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

Abstract

This study examined 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 investigate the relationship between nurses’ knowledge of hand hygiene and their compliance with hand hygiene practices. A structured questionnaire was designed to collect data from a sample of 133 respondents, ensuring a comprehensive assessment of their understanding and execution of hand hygiene protocols. Data analysis was conducted using frequency tables, simple percentages, means, and standard deviations to describe the respondents' characteristics and their responses to the questionnaire items. Additionally, a one-sample t-test was employed to test the stated hypotheses, enabling a statistical evaluation of the relationships between variables under investigation. The findings revealed a high level of knowledge regarding hand hygiene among the respondents, with significant mean differences indicating that nurses perceived hand hygiene practices as critical to infection prevention. The study showed that the majority of respondents reported consistently using alcohol-based hand sanitizers when hand washing was not feasible, highlighting their awareness and adherence to recommended practices.However, the study also identified areas for improvement, particularly concerning the attitudes of nurses towards hand hygiene and their actual practice. While knowledge was generally high, there were discrepancies in reported attitudes and self-reported practices, suggesting that factors beyond knowledge, such as institutional culture and workload, may influence compliance. The t-test results supported the hypothesis that there is a significant relationship between the level of knowledge of hand hygiene and compliance with hand hygiene practices among nurses at RSUTH, with a t-value that far exceeded the critical value at a 5% significance level. This indicated that increased knowledge corresponded with better adherence to hand hygiene protocols. The conclusion drawn from this study emphasized the need for ongoing education and training programs for nurses at RSUTH to reinforce the importance of hand hygiene practices. The findings highlighted that while knowledge is essential, fostering a positive attitude towards hand hygiene and addressing barriers to compliance are crucial for improving practice. Recommendations included regular workshops and seminars on infection prevention, implementation of monitoring systems to assess compliance, and the establishment of a supportive environment that encourages best practices in hand hygiene. Overall, this study contributes to the existing literature on nursing practices and infection control by providing valuable insights into the factors influencing hand hygiene compliance among nurses. It underscores the importance of integrating knowledge, attitudes, and practices to achieve optimal patient care and reduce healthcare-associated infections. Future studies should explore the impact of organizational policies and staff training on the sustained improvement of hand hygiene practices, as well as the role of interdisciplinary collaboration in promoting a culture of safety and compliance in healthcare settings.

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Hand hygiene is recognized globally as one of the most effective measures in preventing healthcare-associated infections (HAIs). Healthcare-associated infections are infections that patients acquire during the course of receiving treatment for other conditions within a healthcare setting, and they are a major challenge in health institutions worldwide. Among healthcare professionals, nurses play a critical role in infection prevention and control, as they are often the primary caregivers in hospitals. Their knowledge, attitude, and practice of hand hygiene are crucial in reducing the transmission of infections to patients, colleagues, and the general public. For instance, a study conducted by Agbede et al. (2021) highlights the need for improved hand hygiene compliance among nurses to effectively mitigate the risk of HAIs in hospital settings.

The World Health Organization (WHO) has emphasized hand hygiene as a key intervention to minimize the spread of infectious diseases, especially in the context of ongoing challenges such as COVID-19 and other communicable diseases. Despite clear guidelines and protocols on hand hygiene, studies have shown that compliance rates among healthcare workers, including nurses, remain suboptimal globally, posing a significant risk in healthcare environments. Yadav et al. (2022) conducted a systematic review demonstrating the positive impact of proper hand hygiene on the health of healthcare workers, suggesting that enhanced awareness and training could lead to improved compliance rates.

Hand hygiene involves washing hands with soap and water or using alcohol-based hand sanitizers to eliminate harmful microorganisms. The effectiveness of hand hygiene depends on the knowledge of healthcare workers about proper handwashing techniques, their attitudes toward infection control, and their regular practice of hand hygiene. A study by Al-Haddad et al. (2021) underscores the importance of knowledge and attitude in influencing compliance among healthcare workers, noting that education on proper hand hygiene techniques can significantly enhance adherence to recommended practices.

In Nigeria, healthcare systems are burdened with high rates of HAIs, and Rivers State University Teaching Hospital (RSUTH) is no exception. Nurses, being at the forefront of patient care in RSUTH, are expected to adhere strictly to hand hygiene practices to prevent the spread of infections within the hospital. This study is aimed at exploring the knowledge, attitude, and practice (KAP) of hand hygiene among nurses in RSUTH to determine the current state of hand hygiene compliance and suggest improvements where necessary. Ayub et al. (2020) found that a significant percentage of nurses in their study reported inadequate hand hygiene practices, indicating a need for targeted interventions to improve compliance in similar settings.

Healthcare-associated infections can lead to severe complications, prolonged hospital stays, and increased healthcare costs, making effective hand hygiene practices essential. A systematic review by Askarian and Ghazisaeedi (2021) supports the argument that educational interventions can significantly improve hand hygiene practices among nurses, suggesting that training programs could be vital in addressing compliance issues.

The role of nurses in infection control cannot be overstated, as they are often the first point of contact for patients. Nwankwo and Uche (2020) emphasized that nurses’ adherence to hand hygiene protocols is directly linked to their knowledge and attitudes towards infection prevention. This correlation highlights the need for ongoing education and support to foster a culture of safety within healthcare settings.

Furthermore, the attitude of nurses towards hand hygiene plays a crucial role in their practice. A study by Akinwunmi et al. (2021) revealed that nurses with positive attitudes toward hand hygiene were more likely to practice proper hand hygiene techniques consistently. This finding emphasizes the importance of not only providing knowledge but also addressing the attitudes of healthcare workers to improve compliance rates effectively.

In light of the persistent challenges in hand hygiene compliance, it is essential for healthcare institutions, particularly in Nigeria, to implement comprehensive training and awareness programs tailored to the specific needs of their healthcare workers. The findings from Nwankwo and Uche (2020) support the idea that targeted educational interventions can enhance nurses’ knowledge and practices related to hand hygiene, thereby reducing the incidence of HAIs in healthcare facilities.

Moreover, addressing the environmental factors within healthcare settings is crucial in promoting effective hand hygiene practices. Factors such as availability of hand hygiene facilities, accessibility of alcohol-based sanitizers, and supportive policies can significantly impact nurses’ compliance with hand hygiene protocols. Akinwunmi et al. (2021) pointed out that inadequate resources and facilities are common barriers to effective hand hygiene, highlighting the need for healthcare administrators to ensure that proper supplies are readily available to healthcare workers.

In essence, hand hygiene is a fundamental aspect of infection prevention and control in healthcare settings, particularly in the context of high rates of HAIs in Nigeria. The KAP of nurses regarding hand hygiene is pivotal in mitigating the risk of infections in hospitals. Comprehensive educational programs and supportive environments are necessary to improve compliance rates among nurses. Addressing the knowledge gaps, fostering positive attitudes, and providing adequate resources will be critical in enhancing hand hygiene practices in healthcare institutions like Rivers State University Teaching Hospital. Continuous monitoring and evaluation of hand hygiene practices should be a priority for healthcare facilities to ensure the safety of patients and healthcare workers alike. The insights gathered from studies, including those by Yadav et al. (2022) and Al-Haddad et al. (2021), underscore the importance of ongoing efforts to improve hand hygiene compliance and ultimately reduce the burden of HAIs in healthcare systems worldwide.

1.2 Statement of Problem

Despite the global recognition of hand hygiene as a vital measure for preventing healthcare-associated infections (HAIs), significant gaps remain in the understanding and implementation of effective hand hygiene practices, particularly among nurses in Nigeria. While various studies have highlighted the importance of hand hygiene in infection prevention, many have not sufficiently explored the underlying factors influencing nurses’ compliance with hand hygiene protocols within specific healthcare settings, such as Rivers State University Teaching Hospital (RSUTH). Existing research often presents generalized findings without delving into the contextual challenges faced by healthcare professionals in local settings, leading to a lack of tailored strategies for improving hand hygiene compliance (Nwankwo & Uche, 2020).

Moreover, while the World Health Organization (WHO) has established clear guidelines for hand hygiene, many studies report suboptimal compliance rates among healthcare workers, indicating a disconnect between knowledge and practice (Yadav et al., 2022). Most research has concentrated on knowledge assessments, leaving a significant gap regarding the actual attitudes and practices of nurses. A thorough investigation of these elements is crucial to identify barriers that hinder adherence to hand hygiene protocols. For instance, while Akinwunmi et al. (2021) noted the correlation between nurses’ attitudes and their hand hygiene practices, they did not explore how institutional factors, such as staffing levels and availability of resources, influence these attitudes.

Additionally, prior studies have often employed small sample sizes or limited demographic representations, which may not accurately reflect the broader nursing population's practices and challenges. Research by Al-Haddad et al. (2021) suggests that broader and more diverse samples are necessary to capture a comprehensive understanding of the factors influencing hand hygiene compliance among nurses. This limitation restricts the generalizability of findings and hinders the development of effective interventions tailored to the unique needs of different healthcare environments.

Furthermore, there is a notable scarcity of longitudinal studies examining the long-term impacts of educational interventions on hand hygiene compliance among nurses in Nigeria. While some studies advocate for continuous education and training (Askarian & Ghazisaeedi, 2021), they often lack a follow-up to assess the sustained effects of these interventions over time.

In summary, to effectively reduce HAIs and enhance patient safety in Nigerian healthcare settings, it is essential to address these gaps through focused research on the KAP of nurses regarding hand hygiene. This study aims to fill these critical voids by exploring the nuanced factors that influence hand hygiene compliance, ultimately informing better strategies for practice improvement.

1.3 Purpose of the Study

The main aim of this study is to explore the knowledge, attitudes, and practices of hand hygiene among nurses in Rivers State University Teaching Hospital. Specifically, the objectives are:

1. To assess the knowledge of hand hygiene among nurses in RSUTH.
2. To demonstrate the hand hygiene practices employed by nurses in RSUTH.
3. To evaluate the effectiveness of hand hygiene practices among nurses in RSUTH.

1.4 Research Questions

This study will be guided by the following research questions:

1. What is the level of knowledge of hand hygiene among nurses in Rivers State University Teaching Hospital?
2. What hand hygiene practices are employed by nurses in Rivers State University Teaching Hospital?
3. How effective are the hand hygiene practices of nurses in reducing the transmission of infections in Rivers State University Teaching Hospital?

1.5 Research Hypotheses

The following hypotheses will be tested in this study:

1. There is no significant relationship between the level of knowledge of hand hygiene and the compliance with hand hygiene practices among nurses in RSUTH.
2. There is no significant relationship between the attitudes of nurses toward hand hygiene and their hand hygiene practices in RSUTH.
3. The effectiveness of hand hygiene practices does not significantly impact the rate of healthcare-associated infections in RSUTH.

1.6 Significance of the Study

This study holds significant importance for various reasons, primarily contributing to the understanding of hand hygiene practices among nurses at Rivers State University Teaching Hospital (RSUTH). By systematically investigating the current state of hand hygiene compliance, the research adds to the expanding body of knowledge surrounding infection prevention in Nigerian healthcare environments. This contribution is crucial, as it offers a detailed perspective on the specific challenges and practices related to hand hygiene within the context of RSUTH, which may differ from findings in other regions or countries.

The insights gained from this study will be invaluable for hospital administrators and policymakers. By revealing the actual compliance levels with established hand hygiene protocols among nurses, the findings can serve as a foundation for decision-makers to assess existing practices and identify areas needing improvement. This information is critical for developing targeted interventions aimed at enhancing hand hygiene adherence. Such interventions could include tailored training programs, enhanced resource allocation, or the implementation of strict monitoring systems. By directly addressing the identified gaps in compliance, hospital management can create a more effective infection control environment.

Moreover, the study's implications extend beyond administrative concerns to directly benefiting patients at RSUTH. It emphasizes the vital role that proper hand hygiene plays in preventing the transmission of healthcare-associated infections (HAIs), which are a major concern in hospitals worldwide. By focusing on improving the hand hygiene practices of nurses, the study has the potential to significantly reduce the incidence of HAIs within the hospital. This reduction is not only crucial for safeguarding patients' health but also for enhancing their overall healthcare experience. Improved hand hygiene practices can lead to better patient outcomes, including shorter hospital stays, reduced morbidity, and enhanced recovery rates.

In essence, this study is poised to influence both clinical practices and administrative strategies at RSUTH. By highlighting the importance of hand hygiene in infection prevention, it aims to foster a culture of safety and vigilance among healthcare providers. The long-term benefits of improved hand hygiene compliance could ultimately lead to a more efficient healthcare system in Nigeria, characterized by enhanced patient safety and quality of care. Thus, the significance of this research lies not only in its immediate findings but also in its broader implications for the healthcare landscape in Nigeria.

1.7 Scope of the Study

This study is limited to Rivers State University Teaching Hospital (RSUTH) and focuses specifically on the knowledge, attitude, and practice of hand hygiene among nurses in the hospital. The study will assess nurses' understanding of hand hygiene principles, their compliance with hand hygiene protocols, and the effectiveness of these practices in preventing the spread of infections within the hospital setting.

The study will involve nurses working in different departments and wards within RSUTH, including surgical, medical, pediatric, and emergency wards. It will not extend to other healthcare professionals such as doctors, laboratory technicians, or non-clinical staff. Additionally, the study will not cover hand hygiene practices outside the hospital environment, such as in community health settings.

1.8 Operational Definition of Terms

For clarity, the following key terms are defined as they will be used in this study:

1. Hand Hygiene: A general term that refers to the cleaning of hands by washing with soap and water or using alcohol-based hand sanitizers to remove dirt, germs, and infectious agents.
2. Healthcare-Associated Infections (HAIs): Infections that patients acquire while receiving treatment in a hospital or other healthcare facility, which were not present at the time of admission.
3. Nurses: Licensed healthcare professionals who provide care to patients in hospitals, including administering medication, monitoring patients’ conditions, and coordinating with other healthcare staff.
4. Knowledge of Hand Hygiene: The level of understanding that nurses possess regarding hand hygiene protocols, techniques, and their importance in infection control.
5. Attitude Toward Hand Hygiene: The perceptions, beliefs, and feelings that nurses hold toward the practice of hand hygiene and its role in preventing infections.
6. Practice of Hand Hygiene: The actual behavior or actions taken by nurses to clean their hands, including frequency, technique, and compliance with established guidelines.
7. Compliance: The extent to which nurses adhere to recommended hand hygiene practices and protocols as outlined by WHO or institutional guidelines.
8. Effectiveness: The degree to which hand hygiene practices succeed in preventing or reducing the transmission of healthcare-associated infections among patients and healthcare workers.