Professional Documents
Culture Documents
org
Original article
ABSTRACT
Introduction: There is very little published information on hand
washing practices of Health Care Workers (HCWs), their knowledge, perceived barriers & facilities for practicing hand washing
in hospitals from India. So this study was undertaken. Such
studies give important inputs for further research, policy &
planning.
Materials & Methods: This cross-sectional study conducted in
hospitals of mangalore city had two components: 1) Direct observation of hand washing pre & post patient contact followed by 2)
administration of anonymous questionnaire testing knowledge. A
total of 142 hand washing opportunities were studied. The study
was conducted in consenting hosptials affiliated to medical
schools, nursing homes, corporate hospitals. Two study tools
based on used were: 1) Proforma to record practices; and 2)
Questionnaire to test knowledge of HCWs.
Results: Only 129 observations could be made. Though the
HCWs had general awareness about Hand Washing Practices
(HWPs), they lacked information about specific aspects & the
practices were poor. Low hand washing rates (%) were observed
among nurses (28) & doctors (23).There was gap between knowledge and practice. Knowledge of doctors on various aspects of
hand washing was inadequate though it was better than nurses.
High Work Load & Lack of Time were perceived to be important barriers for HWPs. Shortage of sinks was noticed in
hospitals.
Conclusion: There is a need to evolve guidelines for hand washing practices & the facilities for it in hospitals of India.
Keywords: Hand washing, health care worker, hospital
INTRODUCTION
Health Care Workers (HCW) hands become
progressively colonized with commensal flora as
well as with potential pathogens during patient
care. 1 Contaminated hand could be vehicles for
the spread of certain viruses and bacteria.1 Nosocomial infections constitute a major challenge of
modern medicine. On an average, infections
complicate 7% to 10% of hospital admissions.2
Transmission of microorganisms from the hands
Page 261
Page 262
Data Analysis: Information obtained was analyzed by SPSS version 10. Results have been
expressed as proportions. The knowledge component has been expressed as total scores, mean
and standard deviation. Significance of difference in Mean knowledge scores was assessed
using students independent t test. Comparison
of proportion of doctors and nurses with inadequate/ satisfactory and good knowledge was
done. p <0.05 was considered significant.
RESULTS
Only 129 observations could be made from 4
medical school hospitals, 3 private hospitals & 1
Nursing Home giving us a response rate of
90.8%. the number of observations from each of
these are as follows (%): Medical school hospitals
91 (70.5), private hospitals 33 (25.6), Nursing
Homes 5 (3.9). the breakup of the HCWs are as
follows (n): Interns (32), Post-Graduate Students
(51), Nurses (46).
Knowledge on various aspects of hand washing
Overall knowledge of the HCWs for various
indications of Hand washing are as follows
[Correct answers (%)]: Before touching the
patient (100), after touching patient (97.7), Before
handling an invasive device for the patient (86.7),
Working in ICU (96.1), After handling blood or
other body products with gloves (83.7),While
examining patients in OPD (76.7), After using a
hand sanitizer (58.1), Attending to a patient after
being interrupted by a phone call (57.4). Most of
them (46.5) had satisfactory knowledge about the
choice of agents used & inadequate knowledge
(34.1) about duration of hand washing. Knowledge about certain common wrong practices are
presented in Table 1. Comparison of knowledge
between doctors & nurses (Table 2) on various
aspects of hand washing reveals that doctors had
better knowledge though the knowledge of
doctors on some aspects is inadequate.
Correct
Answer (%)
96 (74.4)
109 (84.5)
Wrong
Answer (%)
33 (25.6)
20 (15.5)
73 (56.6)
56 (43.4)
106 (82.2)
56 (43.4)
73 (56.6)
23 (17.8)
100 (77.5)
29 (22.5)
Page 263
1 (1.2)
59 (71.1)
23 (27.7)
3 (7.0)
34 (79.1)
6 (14)
4.19 (0.000)
6 (7.2)
34 (41)
43 (51.8
12 (27.9)
26 (60.5)
5 (11.6)
5.68 (0.000)
0 (0)
63 (75.9)
20 (24.1)
4 (9.3)
33 (76.7)
6 (14)
4.33 (0.02)
Pre-Contact
(%)
81 (62.8)
13 (10.1)
16 (12.4)
19 (14.7)
Post-Contact
(%)
--NA-23 (17.82)
18 (13.95)
88 (68.21)
Yes (%)
No (%)
92 (71.3)
86 (66.7)
81 (62.8)
78 (60.5)
71 (55.0)
70 (54.3)
37 (28.7)
43 (33.3)
48 (37.2)
51 (39.5)
58 (45.0)
59 (45.7)
58 (45.0)
43 (33.3)
71 (55.0)
86 (66.7)
DISCUSSION
The knowledge of doctors on various aspects of
hand washing is better than nurses. There are no
comparable studies from India. Poor knowledge
about hand washing practices are reported from
turkey.7 Though the level of knowledge of doctors is better than nurses, it is inadequate regarding choice of agents. Many HCWs do not
recognize the inappropriateness of certain wrong
practises (Table 1). Information about hand
hygiene is generally limited to antiseptic /
disinfecting agents in the undergraduate medical
curriculum. Though the nurses study it in detail,
knowledge acquired during student days seem
to have been forgotten. There is a need to reorient the interns, postgraduates & nursing students before they begin their work in the
hospitals.
Practices of the HCWs reflect that it is not in tune
with their knowledge. They do not practice what
they know. Use of gloves is not a substitute for
hand washing.1 so, the use of gloves without
associated hand washing amounts to noncompliance. Low proportion of HCWs practiced
hand washing with soap & water. But when we
Page 264
2.
Page 265
4.
6.
7.
Page 266