Major Article
Guiding hand hygiene interventions among future healthcare workers: implications of knowledge, attitudes, and social influences

https://doi.org/10.1016/j.ajic.2018.02.019Get rights and content

Highlights

  • Hand hygiene compliance was found to be low among Pakistani medical students.

  • Hand hygiene awareness, attitudes, and peer pressure predict compliance.

  • Public university students expressed superior hand hygiene awareness.

  • Women expressed superior hand hygiene attitudes.

  • Need for “role models” was rated as the most important intervention.

Background

Medical students in their clinical years play an important role in healthcare delivery, yet poor levels of hand hygiene (HH) compliance in this population raise the risk for propagating nosocomial infections. To date, there has been a lack of dedicated interventions showing sustainable improvements in HH in this population.

Methods

A multicenter, cross-sectional study was conducted among 450 medical students in their clinical years (third to fifth years). A self-administered, pre-validated questionnaire based on the World Health Organization's “Knowledge” and “Perception” questionnaires was used to explore HH knowledge, attitudes, practices, and desired interventions.

Results

Self-reported HH compliance was found to be low (56.8%), and moderate HH knowledge (61.8%) was observed among all study respondents. Public university students expressed greater knowledge than students in private and semi-private universities. Superior HH practices were associated with better individual HH attitudes, positive perceived HH attitudes in other healthcare workers (HCWs), and higher HH knowledge scores. The highest-rated interventions for improving HH compliance included role-modeling by HCWs, display of “clear HH instructions,” and “ensuring availability of hand sanitizers.”

Conclusion

Our results call for a multifaceted approach to improve HH compliance among medical students, by ensuring adequate HH supplies/hand sanitizers, providing HH training in curricula, and effecting a cultural change mediated by professional modeling and open communication.

Section snippets

Methods

This cross-sectional study spanning 6 months was conducted among medical students enrolled in 3 different medical universities in Karachi, Pakistan, with each university corresponding to a different sector: public, private, or semi-private. A sample size of 384 respondents was calculated under a 95% confidence interval using Open Epi, however, we opted for a total sample of 450 medical students. The study received approval from the Ethical Review Committee of Baqai Medical University.

The

Results

Our response rate was 96%, as 15 of 450 questionnaires were left unfilled. Three-quarters of the participants (74.8%) were women. Participants were from the third year (n = 139), fourth year (n = 150), and fifth year (n = 145) of medical training. They were from public (n = 133), semi-private (n = 150), and private (n = 151) medical colleges, respectively (Table 1). The mean age of study participants was 22.0 ± 1.22 years. The mean age for men and women was 22.5 ± 1.32 years and 21.9 ± 1.14

Discussion

The results of this multicenter study conducted among medical students in their clinical years show that self-reported HH compliance is uniformly low irrespective of sex, year of study, and institute of study. Women comprised approximately three-quarters of our sample, which reflects the prevalence of female medical students in Pakistani medical colleges. Only 56.8% of students in our sample reported a “high” likelihood of performing HH when indicated, whereas the same was reported for only

Limitations

Despite our best efforts, this study is subject to limitations arising from its methodological design. The first of these is the use of a nonprobability sampling technique, which is predisposed to selection bias. However, the inclusion criteria applied during judgmental sampling were relatively broad (all medical students in their clinical years who were enrolled in the selected colleges were given equal consideration for inclusion). In addition, to ensure a representative and valid sample, a

Strengths

To our knowledge, this is the first large-scale study to investigate HH trends across multiple centers in Pakistan corresponding to 1 of 3 medical university types (public, private, and semi-private). It therefore provides an unmatched, holistic view of the situation in Pakistan. In contrast to previous studies, we did not include students from disciplines outside of medicine, such as nursing or dentistry, thus providing a uniform representation of HH trends in our chosen population.

Conclusion and recommendations

This study showed that HH awareness and compliance are uniformly low among medical students in public, private, and semi-private universities in Pakistan. Public university students demonstrated greater HH knowledge compared to their counterparts in other institution types. This may be attributed to the higher level of “achievement orientation” among public university students and indicates that incorporation of HH training in assessment situations (such as SBLs and OSCEs) may improve HH

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      HCW include a diverse mix of doctors, residents, nurses, and paramedical staff, with gaps in knowledge and many behavioral issues impacting their compliance with hand hygiene.8 Hand hygiene knowledge and practices among medical undergraduate students, who are the future HCWs, have not been studied comprehensively.9 However, there have been many studies on hand hygiene compliance among student nurses.10

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    Conflicts of interest: Authors declare no conflicts of interest.

    Financial disclosure: None to declare.

    Name(s) of institutions where research was conducted: Dow University of Health Sciences (DUHS), Karachi, Pakistan, Baqai Medical University, Karachi, Pakistan, and Karachi Medical and Dental College, Karachi, Pakistan.

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