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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 8  |  Issue : 1  |  Page : 52-59

The practice of hand hygiene among undergraduate medical students


Department of Microbiology, N.C. Medical College and Hospital, Israna, Panipat, Haryana, India

Date of Submission16-Dec-2020
Date of Acceptance01-Jan-2021
Date of Web Publication16-Mar-2021

Correspondence Address:
Dr. Gurjeet Singh
Department of Microbiology, N.C. Medical College and Hospital, Israna, Panipat 132107, Haryana.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mgmj.mgmj_93_20

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  Abstract 

Background: Health care-associated infections (also called hospital-acquired or nosocomial infections) add to the morbidity and mortality and costs that one might expect from the underlying illness alone. All this has led to concerted efforts to implement infection control programs in all teaching hospitals, hospitals, and other health centers; the quality of such programs reflects the overall standard of care provided by the institution. The practice of hand hygiene is a simple yet effective way to prevent infections. Cleaning of the hands can prevent the spread of microorganisms, specifically those that are multidrug-resistant organisms (MDRO), and that are getting troublesome, if certainly feasible, to treat. These factors, compounded by the scarcity of accessibility of new antimicrobials, have required a relook into the function of essential acts of contamination counteraction in current medical services. Good hand hygiene practice, including the use of alcohol-based hand rubs and handwashing with soap and water, is critical to reducing the risk of spreading infections in ambulatory care settings. Aims and Objectives: This study was conducted to evaluate the knowledge, attitudes, and practices of hand hygiene of undergraduate medical students. Materials and Methods: A cross-sectional study was carried out at the Department of Microbiology, N.C. Medical College and Hospital, Israna, Panipat, Haryana, India, over six months from January 2018 to May 2018. A total of 147 students from the second professional year were told to fill a questionnaire consisting of their age, gender, class, washing of hands with soap and water before eating food, washing with soap and water after urinating, washing with soap and water after defecating, washing hands after using the practical laboratory, the reason for the disinfection of the body, and the number of illnesses in the past one year. Results: Analysis of the outcome demonstrated that the medical students studied were careful about the average towards hand hygiene and on an overall note have come to embrace the importance of hand hygiene stressing on the numerous adverse effects its lack of practice have come to prove over the years. Conclusion: A connection between hand cleanliness, sickness rate, and explanations behind not rehearsing hand cleanliness appears in the outcomes. The current examination proposes that both handwashing and the utilization of hand sanitizers have a beneficial outcome on the health of medical students. The results of improved hand cleanliness propensities for the students bring about diminished medical services costs for the college since fewer students may need to use well-being focus assets.

Keywords: Hand hygiene, health care-associated infections, medical students, practice


How to cite this article:
Singh G, Singh R. The practice of hand hygiene among undergraduate medical students. MGM J Med Sci 2021;8:52-9

How to cite this URL:
Singh G, Singh R. The practice of hand hygiene among undergraduate medical students. MGM J Med Sci [serial online] 2021 [cited 2021 Apr 14];8:52-9. Available from: http://www.mgmjms.com/text.asp?2021/8/1/52/311394




  Introduction Top


In 1846, a doctor named Ignaz Semmelweis worked in the maternity center at the overall clinic in Vienna. Dr. Semmelweis needed to sort out why there were endless passings from puerperal fever, generally known as youngster bed fever, among ladies in the emergency clinic maternity wards. It was suggested that sterilization of hands could prevent the exchange of illness from dead bodies to pregnant ladies. Anyway, the death pace of ladies conveyed by clinical understudies tumbled to a similar level as those of ladies conveyed by the birthing assistant learners; thus, it was accordingly important for all clinical understudies to wash their hands in chlorinated lime after postmortems and before analyzing patients.[1]

Hand hygiene includes any activity of hand purifying, scouring one’s hands with a liquor-made hand rub, or washing one’s hands with cleanser and water to maintain a strategic distance from the development of miniature creatures on hands.[2] Ordinary handwashing with cleanser and water is the best part of a hand cleanliness program to lessen the danger of contracting the disease through contact with hands; notwithstanding, there is the trouble of keeping up consistence with essential handwashing practices and these are challenges to vanquish, particularly being in a school climate.[3],[4] The practice of hand cleanliness can be hard to perform because of elements, for example, time limitations and the absence of a washbowl in most homeroom conditions. In these cases, rather than the ordinary hand cleanliness practice of handwashing with cleanser and water the utilization of a waterless liquor gel and hand sanitizers, for example, liquor gels, offers quick, basic, and compelling hand cleanliness. Hammond et al. showed in a research that elementary school absenteeism due to illness was greatly reduced when the students were told to practice good hand hygiene by using an alcohol gel hand sanitizer.[5] In another examination, Fendler et al. demonstrated that liquor gel hand sanitizers additionally decreased the rate at which contamination moves in an all-inclusive consideration office where there are closeness and direct contact among living and working in a specific spot and parental figures that can prompt the exchange of microorganisms unexpectedly starting with one individual and then onto the next.[6]

Hand hygiene is an important aspect of Infection Prevention and Control (IPC), and its compliance requires measurement. Monitoring conformance with established hand hygiene parameters and providing health-care personnel with results regarding their performance is a vital part of hand hygiene in the hospital setting. Observational surveys done covertly are one of the means of determining compliance.[7]

The transmission of microorganisms from the hands of hospital personnel is a huge source of infections and these can be readily prevented by staff conforming with laid down handwashing protocols such as the World Health Organization’s (WHO) five moments of hand hygiene. This is because unwashed personnel’s hands are the most common means for the transmission of pathogens from patient to patient and within the health-care environment.[8]

Hand hygiene is, therefore, the easiest means for preventing the spread of pathogens with huge antimicrobial resistance potential and reducing rates of health care-associated infections. However, health-care workers’ conformance with optimal practices has been observed to be low in most settings.[9]

These infections acquired in the hospital are a major cause of morbidity as well as mortality. Some studies have also shown that handwashing practices are persistently poor and suboptimal. It has also been challenging to show that handwashing practices can be easily improved and this has been attributed to difficulties associated with behavior modification among hospital staff.[10]

Appropriate hand hygiene practices have been shown to reduce the rates of gastrointestinal, respiratory tract, and skin infections. Such hand hygiene practices of recent times have included the application of alcohol-based lotions or rubs.[11]

Health-care workers handle animate objects that are colonized with bacteria and other microbes. Hands have two microbial floras: resident and transient. The highest rates of hand colonization are found in areas such as in the Intensive Care Unit (ICU); in such critical care areas, merely touching inanimate objects may lead to contamination.[12]

It has been postulated that if adequate hand hygiene protocols are strictly followed by health-care personnel, it could lead to a significant 15% to 30% reduction in hospital-acquired infection; however, observational studies show that hand hygiene compliance rates are about 50% of opportunities in hospitals.[13],[14]

The impact of nonadherence to hand hygiene on the part of health-care workers is seen in the high rates of nosocomial infections. This is fueled by the lack of improvement strategies in health-care institutions. Effective strategies targeted at improving hand hygiene should include education and training on handwashing and the donning of gloves.[15]

The WHO has developed an evidence-based measure of hand hygiene called the five moments of hand hygiene, which refer to washing hands before touching a patient, before performing an aseptic or clean procedure, after potential exposure to body fluids, after touching a patient, and after touching the patient’s surroundings.[16]


  Materials and methods Top


Study area

The study was conducted at the Department of Microbiology, N.C. Medical College and Hospital, Israna, Panipat, Haryana, India, over six months from January 2018 to May 2018. N.C. Medical College and Hospital aims at becoming a premier institute imparting the best-quality medical science education in the region. This can be understood by our trust’s commitment to high-quality education in all the education institutions running under its name. All our institutions are ISO 9000:2008 Certified quality institutions. The institution is ideally located on NH-71A (Rohtak-Panipat Road), 14 km from Gohana Mod (Panipat) city. The college is spread over many acres, with lush green shades and avenues. The green and quiet environment acts as a catalyst along with a world-class academic environment for various avenues and options for research pursuits also, being far from the din and bustle of the city. The college is well connected by roads and railways to different parts of the state and country. The IGI airport, located at Delhi, and the airport at Chandigarh offer domestic flights as well as international flights that are suitable for convenient visits to the college campus. The hospital was established in 2006 as a general hospital, and it became a teaching hospital in 2016. It serves as a referral center for all other health institutions in Panipat. The hospital comprises 650-bed spaces, including the ICU. N.C. Medical College and Hospital are affiliated with Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, Haryana, India.

Study population

A total of 147 undergraduate medical students were enrolled in this study.

Study design

A cross-sectional study was conducted, and data were collected by using a questionnaire.

Sampling

Medical students explained the content and nature of the study. Verbal consent was obtained from 130 medical students who volunteered to participate. A self-administered questionnaire containing a set of questions regarding hand hygiene knowledge, attitudes, and practices was distributed to all participants.

Inclusion criteria

  1. Second professional year students of N.C. Medical College and Hospital, Israna, Panipat were included in this study.


  2. Undergraduate medical students who volunteered to participate.


Exclusion criteria

  1. Students outside of N.C. Medical College and Hospital, Israna, Panipat were excluded from this study.


  2. Students who did not volunteer to participate.


Data collection

The purpose of the study was fully explained to the participants, and verbal consent was obtained. Confidentiality was ensured by avoiding the use of the names of participants. The investigator visited the participants in the classroom and explained the nature of the study. Thereafter, a questionnaire was administered. It was a self-structured, hand hygiene questionnaire for medical students. The practice of hand hygiene was assessed by using two different sets of questionnaires containing five questions in each. Demographic information was also collected.

Statistical analysis

Data analysis was done by using SPSS version software. Descriptive statistics were used to calculate percentages for each of the responses given.


  Results Top


A total of 147 undergraduate medical students were enrolled in the study, out of which 69 (46.94%) were males and 78 (53.06%) were females. The study showed that 81 (55.10%) always washed their hands with soap and water before eating food, 55 (37.41%) sometimes did so, and 11 (7.48%) never did so. The majority of those who did not wash their hands before eating gave reasons of time factor, 7 (63.64%), and hygienic materials not available, 4 (36.36); 112 (76.19%) always washed their hands after urinating; 33 (22.45%) sometimes did; and 2 (1.36%) never washed their hands after urinating. Those who did not wash their hands after urinating gave reasons for the time factor, 1 (50%), and not required, 1 (50%) each; 128 (87.07%) always washed their hands after defecation; 11 (7.48%) sometimes did; and 8 (5.44%) never washed their hands after defecation. Those who did not wash their hands after defecation gave reasons of the time factor, 4 (50%), and feeling it was not required, 1 (12.50%); 3 (37.50%) answered that hygiene materials were not available.

Interestingly, the analysis showed that hand hygiene practice after touching the culture plate and practical classes were relatively low; only 29 (19.73%) students wash their hands after touching the culture plate, with 66 (44.90) of them sometimes and 52 (35.37) never, stating reasons of the time factor; 22 (75.86), not required 4 (13.79) and hygiene material unavailable; 3 (10.34). However only 22 (14.97) students wash their hands after practical classes, 86 (58.50%) washed their hands sometimes and 39 (26.53%) never washed their hands after practical classes. Stating reasons of the time factor 17 (77.22%), not required 4 (18.18%) and hygiene material unavailable 1 (4.55%) [Table 1] and [Table 2], [Figure 1] and [Figure 2].
Table 1: Distribution of answers on washing hands before and after certain activities

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Table 2: Reasons given for not washing hands

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Figure 1: Distribution of answers on washing hands before and after certain activities

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Figure 2: Reasons given for not washing hands

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Based on gender, there was a comparison on handwashing before eating, after urinating, after defecation, after touching the culture plate, and after practical class. Analysis for males showed that 37 (53.62%) always washed their hands before eating, 23 (33.33%) sometimes did, and 9 (13.04%) never did; whereas for females, 45 (57.69%) always did, 31 (39.74%) sometimes did, and 2 (2.56%) never washed their hands before eating food. Again, for males, 51 (73.91%) always did, 16 (23.19%) sometimes did, and 2 (2.90%) never washed their hands after urinating; whereas for females, 61 (78.21%) and 17 (21.79%) always and sometimes did, respectively. The number of males who washed their hands after defecation was: 57 (82.61%) always, 7 (10.14%) sometimes, and 5 (7.25%) never; whereas for females, it was: 68 (87.18%) always, 7 (8.97%) sometimes, and 3 (3.85%) never. The number of males who washed their hands after touching the culture plate was: 33 (47.83%) always, 19 (27.54%) sometimes, and 17 (24.64%) never; whereas for females, it was: 37 (47.44%) always, 29 (37.18%) sometimes, and 12 (15.38%) never. Males who washed their hands after touching the culture plate were: 42 (60.87%) always, 14 (20.29%) sometimes, and 13 (18.84) never; however, for females it was: 48 (61.54%) always, 21 (26.92%) sometimes, and 9 (11.54%) never. [Table 3] and [Figure 3]
Table 3: Hand wash comparison between males and females

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Figure 3: Hand wash comparison between males and females

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  Discussion Top


The outcomes achieved from this study show a measurably noteworthy increment in the act of handwashing and hand sanitizer use among understudies. Strikingly, several medical students did not practice hand hygiene, particularly after the practical classes. A few students had their very own jugs either in their room or in their satchels or pockets. It ought to be referenced that ailment depended on self-detailing by understudies and that no clinical affirmation of these ailments was got from the students.

Our study group had relatively good knowledge and attitude but poor practice of hand hygiene. Though the majority recognized the importance of hand hygiene practically compliance regarding the same was poor. Study results show that most of the respondents maintained hand hygiene but inadequately. The main reason for skipping hand hygiene was “forget to wash.” Similar findings were seen in other studies as well.[8],[17] Other barriers were lack of soap and water and lack of time. Similar findings were seen in other studies as well.[8],[17] The “forgetfulness” factor can be removed by regular sensitizing of the medical students via displaying posters on walls., CMEs, and training and retraining. Hospital authorities should ensure the availability of facilities, including water, soap, tissue paper sanitizers, etc.

The main motivation factor for hand hygiene among workers was fear of contracting the infection. This is consistent with other studies.[18],[19]

The findings, however, from our study show that the rates of compliance in our local center are still low. The reasons for this could include lack of an educational program on hand hygiene; unfortunately, health-care workers in developing settings such as ours regard such programs as being mundane. A similar study to ours conducted by Albert and Condie in the ICU showed that despite the various advancements in infection control, health-care workers still do not fully adhere to the recommended hand hygiene practices and, as such, compliances are still low.[20]

In a systematic review conducted by Erasmus et al., on hand hygiene practices, it was discovered that in ICUs and general wards, the compliance rate was 40% among physicians. This goes to show that even in critical care units in hospitals compliance with hand hygiene is still a topical issue.[21]

In the current study, our observation was that many personnel did not perform hand hygiene before conducting an invasive procedure but simply went on to don their gloves. This also buttresses the fact that hand hygiene was basically for their protection and not that of the patient or the immediate environment. A variety of factors have described why health-care workers do not sanitize their hands before and after patient contact, and these include a high workload, insufficient time, forgetfulness due to a huge workload, lack of running water, and nonavailability of alcohol hand lotions. Hand hygiene has, therefore, been promoted as one of the tools that will help to mitigate this rise in antimicrobial resistance.[11],[22]

This behavioral pattern is also seen in our study, with low levels of compliance and with the WHO-prescribed five moments of hand hygiene. A worrisome trend is the high noncompliance rates of hand hygiene after touching the patient, as the hands of health-care workers could then become a reservoir for the transmission of pathogens among patients. The several microorganisms causing health care-associated infections are regularly mutating and, as such, their antimicrobial resistance rates are higher in the hospital compared with the community. Such pathogens may enter into the local community via three means: health-care workers, discharged patients, or the relatives of such patients who visit the hospital.

Health care-associated infections are an important cause of morbidity and mortality in clinical practice and they pose a challenge in efficient health-care delivery; one of the easily identified routes of transmission of such infections is the hands of health-care workers. Health care-associated infections are a burden to both physicians and patients, as they lead to complications in therapy, the overall increase in admission days, increase health-care costs, and may result in mortality.[15],[23]

At the moment, the situation in developing countries is such that handwashing facilities are suboptimal. The nonavailability of sufficient sinks or running water is also an impediment. In addressing hand hygiene, however, this is now being addressed with the use of alcohol-based hand rubs. Educational programs must also be supplemented with the presence of an effective infection control team. There must also be an active surveillance system in place to rapidly detect cases of health care-associated infections and rip further ones in the bud.[24],[25],[26]

This examination anyway indicated that medical students who were not aware of their hand hygiene were inclined to contaminations, which, thus, can be answerable for the spread of diseases among associates and their patients, prompting medical clinic obtained diseases (HAI).[12] Studies have proposed that diseases reduce by the washing of hands with soap and water in the presence of visible dirt or contamination (with proteinous material, blood, body fluids), after using the restroom, and before and after having food. Studies have proposed that diseases reduce by washing hands with soap and water in the presence of visible dirt or contamination, after using the restroom, and before and after having food. Washing hands with soap and water after urination, defecation, laboratory work, and after using the cadaver room are important for medical students because it is the simplest and least expensive means of reducing the prevalence of diseases among medical students and the spread of hospital acquired infection in particular the organisms that are antimicrobial resistant.[12],[14],[27],[28]

A recent study has suggested that the adherence of medical care laborers to the suggested handwashing rehearses remains inadmissibly, low, once in a while surpassing 40% wherein hand cleanliness is demonstrated,[8],[29] which is in relationship with this investigation. Various creators have conducted great hand cleanliness practices to show signs and signs for mindfulness reasons. In an exploration, by de Mortel[30] it was seen that 63% of clinical understudies knew about the right signs for hand cleanliness whereas Mann and Wood[31] revealed mindfulness in just 56% of students.

In an examination conducted by Azzam and Sajad,[32] just 29% of medical students had the option to distinguish between all signs of hand hygiene,[32] whereas in another study conducted by Graf et al., 33% could distinguish between signs of hand cleanliness.[33] Feather et al. carried out a study on 187 students, it was discovered that only 8.5% washed their hands after contact with patient, however, it has been increased to 18.3% when hand hygiene signs were displayed.[34]

Such surveillance systems may also use personnel who have high rates of patient contact to drive the process. The highest rates of direct patient contact in the study were the circulating nurses and the anesthetists. These two categories of health-care workers are points of easy access to both patients and other health-care personnel and, as such, interventional measures may be fashioned around them. Also, they attract a high degree of respect from their colleagues and, as such, would be effective in achieving a change in hand hygiene behavior.


  Conclusion Top


A connection between hand cleanliness, sickness rate, and explanations behind not rehearsing hand cleanliness appears in the outcomes. The current examination proposes that both handwashing and the utilization of hand sanitizers have a beneficial outcome on the health of medical students. The results of improved hand cleanliness propensities for the students bring about diminished medical services costs for the college since fewer students may need to use well-being focus assets.

It is important to carry out hand hygiene training programs regularly to achieve increased compliance with hand hygiene practices. This study also emphasizes that an objective technique of demonstration has a greater effect on changing a professional’s attitude toward hand hygiene.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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33.
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34.
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    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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