Introduction

According to the World Health Organization, Hand hygiene is a common term which is applicable to hand washing, antiseptic hand rub, antiseptic hand wash or surgical hand antisepsis. (Mohesh & Dandapani, 2014) Hand Hygiene helps in preventing cross-transmission of microorganism and controlling the prevalence of healthcare associated infections. The most appropriate hand hygiene behaviour is considered as the keystone for preventing health care associated infections. (Allegranzi & Pittet, 2009; Kamble & Biradar, 2016) The World Health Organization (W.H.O.) has introduced the concept of “My five moments for Hand hygiene” for Global Patients Safety Challenges, it includes:-

• Moments before touching a patient

• Before performing aseptic and clean procedures

• After being at risk of exposure to body fluids

• After touching a patient

• After touching patient and surrounding

So the application and adherence to hand hygiene practices can prevent Healthcare Acquired Infections (HAI). (Shinde & Mohite, 2014) This concept of hand hygiene is used to improve, training, understanding, monitoring and reporting hand hygiene among the Health Care Workers. It is recommended in all National and International Infection Control Guidelines. (Ansari & Gupta, 2015)

The major cause of mortality and morbidity in admitted patients is due to Health care associated infections (HAI) contributing to 7-10% of the total hospital infections. (Arthi & Abarna, 2016) The significance of hand hygiene first identified in 1840s by Dr. Oliver Wendell Holmer to prevent Childbed fever. (Nawab & Mehnaz, 2015) Later Ignaz Semmelweis introduced the concept of Hand hygiene and antisepsis by demonstration that the contaminated hand cleansing with an antiseptic agents into patient contact reduces the transmission of infectious diseases effectively than just washing hands with plain soap and water. (Paudel & Ghosh, 2017)

In 2002, the Centers for Disease and Control and Preventions (CDC), USA and Healthcare Infection Control Practices Advisory Committee published comprehensive guidelines for hand hygiene in health care settings, mainly to overcome the lack of awareness among workers regarding the importance of hand hygiene in preventing the disease transmission.

The recommended duration for hand washing is between 30 seconds to one minute. It is noted that Alcohol based hand antiseptics are used in most of the countries for rapid antimicrobial effects, broad spectrum coverage, better patient tolerability and also ease of application. (Al-Naggar & Jashamy, 2013)

The maximum of health care workers are composed by the nurses which are appraised as “nucleus of the healthcare system”, it is very crucial in preventing the diseases among the hospitalized patients.

Hand hygiene is also used in the prevention of Hospital Acquired Infections or Nosocomial infections; these are obtained during patient hospitalization within 48-72 hours. (D’souza & Urnarani, 2014) For preventing cross infections and Healthcare associated infections, several countries worldwide started their national campaigns to improve hand hygiene as a part of the World Health Organization’s ‘Clean Care is Safer Care’ Campaign. (Allegranzi & Gayet-Ageron, 2013; Reichardt & Königer, 2013)

Two types of micro-organism are found over the human skin:-

• Resident’s flora (organisms that normally inhabited in skin).

• Transient’s flora (Contaminates).

Transient’s flora causes most hospital acquired infections by cross-transmission, but it can be comfortably removed by hand cleaning. So regular hand washing by doctors and nurses decreases the colonization of skin with transient flora and render safe for next patient’s contact. (Pittet, 2001)

According to the W.H.O., prevalence of nosocomial infections is 19% in developing countries, so the personal hygiene and standard universal safety precautions should be included. W.H.O. estimated that washing hands with soap and water reduces the death caused by diarrhea up to 50%. Hand washing prevents acute respiratory infections by 16%. (Chakraborty & Karmakar, 2018)

As per our knowledge, very few community studies have been conducted regarding the awareness of hand hygiene in India. The staff has exposed to a variety of infectious throughout the process of day to day nursing activities and they are at higher risk in contacting infections. Hand hygiene education should be mandatory for all clinical courses.

Hence, present study has undertaken to determine the “Knowledge, Attitude and Practices about hand hygiene among medical students and nurses.

Research methodology

The methodology adapted for the study including research settings, design, research approach, population and sampling technique, data collection tools, collection process, analysis technique and operational definitions.

Study period

1 year

Research approach

A descriptive cross sectional study approach had approach.

Research design

The collection of information and data directly from the study through a predesigned and pretested questionnaire scheduled.

Population

The population for this study included the medical students and nurses working in Tertiary teaching hospital of Jawaharlal Nehru Medical College.

Sample size

Sample size of the study is two hundred and seventy six (276), health care workers.

Construction of tool

The tool was a predesigned and pretested questionnaire schedule constructed using review of literature from books, journals and published research studies.

Description of tool

The structured questionnaire had three sections as follows

Section 1

It consists of items related with selected demographic variables such as age, gender, qualification and profession.

Section 2

A structured questionnaire was used to access the awareness. It consists of items related to assess the awareness regarding hand hygiene practice among medical students and nurses in hospital.

Section 3

It consists of items related to source of awareness for students about hand hygiene.

Data collection process

Step-I =The investigator procured permission from respective authority to conduct the study.

Step-II = Investigator introduced herself to the participants and notifies about his

Step-III = Conducted survey using structured Performa.

Data analysis technique

Variables were tested using chi-square tests and Data analyses were conducted using MS excel and SPSS version 20, p<0.05 was considered statistically significant.

Results

Table 3 showed that 25 (9.1%) subjects had poor knowledge, 186 (67.4%) subjects had average knowledge and 65 (23.6%) subjects had good knowledge regarding hand hygiene.

Table 5 showed that 33 (12.0%) subjects had poor attitude, 190 (68.8%) subjects had average attitude and 53 (19.2%) had good attitude.

Table 7 indicates that 60 (21.7%) subjects had poor practice, 173 (62.7%) subjects had average level of practice, and 43 (15.6%) had good level of practice regarding hand hygiene.

Discussion

The discussion includes

• Socio-demographic variables of medical students and nurses.

• Findings related the knowledge, Attitude and Practice of hand hygiene among young medical undergraduates’ students and nurses.

S ocio-demographic variables of medical students and nurses

In this study, 214 (77%) students age of 18 - 25 years, 49 (17.8%) between 26 - 35 years and 13 (4.7%) were age of above >35 years.

The majority of 164 (59.4%) were males and 117 (49.6%) were females. Where majority of the participants, 174 (102%) were medical students and 63 (37%) were nurses.

The finding is similar to the study is done in Mangalore, in 2014. Hundred (100) nursing students were included in the study, yielding a response rate 94%.

About (95%) of the respondents were between the ages of 20-22 years. Majority (95%) were females and (5%) were males. About (6%) of the respondents had attended seminars and workshop. (Table 1).

Findings related the knowledg e of hand hygiene among medical undergraduates students and nurses

In the present study, majority of participants i.e. 186 (67.4%) had average level of knowledge (5-7) regarding hand hygiene, 25 (9.1%) participants had poor level of knowledge (0-4) and 65 (23.6%) had good level of knowledge (>7). The reason could be that more than half of the respondents had attended the seminars. The mean knowledge score among 276 students, mean was 6.32, median 6, and mode 6, range 6 and standard deviation was 1.40, out of 10 questions.

The finding is similar to the study done at Aligarh, in 2015. About 130 students were included in study 71 (80%) had average knowledge only (7%) had good knowledge regarding hand hygiene. (Table 2).

Findings related to the Attitude of hand hygiene among medical undergraduates and nurses

The present study majority of participants i.e. 33 (12.0%) had poor level of attitude (0-3) regarding HH, 190 (68.8%) participants had average attitude (4-5) and 53(19.2%) had good attitude (>6). The reason could be that more than half of respondents had attended workshops and had good education about it. The mean attitude score among 276 students, mean was 4.66, median 5, mode 5, range 4 and standard deviation 0.944, Out of 6 questions.

The finding is similar to the study done at Raichur, Karnataka, in 2013. About 144 students were included in the study (52.1%) had average attitude only (20%) had good attitude regarding hand hygiene where they had received a formal training. (Table 4)

Findings relate the Practice of hand hygiene among medical undergraduates' and nurses

In the present study majority of participants 173 (62.7%) had a through aware about the practices (5-6), 43 (15.6%) had good practice regarding hand hygiene (>6) and 60 (21.7%) had poor practice (0-4). More of the participants daily practiced the hand hygiene moments and monthly they got the training from the hospital. The mean practice score among 276 participants mean 5.39, median 6, mode 6, range 5 and standard deviation 1.101. Out of given 7 questions. The finding is similar to the study done in Sri Lanka, in 2013. About 289 students were included in the study where (5.53%) had good practice, (26.9%) had average practice and two-third (67%) has low HH practice. (Table 6)

Conclusions

The present study concludes, in the current study overall level of knowledge in medical students and nurses was average 186 (67.4%), attitude was average 190 (68.8%) and practice was average 173 (62.7%). The knowledge scoring for hand hygiene was found to be average (score 5-7), for attitude the average score was (4-5) and for practice score was average (5-6). The present study concluded that knowledge, attitude and hand hygiene practice among medical students and nurses was found to be adequate among the study group was satisfactory. There is need to continue training program for nurses and medical students on major concept of hand hygiene. Continuous vigilance, assessment and supervision regarding hand hygiene can be a logical solution to improve the KAP among medical students and nurses for awareness.

Conflict of interest

The authors declare that they have no conflict of interest for this study.

Funding support

The authors declare that they have no funding support for this study.