevention: More of the
same or different approaches? Clin Infect Dis 1999;29:1287‑94.9. Centres for Disease Control and Prevention. Guideline for Hand
Hygiene in Health‑Care Settings: Recommendations of the
Healthcare Infection Control Practices Advisory Committee and
the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force;
2002. p. 1‑45. [Last assessed on 2017 Apr 05].
10. Campagna M, Maria Mereu N, Mulas L, Pilia R,
Francesca Piazza M, Spada L, et al. Pattern of hepatitis A virus
epidemiology in nursing students and adherence to preventive
measures at two training wards of a university hospital. Hepat
Mon 2016;16:e34219.
11. Uneke CJ, Ijeoma PA. The potential for nosocomial infection
transmission by white coats used by physicians in Nigeria:
Implications for improved patient‑safety initiatives. World Health
Popul 2010;11:44‑54.
12. Uneke CJ, Ogbonna A, Oyibo PG, Ekuma U. Bacteriological
assessment of stethoscopes used by medical students in Nigeria:
Implications for nosocomial infection control. World Health
Popul 2008;10:53‑61.
13. SalamaMF, JamalWY, Mousa HA, Al‑AbdulghaniKA, RotimiVO.
The effect of hand hygiene compliance on hospital‑acquired
infections in an ICU setting in a Kuwaiti teaching hospital. J Infect
Public Health 2013;6:27‑34.
14. Pittet D, Hugonnet S, Harbarth S, Mourouga P, Sauvan V,
Touveneau S, et al. Effectiveness of a hospital‑wide programme
to improve compliance with hand hygiene. Infection control
programme. Lancet 2000;356:1307‑12.
15. Grol R, Grimshaw J. From best evidence to best practice:
Effective implementation of change in patients’ care. Lancet
2003;362:1225‑30.
16. Chavali S, Menon V, Shukla U. Hand hygiene compliance among
healthcare workers in an accredited tertiary care hospital. Indian
J Crit Care Med 2014;18:689‑93.
17. Teker B, Ogutlu A, Gozdas HT, Ruayercan S, Hacialioglu G,
Karabay O, et al. Factors affecting hand hygiene adherence at a
private hospital in Turkey. Eurasian J Med 2015;47:208‑12.
18. Vandijck DM, Labeau SO, De Somere J, Claes B, Blot SI; Executive
Board of the Flemish Society of Critical Care Nurses. et al.
Undergraduate nursing students’ knowledge and perception of
infection prevention and control. J Hosp Infect 2008;68:92‑4.
19. Jennings‑Sanders A, Jury L. Assessing methicillin‑resistant
Staphylococcus aureus knowledge among nursing students. Nurse
Educ Today 2010;30:789‑93.
20. Mitchell BG, Say R, Wells A, Wilson F, Cloete L, Matheson L, et al.
Australian graduating nurses’ knowledge, intentions and beliefs
on infection prevention and control: A cross‑sectional study. BMC
Nurs 2014;13:43.
21. Harbarth S, Pittet D, Grady L, Goldmann DA. Compliance with
hand hygiene practice in pediatric intensive care. Pediatr Crit
Care Med 2001;2:311‑4.
22. Girou E, Chai SH, Oppein F, Legrand P, Ducellier D, Cizeau F,
et al. Misuse of gloves: The foundation for poor compliance with
hand hygiene and potential for microbial transmission? J Hosp
Infect 2004;57:162‑9.
23. Pittet D, Allegranzi B, Sax H, Dharan S, Pessoa‑Silva CL,
Donaldson L, et al. Evidence‑based model for hand transmission
during patient care and the role of improved practices. Lancet
Infect Dis 2006;6:641‑52.
24. Burnett E. Perceptions, attitudes, and behavior towards patient
hand hygiene. Am J Infect Control 2009;37:638‑42.
25. De Wandel D, Maes L, Labeau S, Vereecken C, Blot S. Behavioral
determinants of hand hygiene compliance in Intensive Care Units.
Am J Crit Care 2010;19:230‑9.
26. Pittet D, Simon A, Hugonnet S, Pessoa‑Silva CL, Sauvan V,
Perneger TV, et al. Hand hygiene among physicians: Performance,
beliefs, and perceptions. Ann Intern Med 2004;141:1‑8.
27. Harbarth S, Pittet D, Grady L, Zawacki A, Potter‑Bynoe G,
Samore MH, et al. Interventional study to evaluate the impact of
an alcohol‑based hand gel in improving hand hygiene compliance.
Pediatr Infect Dis J 2002;21:489‑95.
28. Gopal Rao G, Jeanes A, Osman M, Aylott C, Green J. Marketing
hand hygiene in hospitals – A case study. J Hosp Infect
2002;50:42‑7.
29. Bischoff WE, Reynolds TM, Sessler CN, Edmond MB, Wenzel RP.
Handwashing compliance by health care workers: The impact of
introducing an accessible, alcohol‑based hand antiseptic. Arch
Intern Med 2000;160:1017‑21.
30. Lankford MG, Zembower TR, Trick WE, Hacek DM, Noskin GA,
Peterson LR, et al. Influence of role models and hospital design
on hand hygiene of healthcare workers. Emerg Infect Dis
2003;9:217‑23.
31. Fadeyi A, Bolaji BO, Oyedepo OO, Adesiyun OO, Adeboye MA,
Olanrewaju T. et al. Methicillin resistant Staphylococcus aureus
carriage amongst healthcare workers of the critical care units in
a Nigerian hospital. Am J Infect Dis 2010;6:18‑23.
32. Tropea J, Brand C, Roberts C. A National Stakeholder Review
of Australian Infection Control Programs: The Scope of Practice
of the Infection Control Professional. Sydney: Australian
Commission on Safety and Quality in Healthcare; 2008.
33. Pravikoff DS, Tanner AB, Pierce ST. Readiness of U.S. Nurses for
evidence‑based practice. Am J Nurs 2005;105:40‑51.
34. O’leary DF, Mhaolrúnaigh SN. Information‑seeking behaviour
of nurses: Where is information sought and what processes are
followed? J Adv Nurs 2012;68:379‑90.
35. Thompson C, Cullum N, McCaughan D, Sheldon T, Raynor P.
Nurses, information use, and clinical decision making – The real
world potential for evidence‑based decisions in nursing. Evid
Based Nurs 2004;7:68‑72.
36. Ward DJ. The role of education in the prevention and control
of infection: A review of the literature. Nurse Educ Today
2011;31:9‑17.
37. World Health Organization. World Health Organization Save
lives clean your hands‑Guide to Implementation. In: A Guide
to the Implementation of the WHO Multimodal Hand Hygiene
Improvement Strategy. Geneva: World Health Organization; 2009.
Journal of Education and Health Promotion
Volume 8, Issue 11
November 2018
Pages 1-8

Home

Guide for Authors

Submit Manuscript

Reviewers

Contact Us