Knowledge and Perceptions of Hand Hygiene among Nurses in a Teaching Hospital in Pahang
DOI:
https://doi.org/10.31436/ijcs.v8i1.422Keywords:
Hand hygiene, Healthcare-associated infections (HAIs), Nurses, Healthcare workers, Knowledge, PerceptionAbstract
Background: Healthcare-associated infections (HAIs) frequently commonly occur in hospitalised patients, yielding various consequences, including extended inpatient stays, increased microbial resistance to antimicrobial agents, and potentially substantial mortality rates. Emphasising the paramount significance of hand hygiene, it is considered the primary preventive measure against the dissemination of infectious agents. However, hand hygiene compliance among staff nurses and other healthcare workers (HCWs) was still low partly due to the lack of hand hygiene knowledge and it is able to have a significant impact on patients’ health status. The objective of this study is to assess knowledge and perceptions of hand hygiene among staff nurses in a new teaching hospital.
Methods: This quantitative study used a convenience sampling method in which nurses were invited from three critical care areas and five non-critical care areas. Data were collected through a self-administered questionnaire, and Statistical Package for Social Science (SPSS) was used for data analysis.
Results: The majority of staff nurses (88.9%) had moderate knowledge with a mean score=66.6 (SD±7.4). Although there was no significant difference between the sociodemographic characteristics of nurses (age, gender, department, received formal hand hygiene training, and routinely used alcohol-based hand rub) (p>0.05) and the knowledge level of nurses, this study found that the nurses have good perceptions about hand hygiene 79.8%.
Conclusion: This study highlights the knowledge of hand hygiene at a moderate level across critical and non-critical areas. Thus, the study suggests the need for targeted interventions to enhance hand hygiene knowledge among healthcare personnel, thereby contributing to improve patient outcomes.
References
Szabó S, Feier B, Capatina D, Tertis M, Cristea C, Popa A. An overview of healthcare associated infections and their detection methods caused by pathogen bacteria in Romania and Europe. Journal of clinical medicine. 2022 Jun 4;11(11):3204.
Hand Hygiene | FAQs | Infection Control | Division of Oral Health | CDC. (2016). Centers for Disease Control and Prevention. https://www.cdc.gov/oralhealth/infectioncontrol/faqs/hand-hygiene.html
World Health Organization. Health care-associated infections. Fact Sheet. Available from: http://www.who.int/gpsc/country_work/gpsc_ccisc_fact_ sheet_en.pdf [Accessed on 22 March 2020].
Gidey K, Gidey MT, Hailu BY, Gebreamlak ZB, Niriayo YL. Clinical and economic burden of healthcare-associated infections: A prospective cohort study. Plos one. 2023 Feb 23;18(2): e0282141.
Kritsotakis EI, Kontopidou F, Astrinaki E, Roumbelaki M, Ioannidou E, Gikas A. Prevalence, incidence burden, and clinical impact of healthcare-associated infections and antimicrobial resistance: a national prevalent cohort study in acute care hospitals in Greece. Infection and drug resistance. 2017 Oct 10:317-28.
Gould DJ, Moralejo D, Drey N, Chudleigh JH, Taljaard M. Interventions to improve hand hygiene compliance in patient care. Cochrane database of systematic reviews. 2017(9).
Haque M, McKimm J, Sartelli M, Dhingra S, Labricciosa FM, Islam S, Jahan D, Nusrat T, Chowdhury TS, Coccolini F, Iskandar K. Strategies to prevent healthcare-associated infections: a narrative overview. Risk management and healthcare policy. 2020 Sep 28:1765-80.
Engdaw GT, Gebrehiwot M, Andualem Z. Hand hygiene compliance and associated factors among health care providers in Central Gondar zone public primary hospitals, Northwest Ethiopia. Antimicrobial Resistance & Infection Control. 2019 Dec; 8:1-7.
Goh LP, Marbawi H, Goh SM, bin Abdul Asis AK, Gansau JA. The prevalence of hospital-acquired infections in Southeast Asia (1990-2022). The Journal of Infection in Developing Countries. 2023 Feb 28;17(02):139-46.
Alshagrawi S, Alhodaithy N. Determinants of hand hygiene compliance among healthcare workers in intensive care units: a qualitative study. BMC public health. 2024 Aug 28;24(1):2333.
Salama O, Elweshahi H, Abd El Raheem A. Knowledge, attitudes and compliance with hand hygiene practices among health care workers in Alexandria Main University Hospital. Journal of High Institute of Public Health. 2017 Oct 1;47(2):39-47.
Hosseinialhashemi M, Kermani FS, Palenik CJ, Pourasghari H, Askarian M. Knowledge, attitudes, and practices of health care personnel concerning hand hygiene in Shiraz University of Medical Sciences hospitals, 2013-2014. American journal of infection control. 2015 Sep 1;43(9):1009-11.
Chavali S, Menon V, Shukla U. Hand hygiene compliance among healthcare workers in an accredited tertiary care hospital. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine. 2014 Oct;18(10):689.
Nadia_Rahman. Hari Kebersihan Tangan Sedunia 2024 [Internet]. Upm.edu.my. 2024 [cited 2025 Mar 20]. Available from: https://medic.upm.edu.my/article/world_hand_hygiene_day_2024-79131
Homepage SASMEC Flagship [Internet]. Iium.edu.my. 2015. Available from: https://sasmec.iium.edu.my/v2/
WHO. (2010). Hand hygiene tools and resources. https://www.who.int/teams/integrated-health-services/infection-prevention-control/hand-hygiene/monitoring-tools
Blomgren PO, Swenne CL, Lytsy B, Hjelm K. Hand hygiene knowledge among nurses and nursing students–a descriptive cross-sectional comparative survey using the WHO's “Hand Hygiene Knowledge Questionnaire”. Infection Prevention in Practice. 2024 Jun 1;6(2):100358
Abd Rahim MH, Ibrahim MI. Hand hygiene knowledge, perception, and self-reported performance among nurses in Kelantan, Malaysia: a cross-sectional study. BMC Nursing. 2022 Jan 31;21(1).
Abiodun IS, Monday EO, Aneke CJ, Akinola-Oloyede R, Olatunji OO, Oyindamola AA. Assessment of Knowledge, Attitude and Practices of Hand Hygiene among Medical and Nursing Students. International Journal of TROPICAL DISEASE & Health. 2022 Apr 9;43(6):1-1.
Zhang Y, Chen X, Lao Y, Qiu X, Liu K, Zhuang Y, Gong X, Wang P. Effects of the implementation of Intelligent Technology for Hand Hygiene in Hospitals: systematic review and Meta-analysis. Journal of Medical Internet Research. 2023 May 29;25:e37249.
Purssell E, Drey N, Chudleigh J, Creedon S, Gould DJ. The Hawthorne effect on adherence to hand hygiene in patient care. Journal of Hospital Infection. 2020 Oct 1;106(2):311-7.
Martos-Cabrera MB, Mota-Romero E, Martos-García R, Gómez-Urquiza JL, Suleiman-Martos N, Albendín-García L, Cañadas-De la Fuente GA. Hand hygiene teaching strategies among nursing staff: a systematic review. International journal of environmental research and public health. 2019 Sep;16(17):3039.
Clancy C, Delungahawatta T, Dunne CP. Hand-hygiene-related clinical trials reported between 2014 and 2020: a comprehensive systematic review. Journal of Hospital Infection. 2021 May 1;111:6-26.
Constantinou D, Leontiou I, Mpouzika M, Michail K, Middletton N, Merkouris A. Health care workers’ knowledge and perceptions on WHO hand hygiene guidelines, and the perceived barriers to compliance with hand hygiene in Cyprus. BMC nursing. 2024 Sep 11;23(1):644.
Gammon J, Hunt J, Duffy L, Humphreys I, Hinkin J, Watkins A. Impact of an educational intervention on hand hygiene practice among nursing students, with a focus on hand drying efficacy. Journal of Infection Prevention. 2024 Mar;25(1-2):3-10.
Dunlop CL, Kilpatrick C, Jones L, Bonet M, Allegranzi B, Brizuela V, Graham W, Thompson A, Cheshire J, Lissauer D. Adapting the WHO hand hygiene ‘reminders in the workplace to improve acceptability for healthcare workers in maternity settings worldwide: a mixed methods study. BMJ open. 2024 Sep 1;14(9):e083132.
Wang Y, Yang J, Qiao F, Feng B, Hu F, Xi ZA, Wu W, Ni ZL, Liu L, Yuan Y. Compared hand hygiene compliance among healthcare providers before and after the COVID-19 pandemic: A rapid review and meta-analysis. American journal of infection control. 2022 May 1;50(5):563-71.
Australian Commission on Safety and Quality in Health Care. National Hand Hygiene Initiative Implementation Guide [Internet]. 2023 Jul. Available from: https://www.safetyandquality.gov.au/sites/default/files/2023-07/nhhi_implementation_guide_july_2023.pdf
Blomgren PO, Swenne CL, Lytsy B, Hjelm K. Hand hygiene knowledge among nurses and nursing students–a descriptive cross-sectional comparative survey using the WHO's “Hand Hygiene Knowledge Questionnaire”. Infection Prevention in Practice. 2024 Jun 1;6(2):100358.
Sagar M, Sharma S, Chaudhary A, Sharma S. A mixed-method study to assess the knowledge-practice gap regarding hand hygiene among healthcare providers in a tertiary care hospital. Journal of Anaesthesiology Clinical Pharmacology. 2020 Jul 1;36(3):359-65.
Ahmadipour M, Dehghan M, Ahmadinejad M, Jabarpour M, Mangolian Shahrbabaki P, Ebrahimi Rigi Z. Barriers to hand hygiene compliance in intensive care units during the COVID-19 pandemic: A qualitative study. Frontiers in public health. 2022 Aug 18;10:968231.
Mouajou V, Adams K, DeLisle G, Quach C. Hand hygiene compliance in the prevention of hospital-acquired infections: a systematic review. Journal of Hospital Infection. 2022 Jan 1;119:33-48.
Liu P, Cao F, Yao Q, Xu L, Dai H. Effectiveness of educational and training intervention for improving hand hygiene compliance amongst nurses: a systematic review and meta-analysis of randomised controlled trials. Scottish Medical Journal. 2023 Aug;68(3):72-9.
Kaveh MH, Motamed-Jahromi M, Hassanipour S. The Effectiveness of Interventions in Improving Hand Hygiene Compliance: A Meta?Analysis and Logic Model. Canadian Journal of Infectious Diseases and Medical Microbiology. 2021;2021(1):8860705.
Elia F, Calzavarini F, Bianco P, Vecchietti RG, Macor AF, D’Orazio A, Dragonetti A, D’Alfonso A, Belletrutti L, Floris M, Bert F. A nudge intervention to improve hand hygiene compliance in the hospital. Internal and Emergency Medicine. 2022 Oct;17(7):1899-905.
Dick A, Sterr CM, Dapper L, Nonnenmacher-Winter C, Günther F. Tailored positioning and number of hand rub dispensers: the fundamentals for optimized hand hygiene compliance. Journal of Hospital Infection. 2023 Nov 1;141:71-9.
Hansen PG, Larsen EG, Modin A, Gundersen CD, Schilling M. Nudging hand hygiene compliance: a large-scale field experiment on hospital visitors. Journal of Hospital Infection. 2021 Dec 1;118:63-9.
Ng WK, Shaban RZ, van de Mortel T. The effect of a hand hygiene program featuring tailored religion-relevant interventions on healthcare workers' hand rubbing compliance and beliefs in the United Arab Emirates: A cohort study. Infection, disease & health. 2019 Aug 1;24(3):115-23.
Al-Maani A, Al Wahaibi A, Al-Zadjali N, Al-Sooti J, AlHinai M, Al Badawi A, Al Saidi A, AlZadjali N, Elshoubary W, Al-Harthi K, Al-Abri S. The impact of the hand hygiene role model project on improving healthcare workers’ compliance: A quasi-experimental observational study. Journal of Infection and Public Health. 2022 Mar 1;15(3):324-30.
Hammerschmidt J, Manser T. Nurses’ knowledge, behaviour and compliance concerning hand hygiene in nursing homes: a cross-sectional mixed-methods study. BMC health services research. 2019 Dec;19:1-3.
Wang Q, Lai X, Zheng F, Yu T, Wang L, Wu Y, Wang K, Zhang X, Zhou Q, Tan L. The impacts of self-expectation leadership and organizational commitment on hand hygiene behavior of medical staff based on the theory of implicit leadership. Frontiers in Psychology. 2022 Nov 14;13:992920.
Shim JY, Park S, Kim GE, Jeong YS, Kim JH, Lee E, Lee EJ, Kim TH, Park SY. Does physician leadership influence followers’ hand hygiene compliance? In Open Forum Infectious Diseases 2019 Jun (Vol. 6, No. 6, p. ofz236). US: Oxford University Press.
Stangerup M, Kavalaris CP, From-Hansen M, Hansen MB, Hansen R, Hesselbo B, Kostadinov K, Knudsen JD. Significantly Improved Hand Hygiene Compliance Using Nudging and Performance Feedback Based on Data from an Automated Monitoring System. American Journal of Infection Control. 2020 Aug 1;48(8): S56-7.
Iversen AM, Stangerup M, From-Hansen M, Hansen R, Sode LP, Kostadinov K, Hansen MB, Calum H, Ellermann-Eriksen S, Knudsen JD. Light-guided nudging and data-driven performance feedback improve hand hygiene compliance among nurses and doctors. American journal of infection control. 2021 Jun 1;49(6):733-9.
Fish L, Bopp D, Gregory D, Kerley KD, Gakhar S, Lavigne MC, Boyd F. Hand hygiene feedback impacts compliance. American journal of infection control. 2021 Jul 1;49(7):907-11.
Schmidtke KA, Aujla N, Marshall T, Hussain A, Hodgkinson GP, Arheart KL, Birnbach DJ, Kudrna L, Vlaev I. A crossover randomized controlled trial of priming interventions to increase hand hygiene at ward entrances. Frontiers in public health. 2022 Jan 17;9:781359.
Ali NA, Dalugoda TY. Are we wash our hands enough? The blessing of COVID-19. International Journal of Care Scholars. 2020 Jan 31;3(1):37-40.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 INTERNATIONAL JOURNAL OF CARE SCHOLARS
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
