Elsevier

Nurse Education Today

Volume 63, April 2018, Pages 112-118
Nurse Education Today

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

https://doi.org/10.1016/j.nedt.2018.01.022Get rights and content

Abstract

Background

In Ireland, the setting for this study, the national prevalence rate of health care-associated infection (HCAI) in acute-care facilities is 5.2%. Hand hygiene and in particular hand rubbing using alcohol-based hand rub (ABHR) is highly efficacious in preventing HCAI transmission. Yet, compliance among healthcare professionals is sub-optimal. Less is known about the practices of nursing and medical students and no study comparing practices among these groups in Ireland was found. Hence, the aim of this study was to provide insight into the current hand hygiene and hand rubbing practices of nursing and medical students in Ireland and, by doing so, contribute to the broader understanding of this topic.

Methods

This observational study employed a cross-sectional, self-reported design. An electronically administered questionnaire was sent to all nursing and medical students from one university. Data were analysed using appropriate software.

Results

The response rate was 37% (323/872). Higher compliance with the World Health Organisation ‘my five moments for hand hygiene’ model was reported among nursing students (NS) than medical students (MS), with scope for improvement in both disciplines identified. Hand hygiene compliance was highest after body fluid exposure (99.5% NS, 91% MS) and lowest after touching a patient's surroundings (61.5% NS, 57.5% MS). Attitudes towards hand rubbing were largely positive in both disciplines. 16% of NS were not aware of the clinical contraindications to ABHR use, compared to 45% of MS. 9% of NS did not know when to use soap and water and when to use ABHR, compared to 36% of MS. In contrast, more medical students (46%) than nursing students (22%) were routinely using alcohol-based hand rub for decontamination of hands as recommended.

Conclusions

Results suggest scope to review current hand hygiene curricula focusing on the knowledge gaps, the practice deficits and the barriers to ABHR usage identified.

Introduction

The burden of health care-associated infection (HCAI) is well documented by the World Health Organization (WHO) and European Centre for Disease Control (ECDC) (WHO, 2013; ECDC, 2013). HCAI results in prolonged hospital stay, increased morbidity and mortality, high healthcare costs, financial burden and increased resistance of microorganisms to antimicrobials, leading to a sharp rise in multi-drug resistant organisms (MDROs) (WHO, 2013; ECDC, 2013). According to the WHO hundreds of millions of patients are affected by HCAI worldwide each year and the ECDC estimates that 25,000 people die in the European Union (EU) annually from infections caused by MDROs with an associated cost of €1.5 billion (WHO, 2013; ECDC, 2013). In Ireland, the setting for this study, the national prevalence rate of HCAI in acute-care facilities is 5.2% (Health Protection Surveillance Centre, 2012). Hand hygiene is considered the most effective measure a healthcare professional can take to prevent the transmission of HCAI (Health Protection Surveillance Centre, 2012). Yet, even though hand hygiene is simple, cost-effective and highly efficacious in controlling the spread of HCAI, evidence suggests that compliance among healthcare professionals is sub-optimal (Kingston et al., 2016; Erasmus et al., 2010).

Section snippets

Background

Hand hygiene is a general term that refers to various actions of hand cleansing suited to different clinical situations, including the action of hand rubbing. Hand rubbing with alcohol-based hand rub (ABHR) is globally advocated as the ‘gold standard’ approach to hand hygiene in most routine patient encounters, except those for which handwashing with soap and water is recommended, for example, when nursing patients with Clostridium difficile infections (WHO, 2009). Despite this, the literature

Methods

This observational study employed a cross-sectional, self-report design and aimed to explore nursing students' and medical students' perceptions of their hand hygiene and hand rubbing practices. All students of a Bachelor of Science Nursing (Honours) degree programme (n = 342) and of a Graduate Entry Bachelor of Medicine and Surgery degree programme (n = 530) within blinded for review, were invited via student email addresses to participate, between March and April 2015. They were provided a

Results

A response rate of 37% (323/872) was achieved. Of the 323 respondents 70% (n = 225) were nursing students and 30% (n = 98) were medical students. Ninety-four percent (n = 212) of the nursing student respondents were female and 58% (n = 57) of the medical student respondents were female.

Discussion

Previous studies suggest that nurses are more compliant with hand hygiene than doctors (Randle et al., 2010; McLaws et al., 2009; Pittet, 2000). However, fewer cross-disciplinary studies comparing hand hygiene behaviour among healthcare students are available (van de Mortel et al., 2010), despite direct patient contact during internships and clinical placements, which increases students' risk of becoming mediators of HCAI or contracting a HCAI (Al-Khawaldeh et al., 2015; Bargellini et al., 2014

Conclusion

Despite reported improvements in patient safety education (Patey et al., 2011) results of this study suggest that a challenge persists. Channelling the reported positive attitudes towards ABHR use among healthcare students to achieving improvements in hand hygiene practice is required and reviewing infection prevention and control curricula and pedagogical approaches seems warranted. Underpinning nursing and medical curricula with national and international evidence-based hand hygiene

Funding

This work was supported in part by the Infection Prevention Society Novice Investigator Grant 2015. The contents of this paper are solely the work of the individual authors and do not reflect the views of the funding body.

References (52)

  • T.F. van de Mortel et al.

    A comparison of the hand hygiene knowledge, beliefs, and practices of Greek nursing and medical students

    Am. J. Infect. Control

    (2010)
  • C.A. O'Boyle et al.

    Understanding adherence to hand hygiene recommendations: the theory of planned behavior

    Am. J. Infect. Control

    (2001)
  • D. O'Brien et al.

    Survey of teaching/learning of healthcare-associated infections in UK and Irish medical schools

    J. Hosp. Infect.

    (2009)
  • L. Price et al.

    Towards improving the World Health Organisation fifth moment for hand hygiene in the prevention of cross-infection

    Am. J. Infect. Control

    (2016)
  • J. Randle et al.

    Twenty-four-hour observational study of hospital hand hygiene compliance

    J. Hosp. Infect.

    (2010)
  • S. Scheithauer et al.

    Hand hygiene in medical students: performance, education and knowledge

    Int. J. Hyg. Environ. Health

    (2012)
  • M. Smiddy et al.

    Systematic qualitative literature review of health care workers' compliance with hand hygiene guidelines

    Am. J. Infect. Control.

    (2015)
  • O.A. Al-Khawaldeh et al.

    Influence of nursing students handwashing knowledge, beliefs, and attitudes on their handwashing compliance

    Health

    (2015)
  • M. Ariyarathne et al.

    Knowledge, attitudes and practices of hand hygiene among final year medical and nursing students at the University of Sri Jayewardenepura

    Sri Lankan J. Infect. Dis.

    (2013)
  • A. Bargellini et al.

    Hand hygiene knowledge, hand contamination and practice of Italian nursing and medical students

    Epidemiol. Biostat. Pub. Health

    (2014)
  • M.A. Borg et al.

    Self-protection as a driver for hand hygiene among healthcare workers

    Infect. Control Hosp. Epidemiol.

    (2009)
  • Centres for Disease Control

    Guideline for Hand Hygiene in Healthcare Settings: Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force

  • R.F. Chemaly et al.

    The role of the healthcare environment in the spread of multidrug-resistant organisms: update on current best practices for containment

    Ther. Adv. Infect. Dis.

    (2014)
  • V. Erasmus et al.

    A Qualitative Exploration of Reasons for Poor Hand Hygiene Among Hospital Workers Lack of Positive Role Models and of Convincing Evidence That Hand Hygiene Prevents Cross-Infection

    Infect. Control Hosp. Epidemiol.

    (2009)
  • V. Erasmus et al.

    Systematic review of studies on compliance with hand hygiene guidelines in hospital care

    Infect. Control Hosp. Epidemiol.

    (2010)
  • European Centre for Disease Prevention and Control

    Summary: Point Prevalence Survey of Healthcare-associated Infections and Antimicrobial Use in European Hospitals 2011–2012

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