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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 3  |  Issue : 1  |  Page : 43-47

Hand hygiene practices among doctors in health facility in a semi-urban setting


1 Department of Paediatrics, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
2 Department of Paediatrics, Federal Medical Centre, Birnin Kebbi, Nigeria
3 Department of Dental and Maxillofacial Surgery, Federal Medical Centre, Birnin Kebbi, Nigeria
4 Institute of Human Virology, Kano, Nigeria

Date of Submission27-Sep-2017
Date of Acceptance09-Jan-2018
Date of Web Publication19-Jun-2018

Correspondence Address:
Dr. Ibrahim Aliyu
Department of Paediatrics, Aminu Kano Teaching Hospital, Kano
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/bjhs.bjhs_26_17

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  Abstract 


INTRODUCTION: Hand hygiene is an integral part of personal hygiene; poor hand hygiene practice may result not only in self-hurt but also may serve as a vehicle for transmission of infection among patients. Hence, knowledge of proper hand hygiene practice will significantly reduce the burden of infectious diseases.
MATERIALS AND METHODS: This was a cross-sectional study involving doctors at Federal Medical Centre Birnin Kebbi; it was conducted from September 2015 to November 2015. Convenience sampling method was adopted. Pretested self-administered questionnaire based was used; relevant information such as age, sex, profession, years of working experience, awareness of Global HandWashing Day, hand-washing technique, steps in hand washing, ability to list the five moments in hand washing, and principles of hand washing were obtained.
RESULTS: There were 33 males and 12 females with a male to female ratio of 2.8:1. All respondents believed hand washing reduces the risk of transmitting or contracting infections. Soap and water was the most common agent for hand cleansing, majority of the respondents (86.7%) had been taught on the technique of hand washing; however, only 19 (42.2%) of them wash their hands before examining patients; but all the respondents (100%) wash their hands after examining patient or handling their secretions; similarly, they all reported washing their hands after using the restroom. Almost all of the respondents (97.8%) use water and soap for hand washing. Furthermore, only 44.4% of the respondents had their personal hand rub.
CONCLUSION: Soap and water was the most common agent for hand cleansing, and there was poor utilization of hand rub; and most respondents did not wash their hands before patient contact.

Keywords: Doctors, hand hygiene, hand sanitizer, soap and water


How to cite this article:
Aliyu I, Lawal TO, Olawale W, Monsudi KF, Zubayr BM. Hand hygiene practices among doctors in health facility in a semi-urban setting. BLDE Univ J Health Sci 2018;3:43-7

How to cite this URL:
Aliyu I, Lawal TO, Olawale W, Monsudi KF, Zubayr BM. Hand hygiene practices among doctors in health facility in a semi-urban setting. BLDE Univ J Health Sci [serial online] 2018 [cited 2018 Dec 14];3:43-7. Available from: http://www.bldeujournalhs.in/text.asp?2018/3/1/43/234642



Hand hygiene is an integral part of personal hygiene. Doctors' activities may directly or indirectly influence the patient outcome; therefore poor hand hygiene practice may result not only in self-hurt but may serve as a vehicle of transmission of infection among patients. Hospital-associated infections from contaminated hands have been associated with high morbidity-mortality. Therefore, a proper hand hygiene practice will significantly reduce these poor health indices. Unfortunately, this fit has not been achieved, especially in most developing countries due to poor compliance to the practice and technique of hand washing. Hence, knowledge of proper hand hygiene practice will significantly reduce the burden of infectious diseases. The World Health Organization (WHO) holds the practice of hand-washing in high esteem; among efforts by the WHO to address the low compliance rate is the introduction of “my five moments for hand hygiene.” These include moments in which hand hygiene should be observed such as before patient contact, after patient contact, before conducting aseptic procedures, after exposure to body fluids, and after contact with patient environment.[1] Furthermore, every 15th October of each year is celebrated as Global Handwashing Day.[1] This day serves to remind us of the relevance of hand washing while ensuring that the technique and critical moments and principles of hand washing are routinely observed in our daily activities.[2],[3],[4],[5],[6] While most emphasis on health-related practices are placed in the urban areas; our study was set to determine the hand hygiene practices among doctors in tertiary center in a semi-urban setting.


  Materials and Methods Top


This was a cross-sectional study involving doctors at Federal medical Centre Birnin Kebbi; it was conducted over 8 weeks from September 2015 to November 2015. A sample size of 58 was calculated from a knowledge base of 64.4% from previous study;[7] and the Fishers formula for population of <10,000[8] (the estimated total population of respondents available at the time of the study was 70); furthermore, a convenience sampling method was adopted for their recruitment. This study was questionnaire-based and it was pretested and self-administered; relevant information such as age, sex, profession, and years of working experience were contained, others were; awareness of Global Hand Washing Day, knowledge on hand-washing technique, steps in hand washing, ability to list the five moments in hand washing and principles of hand washing. Permission for this study was obtained from the Ethics Committee of Federal Medical Centre, Birnin Kebbi and consent was obtained from the respondents.

Data analysis

The information from respondents was analyzed using Statistical Package for Social Sciences (SPSS) version 16 (SPSS Inc., Chicago, Illinois, USA). The mean and standard deviation summarized quantitative variables while qualitative variables were summarized using frequencies and percentages. The relationship between categorical variables was tested using Chi-square or Fisher's exact tests of significance where applicable, and P < 0.05 was considered as statistically significant.


  Results Top


There were 33 males and 12 females with a male to female ratio of 2.8:1; age range from 25 years to 55 years with a mean of 32 ± 4 years.

Most of the respondents had <10-years; 41 (91.1%) working experience while only 4 (8.9%) had more than 10-year working experience.

Though there was almost equal representation of respondents with and without awareness of the Global HandWashing Day, but those who were aware were 55.6% versus 44.4% for those unaware [Table 1].
Table 1: Knowledge of handwashing and its practice among the respondents

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Only 9 (36%) could correctly state the date for Global Hand-Washing Day, 16 (64%) were incorrect. All the respondents believed handwashing reduces the risk of transmitting or acquiring infections. Majority of the respondents (86.7%) had been taught on the technique of handwashing; however, only 19 (42.2%) of them wash their hands before examining patients; but all the respondents (100%) wash their hands after examining the patient or handling their secretions.

Only three (6.7%) of the respondents wash their hands before wearing surgical gloves. However, 42 reported washing their hands after removing their surgical gloves, whereas only 3 (6.7%) do not regularly wash their hands after removing their gloves; furthermore, they all reported washing their hands after using the restroom. Almost all of the respondents (97.8%) use water and soap for handwashing. Only 8 of the respondents (17.8%) were aware of the WHO 5-moments of hand hygiene; and 5 (62.5%) of them could list them correctly while 3 (37.5%) could not.

Most of the respondents had seen posters on hand washing and hygiene, these were seen mainly in the wards; however, most reported seeing only one poster; however, only 12.5% of the respondents did not read the posters. Furthermore, water was readily available (84.4%) for hand washing. However, only 44.4% of the respondents had their personal hand rub but only two respondents disliked hand rub. Among those who disliked hand rub, one (50%) complained of itching while the other complained of the burden of carrying the hand rub [Table 2].
Table 2: The availability of teaching posters and water for hand-washing

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Majority of the respondents were taught on the principles of hand washing but this was not statistically significant (χ2 = 1.153; df = 1; P= 0.356); however, most were not sure of the steps in handwashing despite been taught; there were almost equal proportion of those who gave correct and incorrect response on the steps in handwashing; however, this observation was not statistically significant (Fishers exact = 0.738; P= 0.73) [Table 3].
Table 3: The relationship of hand-washing teaching and adherence to the principles and steps of hand-washing

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Most males and females did not wash their hands before examining patients; therefore the relationship between gender and handwashing before patient examination was not statistically significant (χ2 = 1.990; df = 1; P = 0.19) [Table 4].
Table 4: The relationship of gender and the practice of hand washing

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  Discussion Top


Medical doctors are in the forefront in the provision of health for all; therefore, their knowledge of important health matter is paramount in achieving the goals of the Sustainable Development Goal.[9] Among other factors in infection control, handwashing has been proven to significantly reduce the risk of not only acquiring but also transmitting the infection to patients.[10]

This study showed that almost half of the respondents (44.6%) were unaware of the WHO Global Hand Washing Day and among the 25 respondents who reported been aware of the day, only 9 (36%) could correctly state the date; this showed that the general awareness of Global Hand-Washing Day was low; this observation was similar to previous reports from studies among health trainees and health professionals.[7],[11] This means there is insufficient publicity of this very important day in our health institutions and medical schools; therefore government and nongovernmental organizations should be involved in promoting the awareness of Hand-Washing Day.

Most respondents (86.7%) in this study had training on handwashing and hygiene; this finding was similar to previous studies.[5],[12] This study also showed that only 44.6% of the respondents washed hands before examining patients, which is worrisome; this low compliance rate was similar to those reported by Chavali et al.[12] and Marra et al.[13] The multimodal approach in improving hand hygiene compliance as highlighted by Chavali et al.[12] and Marra et al.[13] is practicable in resource-constrained settings; therefore, modalities such as induction course for all new doctors on hand hygiene, and simple life saving measures like handwashing should be included in continuous medical education programs which are prerequisite for annual practicing license registration in most countries, availability of posters on handwashing at strategic locations, and the availability of alcohol-based hand rubs have been shown to significantly increase the compliance rate.[14],[15] Other general measures such as behavioral changes among health professionals and practical demonstrations and participation sessions by attendees should be encouraged. Feedback mechanisms to evaluate if such teaching activities are well understood by attendees should be put in place; and routine assessment of hand hygiene practices among doctors should be encouraged. Furthermore, only 6.7% of respondents washed hands before wearing gloves; but almost all of them (93.3%) wash their hands after removing gloves; probably because of the powder stains. This observation was similar to previous reports.[7],[11]

WHO recommends the use of alcohol-based hand-rubs for hand cleansing except in visibly dirty hands in which soap and water is preferable,[16] but soap and water was the common agent used for cleansing in this study. This observation was similar to previous reports [7],[11],[17] but differed from those of De Wandel et al.[18] Although over 95% of the respondents liked and agreed to use alcohol-based hand rub, only 44.4% of them had their personal hand-rub. They reported non availability of hand-rub was the main reason for not using. Only two respondents disliked an alcohol-based hand-rub; and their reasons were that it caused itching and also because of the burden of carrying hand-rub respectively. This observation was similar to that reported by Oliveira et al.[19] however Louden [20] in her review reported observed increasing alcohol-based hand sanitizer compliance rate of 79.4% among health professionals in the United States of America; this was achieved by making hand sanitizers more portable and attachable to their badges, pockets and belts making it easy to carry around.

This study did not notice any gender disparity to the practice of handwashing, however Cruz et al.[21] reported more females with better hand hygiene practices, this reason for lack of any gender difference in our study may reflect a generally poor knowledge of the practice of handwashing among our respondents. Therefore, there is the need for better integration of hand hygiene in our routine patient care. We recommend that respondents should be regularly trained and evaluated on hand hygiene practices and all doctors should be encouraged to have their personal hand-rubs. Superior officers should be made to monitor junior colleagues on the possession and utilization of hand rubs. However, the convenient sampling method was a limitation in this study; therefore, it stood the risk of systemic bias; however, the sampled respondents represented over 50% of doctors in our institution at the time of this study.


  Conclusion Top


Soap and water was the most common agent for hand cleansing in this study; however, there was the dismal use of hand rub; therefore, the possibility of frequent hand cleansing especially before and after consulting every patient may not be routinely practiced. Furthermore, there was faulty hand-washing technique reported in this study. Therefore, there is the need for remedial programs to address this knowledge gap such as the provision of hand-washing technique cartoons and ensuring that unit heads of hospital monitor and regularly evaluate their use and routine organization of continuous medical education programs.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
15th October is Global Hand Washing Day. Available from: http://www.globalhandwashing.org/global-handwashing-day/. [Last accessed on 2017 May 08].  Back to cited text no. 1
    
2.
Schäfer WL, Boerma WG, Kringos DS, De Ryck E, Greß S, Heinemann S, et al. Measures of quality, costs and equity in primary health care instruments developed to analyse and compare primary care in 35 countries. Qual Prim Care 2013;21:67-79.  Back to cited text no. 2
    
3.
Beggs CB, Shepherd SJ, Kerr KG. Increasing the frequency of hand washing by healthcare workers does not lead to commensurate reductions in staphylococcal infection in a hospital ward. BMC Infect Dis 2008;8:114.  Back to cited text no. 3
[PUBMED]    
4.
Sax H, Allegranzi B, Uçkay I, Larson E, Boyce J, Pittet D, et al. 'My five moments for hand hygiene': A user-centred design approach to understand, train, monitor and report hand hygiene. J Hosp Infect 2007;67:9-21.  Back to cited text no. 4
    
5.
Allegranzi B, Pittet D. Role of hand hygiene in healthcare-associated infection prevention. J Hosp Infect 2009;73:305-15.  Back to cited text no. 5
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6.
Sax H, Allegranzi B, Chraïti MN, Boyce J, Larson E, Pittet D, et al. The World Health Organization hand hygiene observation method. Am J Infect Control 2009;37:827-34.  Back to cited text no. 6
    
7.
Abdulsalam M, Aliyu I, Michael GC, Mijinyewa M. Hand-washing practices and techniques among health professionals in a tertiary hospital in Kano. J Med Invest Pract 2015;10:8-12.  Back to cited text no. 7
    
8.
Araoye MO. Research Methodology with Statistics for Health and Social Sciences. Ilorin, Nigeria: Nathadex; 2004. p. 123-9.  Back to cited text no. 8
    
9.
Pettigrew LM, De Maeseneer J, Anderson MI, Essuman A, Kidd MR, Haines A, et al. Primary health care and the sustainable development goals. Lancet 2015;386:2119-21.  Back to cited text no. 9
    
10.
Boyce JM, Pittet D; Healthcare Infection Control Practices Advisory Committee, HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Guideline for hand hygiene in health-care settings. Recommendations of the healthcare infection control practices advisory committee and the HICPAC/SHEA/APIC/IDSA hand hygiene task force. Society for healthcare epidemiology of America/Association for professionals in infection control/Infectious diseases society of America. MMWR Recomm Rep 2002;51:1-45.  Back to cited text no. 10
    
11.
Mohammed A, Aliyu I. Hand-washing practices and techniques among clinical students of Bayero University Kano, Nigeria. Sudan Med Monit 2015;10:51-5.  Back to cited text no. 11
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12.
Chavali S, Menon V, Shukla U. Hand hygiene compliance among healthcare workers in an accredited tertiary care hospital. Indian J Crit Care Med 2014;18:689-93.  Back to cited text no. 12
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13.
Marra AR, Moura DF Jr., Paes AT, dos Santos OF, Edmond MB. Measuring rates of hand hygiene adherence in the Intensive Care setting: A comparative study of direct observation, product usage, and electronic counting devices. Infect Control Hosp Epidemiol 2010;31:796-801.  Back to cited text no. 13
    
14.
Lam BC, Lee J, Lau YL. Hand hygiene practices in a neonatal Intensive Care Unit: A multimodal intervention and impact on nosocomial infection. Pediatrics 2004;114:e565-71.  Back to cited text no. 14
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15.
Mathai AS, George SE, Abraham J. Efficacy of a multimodal intervention strategy in improving hand hygiene compliance in a tertiary level Intensive Care Unit. Indian J Crit Care Med 2011;15:6-15.  Back to cited text no. 15
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16.
WHO Guidelines on Hand Hygiene in Health Care (Advanced Draft). Summary World Health Organization; 2005. Available from: http://www.who.int/patientsafety/events/05/HH_en.pdf. [Last accessed on 2017 May 09].  Back to cited text no. 16
    
17.
Opara PI, Alex-Hart BA. Hand washing practices amongst medical students. Niger Health J 2009;9:16-20.  Back to cited text no. 17
    
18.
De Wandel D, Maes L, Labeau S, Vereecken C, Blot S. Behavioral determinants of hand hygiene compliance in Intensive Care Units. Am J Crit Care 2010;19:230-9.  Back to cited text no. 18
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19.
Oliveira AC, Gama CS, Paula AO. Adherence and factors related to acceptance of alcohol for antiseptic hand rubbing among nursing professionals. Rev Esc Enferm USP 2017;51:e03217.  Back to cited text no. 19
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20.
Louden K. Personal Hand Gel Improves Hand-Hygiene Compliance. Available from: http://www.medscape.com/viewarticle/813390#vp_2. [Last accessed on 2017 Apr 10].  Back to cited text no. 20
    
21.
Cruz JP, Cruz CP, Al-Otaibi AS. Gender differences in hand hygiene among Saudi nursing students. Int J Infect Control 2015;11:1-13.  Back to cited text no. 21
    



 
 
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