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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 7  |  Issue : 3  |  Page : 191-195

Hand hygiene practices among nurses in health facility in a semi-urban setting


1 Department of Paediatrics, Federal Medical Centre, Birnin Kebbi, Nigeria
2 Department of Dental and Maxillofacial Surgery, Federal Medical Centre, Birnin Kebbi, Nigeria
3 Institute of Human Virology Nigeria, Kano, Nigeria
4 Department of Family Medicine, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
5 Department of Paediatrics, Niger Delta University, Yenagoa, Bayelsa, Nigeria
6 Department of Nursing, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
7 Department of Paediatrics, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria

Date of Web Publication20-Jul-2018

Correspondence Address:
Dr. Ibrahim Aliyu
Department of Paediatrics, Aminu Kano Teaching Hospital, Kano
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijhas.IJHAS_159_17

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  Abstract 


INTRODUCTION: Hand is an important medium of infection transmission. This is further worsened in the hospital setting where sources of contamination are abundant. Nurses play a vital role in patient care, and while doing so, they are often exposed to health hazards. Therefore, they may act as conduits for transmitting infectious diseases to themselves, family members, and other patients. Good hand hygiene is a prerequisite for infection control; therefore, the objective of this study is to determine the knowledge and practices of hand hygiene among nurses in our institution.
MATERIALS AND METHODS: This was a cross-sectional study involving 113 nurses and it was conducted over 12 weeks; it was questionnaire based, which was pretested and self-administered. Convenience sampling was adopted.
RESULTS: Data from 96 (85%) respondents consisting of 41 (42.7%) males and 55 (57.3%) females with male:female ratio of 0.7:1 were analyzed. All respondents reported using water and soap for hand-washing. Furthermore, majority (59%) of the respondents were not aware of the five moments of hand hygiene. Although majority (76%) reported adhering to the principles of good hand hygiene, 54.2% of the respondents could not correctly mention the steps of hand-washing technique. Sixty-six (68.8%) respondents wash their hands before attending to patients; however, almost all (99%) of the respondents wash their hands after attending to patients and after removing hand gloves. Similarly, all respondents wash their hands after using the restroom.
CONCLUSION: The act of hand-washing is common among respondents in this study; however, the major challenge is with practicing the correct technique involved in hand-washing. Furthermore, knowledge of the critical moments of hand-washing was also deficient among most of the respondents.

Keywords: Hand hygiene, infection control, nurses, semi-urban setting


How to cite this article:
Lawal TO, Monsudi KF, Zubayr BM, Michael GC, Duru C, Ibrahim ZF, Aliyu I. Hand hygiene practices among nurses in health facility in a semi-urban setting. Int J Health Allied Sci 2018;7:191-5

How to cite this URL:
Lawal TO, Monsudi KF, Zubayr BM, Michael GC, Duru C, Ibrahim ZF, Aliyu I. Hand hygiene practices among nurses in health facility in a semi-urban setting. Int J Health Allied Sci [serial online] 2018 [cited 2020 Apr 8];7:191-5. Available from: http://www.ijhas.in/text.asp?2018/7/3/191/237260




  Introduction Top


The hand is an important medium of transmission of infection. This is further worsened in the hospital setting where sources of infection are abundant. Therefore, the activities of those who care for the ill are important in ensuring effective and safe practice. Nurses play a vital role in patient care,[1] and while doing so, they are often exposed to health hazards. Therefore, they may act as conduits for transmitting infectious diseases to themselves, family members, and other patients.[2],[3],[4] The act of hand-washing has been reported to significantly reduce the risk of transmitting/contracting infections, and that is why the World Health Organization (WHO) set aside October 15 of every year [5] to remind ourselves of its importance and further inculcated the practice of hand-washing, ensuring that the technique and principles of this novel practice is maintained and held in high esteem. The goal of this study, therefore, was to determine the knowledge and extent of the practice of hand-washing among nurses in our health institution.


  Materials and Methods Top


This was a cross-sectional study involving nurses of Federal Medical Centre Birnin Kebbi, Kebbi State, Nigeria; it was conducted over 12 weeks from September 2015 to December 2015. A sample size of 113 respondents was calculated from a knowledge base of 82.1% obtained from the study of Mohammed and Aliyu;[6] Fisher's formula for study population <10,000[7] was used (the estimated total population of respondents available at the time of the study was 200); and convenience sampling method was adopted. This was a questionnaire-based study. It was pretested and self-administered; relevant information such as age, sex, profession, years of working experience, awareness of Global Handwashing Day, ability to list the five moments in hand-washing, knowledge on hand-washing technique, steps in hand-washing, and principles of hand-washing were obtained. Permission to conduct this study was obtained from our Research and Ethics Committee, and consent was obtained from the prospective respondents. Those who declined were, however, excluded from the study.

Data analysis

The information obtained from the respondents was analyzed using Statistical Package for the Social Sciences (SPSS) version 16 (SPSS Inc., Chicago Illinois, USA). Quantitative variables were summarized using means and standard deviations, qualitative variables were summarized using frequencies and percentages, and categorical variables were compared using Chi-square or Fisher's exact tests of significance; P< 0.05 was considered statistically significant with 95% confidence interval.


  Results Top


A total of 113 respondents were recruited for this study; however, 17 of the questionnaires were excluded from all analysis due to incomplete data. Therefore, data from 96 (85%) respondents consisting of 41 (42.7%) males and 55 (57.3%) females with male:female ratio of 0.7:1 were analyzed. Their age ranged from 19 years to 48 years and mean of 33 ± 3 years.

Thirty (31.2%) respondents were from the department of pediatrics, 23 (24.1%) were from medicine, 30 (31.2%) from surgery, and 13 (13.5%) from obstetrics and gynecology. Ten (10.4%) respondents were <1 year in nursing practice, 33 (34.4%) were between 1 and 5 years, 21 (21.9%) were between 6 and 10 years, and 32 (33.3%) were more than 10 years in practice; therefore, most of the respondents were 5 years and below in nursing practice. Majority (61.5%) of respondents were aware of the Global Handwashing Day and only 23.0% of them could correctly mention the date of Global Handwashing Day; however, 95 (99.0%) believed that hand-washing is an important modality of reducing infection and cross-infection and only 1 (1%) did not believe in the role of hand-washing in reducing the risk of infection.

Eighty-six (89.6%) respondents reported being taught the technique of hand-washing; 100% of them reported using water and soap for hand-washing. In addition, majority (59.0%) of the respondents were not aware of the five moments of hand hygiene; however, among 39 who were aware, almost half of them (48.7%) were able to correctly list the five moments of hand hygiene [Table 1].
Table 1: Awareness of Global Handwashing Day and knowledge on hand-washing and awareness of the five moments of hand hygiene

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Majority (64.6%) of the respondents had seen posters on hand-washing; however, most of the posters were seen in the wards while none were in the laboratories. However, most had seen at least two posters, but 34 (35.4%) could not remember seeing a poster [Table 2].
Table 2: Availability of posters on hand-washing

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Eighty-four (87.5%) and 82 (85.4%) of the respondents stated that water was readily available and water could be easily located, respectively; also, more than half (52.1%) of the respondents did not have a personal hand-rub. Although 97.9% of respondents preferred hand-rub, those who disliked hand-rub only complained of itching as the main reason [Table 3].
Table 3: The availability of materials for hand-washing and practice of hand-washing among the study population

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Although majority (76.0%) of respondents reported adhering to the principles of good hand hygiene, most (54.2%) of the respondents could not mention the steps in hand-washing technique; 66 (68.8%) respondents wash their hands before attending to patients; however, almost all (99.0%) of the respondents wash their hands after attending to patients and after removing hand gloves. Similarly, all respondents wash their hands after using the restroom [Table 4].
Table 4: Moments of hand-washing reported by the respondents

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Among 86 of the respondents who were taught hand-washing, sixty practiced hand-washing before attending to patients, while 6 among 10 of those who were not taught practiced hand-washing; however, this observation was not statistically significant (χ2 = 0.398; df = 1; P = 0.720). Furthermore, majority (16) of the respondents who could correctly list the five moments of hand hygiene were taught hand-washing technique; however, majority (20) of those who were taught were incorrect in listing the five moments of hand hygiene, but this observation was also not statistically significant (Fisher's exact test =3.421; P = 0.106) [Table 5].
Table 5: The relationship of teaching on hand-washing and hand-washing practices

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Despite being taught, most (46) of the respondents did not know the steps while 31 of them wrongly mentioned the steps. However, this observation was also not statistically significant (Fisher's exact test = 1.684; P = 0.34) [Table 6].
Table 6: Relationship of teaching on hand-washing and ability to mention the steps on hand-washing

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  Discussion Top


Nurses should be very proficient on hand-washing technique; this is so because they are often exposed to the risk of coming in contact with biohazards. Nigeria is a witness to the outbreak of Ebola viral disease which claimed the lives of health-care professionals; therefore, we should be health conscious realizing that we could get infected by handling infectious patients and health professionals could also be vehicle for disease transmission.[8] Therefore, it is encouraging from our results that majority (99%) of the respondents accepted the fact that hand-washing is relevant in disease control. October 15 of every year is celebrated as Global Handwashing Day;[5] however, this study showed that 61.5% of the respondents were aware of the WHO Global Handwashing Day and only 23% of the respondents could state the date correctly. This observation is similar to previous reports by Mohammed and Aliyu and Abdulsalam et al.; this highlights poor participation of health institution in marking this day.[6],[9]

Soap and water were the most common hand-cleaning agents in this study; this observation is similar to previous reports, but differed from that of de Wandel et al. who reported alcohol-based solution as the most common hand-cleaning agent in 79.4% of their respondents. It is noteworthy that despite majority been taught on the technique of hand-washing, only 41% of them could rightly mention the five moments of hand-washing; this calls for the need for an efficient feedback mechanism, which ensures that the information passed are understood by the recipients.[6],[9],[10],[11]

The WHO recommends the use of alcohol-based hand-rubs/sanitizers; however, when the hand is visibly soiled, the hands must be washed with soap and water first before proceeding to use a hand-rub. There are varied reports of its acceptances among health-care professionals. While this study showed that 97.5% of the respondents will readily accept a hand-rub, Oliveira e t a l. reported only 34.8% acceptance among nurses; the main reason for rejecting hand-rub identified in this study was complaint of itching which was similar to that reported by Oliveira e t a l. Faith-based rejection may not be unexpected among Muslim communities.[11],[12],[13],[14],[15],[16],[17],[18],[19],[20],[21]

Health-care professionals in emergency care units with personally worn hand sanitizers have been shown to increase their compliance rates; these are often small containers of hand-rubs attached to their pockets, belts, or badges; the reason put forward was it was easier to remember to use them in such settings when they are within reach.[22] However, 47.9% of respondents in our study had their personal hand-rub which is similar to previous reports.[6],[9]

While 76% of the respondents reported adhering to the principles of hand hygiene, only 45.8% could correctly mention the steps in hand-washing. This highlights the need to reeducate them on the steps in hand hygiene; however, the relationship of teaching hand-washing techniques and ability to mention the steps in hand-washing did not show any statistical significance in this study. Therefore, more proactive measures which should involve routine physical observation of the technique by superior officers with the aim of identifying and correcting defaulters should be encouraged.

Most respondents in this study washed their hands before and after touching patients and also before and after wearing gloves; this finding was similar to that of Mohammed and Aliyu in their study among medical students and that of Abdulsalam et al. in their study among health professionals but our observation was higher than that reported by Braimoh et al. in their study among community health workers; this is because nurses are better educated and informed than community health workers, hence a better knowledge base and clinical practice is expected from nurses.[6],[9],[23]


  Conclusion Top


The act of hand-washing was common among respondents in this study; water and soap were mostly used for hand-washing; however, majority of respondents were deficient in the technique of hand-washing. Furthermore, the use of hand-rub was limited among the respondents and also the knowledge of the five critical moments in hand-washing was also deficient among most of the respondents. Therefore, teachings should not only be didactic but also be practical; routines on the spot assessments by superiors or supervisors should be encouraged.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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