KNOWLEDGE, ATTITUDE AND PRACTICE OF HAND HYGIENE AMONG NURSES IN RIVERS STATE UNIVERSITY TEACHING HOSPITAL (RSUTH)

This study investigated the knowledge, attitudes, and practices of hand hygiene among nurses at Rivers State University Teaching Hospital (RSUTH). A quantitative survey research design was adopted to examine the relationship between nurses’ knowledge of hand hygiene and their level of compliance with recommended hand hygiene practices. Data were collected from 133 respondents using a structured questionnaire developed to assess their knowledge, attitudes, and application of hand hygiene procedures. The data obtained were analysed using frequency distributions, simple percentages, mean scores, and standard deviations to describe the respondents’ demographic characteristics and responses to the questionnaire items. A one-sample t-test was also used to evaluate the stated hypotheses and determine the statistical significance of the relationships under investigation.

The findings indicated that the respondents generally possessed a high level of knowledge of hand hygiene. The mean scores further suggested that nurses recognised the importance of hand hygiene in preventing the spread of infections. Most respondents reported regularly using alcohol-based hand sanitizers when washing their hands with soap and water was not practicable, demonstrating awareness of recommended hand hygiene measures. However, the study identified certain areas requiring improvement, particularly in relation to nurses’ attitudes and actual hand hygiene practices. Although their knowledge was generally satisfactory, differences were observed between their reported attitudes and self-reported practices. This suggests that factors such as institutional culture, workload, and the availability of resources may influence compliance beyond the level of knowledge possessed by nurses.

The statistical results of the t-test supported the hypothesis that a significant relationship exists between nurses’ knowledge of hand hygiene and their compliance with recommended practices at RSUTH. The calculated t-value was considerably higher than the critical value at the 5% level of significance, suggesting that greater knowledge was associated with improved adherence to hand hygiene procedures. Based on these findings, the study concluded that continuous education and training are necessary to strengthen nurses’ commitment to effective hand hygiene practices. It further established that knowledge alone may not guarantee compliance; positive attitudes, adequate resources, and the removal of institutional barriers are equally important.

The study recommended the organisation of regular workshops and seminars on infection prevention and control, the introduction of effective monitoring systems to evaluate compliance, and the provision of a supportive working environment that promotes appropriate hand hygiene practices. Overall, the research contributes to existing knowledge on nursing practice and infection prevention by highlighting factors that influence hand hygiene compliance among nurses. It emphasises the importance of integrating knowledge, positive attitudes, and appropriate practices to improve patient safety and minimise healthcare-associated infections. Further studies should examine how institutional policies, staff training, and collaboration among different healthcare professionals can promote the long-term improvement of hand hygiene practices and strengthen a culture of safety within healthcare facilities.

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Hand hygiene is widely acknowledged as one of the most effective measures for preventing healthcare-associated infections (HAIs). These infections are acquired by patients while receiving medical care or treatment in hospitals and other healthcare facilities, and they remain a major public health concern across the world. Healthcare professionals have important responsibilities in preventing and controlling the spread of infections, with nurses playing a particularly significant role because of their continuous and direct contact with patients. Consequently, nurses’ knowledge, attitudes, and practices regarding hand hygiene are essential in reducing the transmission of infectious organisms among patients, healthcare workers, and other individuals within the hospital environment. Agbede et al. (2021), for instance, emphasised the importance of improving nurses’ compliance with hand hygiene procedures as a means of reducing the risk of healthcare-associated infections.

The World Health Organization (WHO) identifies hand hygiene as a fundamental intervention for controlling the transmission of infectious diseases. Its importance has become even more evident in the face of public health challenges, including COVID-19 and other communicable diseases. Although established guidelines and procedures exist to guide healthcare workers on appropriate hand hygiene, evidence from different studies indicates that compliance among healthcare professionals, including nurses, remains below the desired level in many healthcare settings. This situation creates opportunities for the transmission of infections within hospitals and places patients and healthcare workers at risk. In a systematic review, Yadav et al. (2022) highlighted the positive contribution of proper hand hygiene to the protection of healthcare workers and suggested that improved awareness and continuous training could strengthen compliance with recommended procedures.

Hand hygiene refers to the process of cleaning the hands through the use of soap and water or an appropriate alcohol-based hand rub to remove or eliminate microorganisms that may cause infections. Its effectiveness is influenced by several factors, including healthcare workers’ understanding of appropriate hand hygiene techniques, their perception of infection prevention, and their willingness to practise hand hygiene consistently. Al-Haddad et al. (2021) highlighted the influence of knowledge and attitudes on hand hygiene compliance among healthcare workers. Their findings also suggest that educating healthcare personnel on appropriate hand hygiene procedures can contribute to improved adherence to established guidelines.

In Nigeria, the prevention and control of healthcare-associated infections remain important responsibilities for healthcare institutions. Rivers State University Teaching Hospital (RSUTH) is one of the facilities where effective infection prevention measures are necessary to protect patients and healthcare personnel. Nurses working in the hospital are expected to maintain appropriate hand hygiene practices because of their frequent contact with patients and involvement in different clinical procedures. This study therefore seeks to examine the knowledge, attitudes, and practices (KAP) of hand hygiene among nurses at RSUTH. It is intended to establish the extent of their understanding and compliance with recommended procedures and identify areas where improvements may be required. Ayub et al. (2020) reported that a considerable proportion of nurses in their study demonstrated inadequate hand hygiene practices, indicating the need for focused interventions to improve compliance in comparable healthcare environments.

Healthcare-associated infections can result in serious health complications, longer periods of hospitalisation, increased treatment expenses, and, in severe cases, death. These consequences make the consistent application of effective hand hygiene procedures essential in healthcare delivery. Askarian and Ghazisaeedi (2021), in their systematic review, provided support for the use of educational interventions to improve hand hygiene practices among nurses. This suggests that structured training and continuous professional development may be useful strategies for addressing poor compliance and strengthening infection prevention in hospitals.

The contribution of nurses to infection prevention and control is particularly important because they maintain regular contact with patients and participate in many procedures that may expose individuals to infectious organisms. Nwankwo and Uche (2020) observed that nurses’ compliance with hand hygiene guidelines is associated with their knowledge and attitudes towards infection prevention. This relationship demonstrates the importance of providing continuous education, adequate institutional support, and opportunities for professional development to encourage safe clinical practices and establish a stronger culture of patient safety.

In addition to knowledge, nurses’ attitudes towards hand hygiene can significantly influence how consistently they apply recommended procedures. Positive perceptions and beliefs about the importance of hand hygiene may encourage healthcare workers to maintain appropriate practices, even when their workload is demanding. Akinwunmi et al. (2021) reported that nurses who demonstrated favourable attitudes towards hand hygiene were more likely to observe proper hand-cleaning procedures consistently. This finding indicates that improving compliance requires more than simply providing information; it also involves encouraging positive attitudes and a sense of responsibility towards infection prevention.

Considering the continued challenges associated with hand hygiene compliance, healthcare institutions in Nigeria need to develop and maintain comprehensive training and awareness programmes that address the practical needs of their healthcare personnel. Findings reported by Nwankwo and Uche (2020) support the importance of targeted educational programmes in improving nurses’ knowledge and practices relating to hand hygiene. Such interventions may contribute to reducing the spread of infections and strengthening the quality of healthcare services.

Furthermore, the physical and organisational conditions within healthcare facilities can influence the ability of nurses to practise effective hand hygiene. Important factors include the availability of functional handwashing facilities, access to clean water and soap, the provision of alcohol-based hand sanitizers, and the existence of institutional policies that encourage compliance. When these resources are inadequate or inaccessible, healthcare workers may find it difficult to follow recommended procedures consistently. Akinwunmi et al. (2021) identified inadequate facilities and resources as potential obstacles to effective hand hygiene. This highlights the responsibility of hospital administrators to ensure that essential supplies and appropriate facilities are readily available to healthcare personnel.

In summary, hand hygiene remains a fundamental component of infection prevention and control, particularly in healthcare environments where patients may be exposed to healthcare-associated infections. Nurses’ knowledge, attitudes, and practices concerning hand hygiene are important determinants of their ability to prevent the transmission of infectious organisms within hospitals. Improving compliance requires a combination of comprehensive educational programmes, positive attitudes, adequate facilities, and supportive institutional policies. Addressing knowledge gaps, encouraging favourable attitudes, and ensuring the availability of necessary resources are therefore essential to strengthening hand hygiene practices at Rivers State University Teaching Hospital. Healthcare facilities should also prioritise regular monitoring and evaluation of compliance to protect both patients and healthcare workers. Studies such as those conducted by Yadav et al. (2022) and Al-Haddad et al. (2021) further emphasise the need for sustained efforts to improve hand hygiene and reduce the burden of healthcare-associated infections within healthcare systems.

1.2 Statement of the Problem

Although hand hygiene is internationally recognised as an essential measure for preventing healthcare-associated infections (HAIs), challenges remain in ensuring that healthcare workers understand and consistently apply recommended procedures. These challenges are particularly relevant in healthcare facilities in Nigeria, where nurses are expected to maintain appropriate hygiene standards while attending to patients under varying working conditions. Despite the availability of established hand hygiene guidelines, concerns persist regarding the factors that influence nurses’ compliance with these procedures at Rivers State University Teaching Hospital (RSUTH). Some existing studies have presented general findings on hand hygiene without sufficiently examining the specific institutional and environmental circumstances that may affect compliance in individual healthcare facilities. This creates a need for research that considers the experiences and challenges of nurses within their actual working environment (Nwankwo & Uche, 2020).

Furthermore, although the World Health Organization (WHO) has provided standard recommendations for hand hygiene, research continues to report inadequate compliance among healthcare workers. This suggests that possessing knowledge of the recommended procedures does not necessarily translate into consistent practical application (Yadav et al., 2022). Much of the available research has concentrated on assessing healthcare workers’ knowledge, with comparatively less attention given to the attitudes they hold and the extent to which these attitudes influence their daily practices. Examining these dimensions together is important for identifying the factors responsible for poor compliance. For example, although Akinwunmi et al. (2021) identified an association between nurses’ attitudes and their hand hygiene practices, further investigation is needed into how institutional conditions, including staffing levels, workload, and the availability of necessary supplies, may affect these attitudes and practices.

Another concern is that some previous studies have used relatively small samples or restricted demographic groups, which may limit the extent to which their findings represent the wider nursing population. Al-Haddad et al. (2021) suggested the importance of using broader and more diverse samples to obtain a better understanding of the factors affecting hand hygiene compliance among healthcare workers. Where research is limited in this regard, the findings may not adequately represent the different experiences of nurses working in various healthcare environments. This can also make it difficult to develop interventions that respond to the specific needs and challenges of individual institutions.

In addition, there is a need for more longitudinal research examining whether educational interventions produce lasting improvements in nurses’ hand hygiene practices in Nigeria. Although some studies have recommended continuous training and professional education as strategies for improving compliance (Askarian & Ghazisaeedi, 2021), the long-term effects of such interventions require further assessment. Without adequate follow-up, it may be difficult to determine whether improvements in knowledge and practice are maintained over time.

Therefore, reducing healthcare-associated infections and improving patient safety in Nigerian hospitals require a better understanding of the knowledge, attitudes, and practices of nurses regarding hand hygiene. There is a need to examine these factors within the specific context of Rivers State University Teaching Hospital and identify the possible barriers affecting compliance with recommended procedures. This study is designed to address these concerns by investigating nurses’ knowledge, attitudes, and practices of hand hygiene at RSUTH. The findings are expected to provide information that may support the development of appropriate interventions for improving compliance and strengthening infection prevention and control within the hospital.

1.3 Purpose of the Study

The primary purpose of this study is to examine the knowledge, attitudes, and practices of hand hygiene among nurses at Rivers State University Teaching Hospital (RSUTH).

The specific objectives are to:

1. Assess the level of knowledge of hand hygiene among nurses at RSUTH.

2. Identify the hand hygiene practices adopted by nurses at RSUTH.

3. Evaluate the effectiveness of hand hygiene practices among nurses at RSUTH in preventing the transmission of infections.

1.4 Research Questions

The study will be guided by the following research questions:

1. What is the level of knowledge of hand hygiene among nurses at Rivers State University Teaching Hospital?

2. What hand hygiene practices are adopted by nurses at Rivers State University Teaching Hospital?

3. How effective are the hand hygiene practices of nurses in preventing the transmission of infections at Rivers State University Teaching Hospital?

1.5 Research Hypotheses

The following null hypotheses will be tested in this study:

1. There is no significant relationship between nurses’ level of knowledge of hand hygiene and their compliance with recommended hand hygiene practices at RSUTH.

2. There is no significant relationship between nurses’ attitudes towards hand hygiene and their hand hygiene practices at RSUTH.

3. Hand hygiene practices have no significant effect on the rate of healthcare-associated infections at RSUTH.

1.6 Significance of the Study

This study is important because it will provide useful information on the knowledge, attitudes, and practices of hand hygiene among nurses at Rivers State University Teaching Hospital (RSUTH). By examining the extent to which nurses understand and comply with recommended hand hygiene procedures, the research will contribute to the existing body of knowledge on infection prevention and control in Nigerian healthcare institutions. It will also provide an understanding of the particular challenges associated with hand hygiene within the hospital, which may differ from those experienced in other healthcare facilities and geographical locations.

The findings will be useful to hospital administrators, healthcare managers, and policymakers. Information on nurses’ level of compliance with established hand hygiene guidelines will enable these stakeholders to evaluate existing infection prevention practices and identify areas that require improvement. The results may also guide the development of appropriate strategies for strengthening compliance. Such strategies could include the introduction of specialised training programmes, improved provision of hand hygiene materials, and the establishment of effective monitoring and evaluation systems. By addressing the challenges identified through the study, hospital management may be better positioned to create an environment that supports effective infection prevention and control.

The research will also be beneficial to patients receiving care at RSUTH. Proper hand hygiene is essential for reducing the risk of transmitting infectious organisms during patient care. By identifying ways to improve nurses’ hand hygiene practices, the study may contribute to reducing the occurrence of healthcare-associated infections within the hospital. This is important because preventing such infections can protect patients from avoidable complications, reduce the need for prolonged hospitalisation, and improve the overall quality of healthcare services. Improved infection prevention practices may therefore contribute to better patient outcomes and a safer hospital environment.

Furthermore, the study will be relevant to nurses and other healthcare professionals by reinforcing the importance of maintaining appropriate hand hygiene standards during clinical activities. The findings may help nurses recognise the relationship between their knowledge, attitudes, and daily practices, while encouraging greater responsibility for infection prevention. The research may also provide a basis for future educational activities and professional development programmes aimed at improving compliance.

Overall, this study has the potentia