Attitude And Knowledge Of Nurses And Health Attendance Towards Hand Washing

Project and Seminar Material for Nursing (Science)

Attitude And Knowledge Of Nurses And Health Attendance Towards Hand Washing


Abstract


A cross sectional study was carried out at Uniuyo Teaching Hospital, Nigeria to assess the knowledge and practice of nurses and health attendants towards hand washing. A descriptive design was employed and 30 (thirty) respondents were selected to the study using convenient sampling procedure. Data was collected using a questionnaire.
At large, respondents were highly aware and knowledgeable about hand washing. For instance, all of the respondents 30 (100%) had ever heard about hand washing and understood it clearly, 30 (100%) reported possessing adequate knowledge about hand washing as well as most 20 (67%) being aware of the recommended procedure for effective hand washing. Furthermore, the majority 20(67%) reported that they had never received education and sensitization workshops on how to ensure effective hand washing.

Furthermore, 12 (40%) respondents reported disinfectant as one of the necessities for effective hand washing, followed by 7 (23.3%) who mentioned water, 6 (20%) reported good hand washing practice while the least 5 (16.7%) reported hand washing facilities.

Respondents generally had poor practices towards hand washing and although most 20 (66.7%) regularly carried out hand washing. These poor practices were perhaps attributed to various factors including 20 (66.7%) were sometimes adequately provided with the equipment and resources to carry out effective hand washing, followed by 6 (20%) who were always provided with the equipment and resources while the least 4 (13.3%) were never provided with the resources and equipment. Results showed that 21 (87%) reported that the location of scrubbing facilities affected their hand washing practices while the least 4 (13%) said location of scrubbing facilities did not affect hand washing practices.

In conclusion, the study found out that although respondents were aware and had adequate knowledge about hand washing, their practices towards hand washing were largely affected by various factors such as poor location of sinks, availability of running water and lack of CME among others.


Table of Content


Chapter One:

Introduction

  • 1.1 Background of the Study
  • 1.2 Problem Statement
  • 1.3 Purpose of the Study
  • 1.4 Objectives of the Study
  • 1.5 Research Questions
  • 1.6 Justification of the study
  • 1.7 Scope of the Study
  • 1.8 Definition of Terms
  • 1.9 Limitations of the Study
  • 1.10 Organization of the Study

Chapter Two:

Review of Related Literature

  • 2.1 Conceptual Review
  • 2.2 Theoretical Review
  • 2.3 Summary

Chapter Three:

Research Methodology

  • 3.1 Introduction
  • 3.2 Study Design and Rationale
  • 3.3 Study Setting and Rationale
  • 3.4 Study Population
  • 3.4.1 Sample Size
  • 3.4.2 Sampling Procedure
  • 3.4.3 Inclusion Criteria
  • 3.5 Definition of Variables
  • 3.6 Research Instruments
  • 3.7 Data Collection Procedure
  • 3.7.1 Data Management
  • 3.8 Data Analysis and Presentation
  • 3.9 Ethical Considerations
  • 3.10 Dissemination of Results

Chapter Four:

Data Analysis and Result Presentation

  • 4.1 Data Presentation
  • 4.2 Summary of Findings

Chapter Five:

Discussion, Conclusions, Recommendations and Nursing Implications

  • 5.1 Introduction
  • 5.1.1 Discussion
  • 5.2 Conclusion
  • 5.3 Recommendations
  • 5.4 Implications to Nursing Practice
  • REFERENCES
  • APPENDIX

Chapter One


Introduction

1.1 Background of the Study

This chapter presented the introduction, problem statement, purpose of the study, specific objectives, research questions and justification of the study.

Hand washing or hand hygiene is the act of cleaning one’s hands with or without the use of water or another liquid, or with the use of soap for the purpose of removing soil, dirt, and/or microorganisms (Cowling and Benjamin, 2009).
Hand washing prevents cross-infection in hospitals, but health-care workers’ adherence to hand washing guidelines is poor, yet easy, timely access to both hand hygiene and skin protection was necessary for satisfactory hand hygiene behavior (Erasmus, Daha, Brug, Richardus and Behrendt, 2010).

Hand washing was effectively carried out through hand washing with soap or scrubs such as ethyl alcohol scrub which is a psychoactive, volatile, flammable, colorless liquid used medically as a hand sanitizer (Pittet, 2011). Alcohol-based hand rubs are better than traditional hand washing as they require less time, act faster, are less irritating and contribute to sustained improvement in compliance associated with decreased infection rates (Doebbeling, Stanley, Sheetz, Pfaller and Houston, 2012).

Globally, the Center for Disease Control (CDC, 2014) reported that 33% of health care associated infections could be prevented with better infection control programs and the single most important action a health worker could do to reduce the spread of infection was better hand hygiene (Kampf, 2007). For instance, in USA and Germany, health workers effectively carried out hand washing as recommended because of the presence of well-developed health care systems as well as monitoring during provision of health care services.

In Sub Saharan African countries such as Nigeria and Ghana, hand washing knowledge and practices varied among health workers and institutions with previous research showing that in health care facilities with strict hand washing and monitoring policies, the practice was well carried out (Larson, Cohen and Baxter, 2012). However, in government owned and controlled institutions, which are at times burdened with lack of resources and equipment, understaffing and heavy workload, this practice was often under looked (Scheithauser, Haefner, Schwarz, Schulze-Steinen and Schiefer, 2009).

Similarly, in East African countries such as Kenya and Tanzania, hand washing practice among Nurses was greatly affected and hindered by various factors including knowledge deficit, negative attitudes as well as health facility related factors such as lack of running water, poor provision of soap and alcohol scrubs as well as heavy workload among many other factors (Pittet, Hugonnet, Harbarth, Mourouga and Sauvan, 2010).

In Nigeria, the Ministry of Health (MoH) recommends the use of ethyl alcohol scrub gel as it kills a broad spectrum of pathogenic micro-organisms quickly and effectively without the need for water and soap and this was very effective for health care professionals since they are always more in contact with infectious matter. However, effective hand washing was not always ensured as Nurses encountered various factors such as lack of running water, poor provision of hand washing detergents (Ejemot, Ehiri, John, Meremikwu and Critchley, 2009).


1.2 Problem Statement

Hand hygiene has been considered the most important tool in Nosocomial Infection (NI) control, however, despite the effectiveness of hand hygiene in killing germs and other microorganisms and its widespread use in health facilities in Nigeria, it was not often used adequately and consistently due to various factors such as inadequate knowledge on the right duration of hand washing (Boyce, 2007).

Globally, in countries such as USA and Germany, health workers effectively carrried out hand washing as recommended because of the presence of well-developed health care systems as well as monitoring during provision of health care services while in Sub Saharan African countries such as Nigeria and Ghana, hand washing knowledge and practices varried among health workers and institutions with previous research showing that in health care facilities with strict hand washing and monitoring policies, the practice was well carried out (Larson, Cohen and Baxter, 2012).

Various efforts were made by the administration of Uniuyo Teaching Hospital to offer regular CME about hand washing and the prevention of nosocomial infections through adequate and efficient use of methods such as hand washing/hand hygiene, however, nurses have not fully observed the use of this practice or procedure which showed there was lack of knowledge about the outcome of hand washing.

If nothing was done to assess the knowledge and practices of Nurses/Midwives towards hand washing, the concerned authorities would not know of any knowledge and practice gaps towards hand washing or the reasons as to why effective hand washing, despite its many advantages may not be carried out by health staffs.


1.3 Purpose of the Study

To assess the knowledge and practices of nurses and health attendants towards hand washing at Uniuyo Teaching Hospital, Nigeria in an effort to help come up with measures for professionals to know and practice hand washing.


1.4 Objectives of the Study

  1. To find out the knowledge of nurses and health attendants about hand washing at Uniuyo Teaching Hospital, Nigeria.
  2. To assess the practices of nurses and health attendants towards hand washing at Uniuyo Teaching Hospital, Nigeria.

1.5 Research Questions

  1. What is the knowledge of nurses and health attendants about hand washing at Uniuyo Teaching Hospital, Nigeria?
  2. What are the practices of nurses and health attendants towards hand washing at Uniuyo Teaching Hospital, Nigeria?

1.6 Justification of the Study

This study found out the knowledge and practice of Nurses and health attendants about hand washing. This may assist the administration of Uniuyo Teaching Hospital to come up with measures to improve upon hand washing practices among their health staffs.

The findings may also assist the Ministry of Health as well as policymakers’ understanding of the factors influencing hand washing as well as the knowledge and practices towards hand washing among Nurses and health attendants.

This may assist them to come up with measures such as promotion and funding of CME programs to improve skill levels as well as hand washing practices.

Health workers would be able to implement hand washing as a practice and have knowledge in ensuring infection prevention.

The study also provided a valuable point of reference for researchers carrying out similar studies in future and also contributed to the available literature on the knowledge and practices of Nurses and health attendants towards hand washing.


1.7 Scope of the Study

The study was limited to the Uniuyo Teaching Hospital and health professionals on hand washing, with special reference to the management and administrative issues in Uniuyo Teaching Hospital in Nigeria from the perspectives of the attitude and knowledge of hand washing among midwives and nurses.


1.8 Definition of Terms

Hand Washing

Hand Washing is the act of cleaning one’s hands with or without the use of water or another liquid, or with the use of soap for the purpose of removing soil, dirt, and/or microorganisms

Ethyl Alcohol

Ethyl alcohol is a psychoactive, volatile, flammable, colorless liquid which is used medically as a hand sanitizer.

Knowledge

This is the data, facts or information an individual has gained from learning or experience about hand washing.

Practice

This refers to daily, random acts performed repeatedly by an individual


1.9 Limitations of the Study

The researcher encountered financial constraints in gathering information from the internet and libraries and printing costs. The researcher overcame this limitation by drawing up a budget which was strictly followed to utilize the available means.

The researcher also encountered time constraints in the course of the study, balancing the research study and other demanding works. The researcher overcame these limitations by drawing up a timetable which was strictly followed to overcome the time barriers.


1.10 Organization of the Study

This study is divided into five chapters.

  • Chapter one is introduction which consists of the background to the study, statement of problem, research questions, research hypotheses, objectives of the study, the significance of the study, the scope and limitations of the study and finally the organization of the study.
  • Chapter two deals with the literature review which consists of the conceptual literature, theoretical literature, empirical literature, theoretical framework.
  • Chapter three gives the research methodology including research design, population of study, sample size, sampling technique, method of data collection, instrument of data analysis, method of data analysis, validity/reliability of instrument.
  • Chapter four is presentation and analysis of data, discussion of findings.
  • Chapter five gives the summary, conclusion and recommendations.

Chapter Five


Discussion, Conclusions, Recommendations and Nursing Implications

5.1 Introduction

This chapter presented the discussion of findings, conclusions, recommendations and Implications of the study.

5.1.1 Discussion
5.1.2 Demographic and Social Characteristics

Most respondents 18 (60%) were Nurses while the least 12 (40%) were midwives. This was expected as it was these cadres which mostly interacted with patients and hence needed to possess sufficient knowledge and practice of hand washing.

Results showed that 11 (36.7%) respondents had 2 – 3 years of experience, 10 (33.3%) had more than 4 years of experience which implied that respondents had ample experience and would thus be better placed to ensure effective hand washing practice.

5.1.3 Knowledge of Nurses and health attendants about hand washing

All of the respondents 30 (100%) had ever heard about hand washing. All of the respondents 30 (100%) understood hand washing as the act of cleaning one’s hands with or without the use of water or another liquid, or with the use of soap for the purpose of removing soil, dirt, and/or microorganisms. This implied that since most respondents were aware of and possessed sufficient knowledge about hand washing, they would endeavor to effectively carry out hand washing during the provision of health care services.

Most respondents 12 (40%) reported prevention of infection as a benefit of hand washing, followed by 10 (33.3%) who reported promoting cleanliness while the least 8 (26.7%) mentioned treating disease/infection as a benefit with 12 (40%) respondents reporting disinfectant as one of the necessities for effective hand washing, followed by 7 (23.3%) who mentioned water, 6 (20%) reported good hand washing practice while the least 5 (16.7%) reported hand washing facilities. This implied that since respondents were aware of the benefits of hand washing as well as what to use for hand washing, they would ensure that it was effectively carried out.

Results showed that most respondents 20 (67%) reported being aware of the recommended procedure for effective hand washing while 10 (33%) of the respondents were not aware of the recommended procedure. All of the respondents 30 (100%) reported that the recommended hand washing procedure included putting disinfectant in the hands, scrub them together including the nails and up to the elbow for 30 seconds afterwards rinse and dry on aseptic napkin which implied that since respondents were aware of the recommended hand washing procedure, they would ensure it is effectively carried out. This study finding was in agreement with Kampf and Kramer (2008) who documented in their study about the epidemiologic background of hand hygiene and evaluation that most respondents interviewed had adequate level of knowledge about hand washing as well as how to effectively carry out hand washing to achieve infection control and prevention.

Most respondents 20 (67%) reported that they had never received education and sensitization workshops on how to ensure effective hand washing. This implied that since most respondents did not regularly receive CME, it may greatly affect their hand washing practices. This study was not different from the study by Girou, Loyeau, Legrand, Oppein and Brun-Buisson (2007) who reported in their study about the efficacy of hand rubbing with alcohol based solution versus standard hand washing with antiseptic soap that most respondents had poor practices towards hand washing. It was noted that this poor hand washing was attributed to inadequate provision of CME on effective hand washing practice and infection control among other factors.

Half of the respondents 15 (50%) strongly agreed that hand washing is effective for hand disinfection, followed by 10 (33.3%) respondents who agreedwhile the least 5 (16.7%) respondents disagreed. Results showed that 12 (40%) respondents reported disinfectant as one of the necessities for effective hand washing, followed by 7 (23.3%) who mentioned water, 6 (20%) reported good hand washing practice while the least 5 (16.7%) reported hand washing facilities which demonstrated that respondents were fully aware of the importance of hand disinfection. It also implied that since respondents were aware of the importance of hand disinfection, they would ensure that it was effectively carried out. This study finding was in agreement with Ejemot, Ehiri, John, Meremikwu and Critchley (2009) who mentioned in their cochrane review about hand washing for preventing diarrhea that most respondents interviewed had adequate knowledge about hand washing as well as the importance of ensuring effective hand washing including the prevention of nosocomial infections.

5.1.4 Practices of Nurses and health attendants towards hand washing

Results showed that majority 20 (66.7%) of respondents regularly carried out hand washing, which was expected as respondents provided health care services and hand washing was one of the principles of providing quality health care services. However, a significant number did not carry it out as recommended which put their health and that of their patients at risk.

Most respondents 20 (66.7%) were sometimes adequately provided with the equipment and resources to carry out effective hand washing, followed by 6 (20%) who were always provided with the equipment and resources, which implied that provision of required resources and equipment was not guaranteed and this directly influenced hand washing practices among health workers. This study was in agreement with Meengs, Giles, Chisholm, Cordell and Nelson (2010) in their study about hand washing frequency in an emergency department noted that most respondents had poor practices towards hand washing and this included poor provision of necessary resources such as running water and hand scrubs.

Results showed that 21 (87%) reported that the location of scrubbing facilities affected their hand washing practices, which implied that location of sinks directly influenced the practices of health workers towards hand washing. This study finding is consistent with Pittet (2011) who reported in a study about compliance with hand disinfection and its impact on hospital-acquired infections that most respondents had poor practices towards hand washing. The poor hand washing practices were attributed to various factors including poor location of sinks. It was revealed that poor location of sinks often made it impossible for Nurses and health attendants to carry out effective hand washing if they had to leave their duty stations to carry out the procedure.

Most respondents 15 (50%) recommended providing regular CME on hand washing, followed by 10 (33.3%) respondents who recommended ensuring provision of all required resources and equipment while the least 5 (16.7%) recommended providing running water. This showed that respondents were aware of what had to be done to improve hand washing in the study setting.


5.2 Conclusion

In conclusion, respondents were highly aware and knowledgeable about hand washing. For instance, all of the respondents had ever heard about hand washing and understood it clearly and reported possessing adequate knowledge about hand washing as well as most being aware of the recommended procedure for effective hand washing. Furthermore, majority of respondents never received education and sensitization workshops on how to ensure effective hand washing.

These poor practices were perhaps attributed to various factors including inadequate provision of equipment and resources, poor provision of running water in the ward/department, poor location of sinks in the ward/department yet most reported that the location of scrubbing facilities always affected their hand washing practices.


5.3 Recommendations

5.3.1 Recommendations to the Ministry of Health
  1. The Ministry of Health should improve upon the available sensitization campaigns and programs about hand washing as well as the importance of hand washing.
  2. The Ministry of Health should further endeavor to provide literature and guidelines to health facilities to help guide hand washing practices.
5.3.2 Recommendations for administration of Uniuyo Teaching Hospital
  1. There is need for the administration of Uniuyo Teaching Hospital to always ensure regular provision of CME to all health staffs in an effort to improve hand washing practices.
  2. The hospital should employ adequate levels of staff to enable a favorable health worker-patient ratio and also favor hand washing practices.
  3. There is need to ensure timely and regular provision of required resources and equipment to promote and encourage hand washing.
  4. The hospital administration should also endeavor to adequately position washing equipment such as sinks as poor location affects hand washing practices.
5.3.3 Recommendations for health workers at Uniuyo Teaching Hospital
  1. The health workers at Uniuyo Teaching Hospital should endeavor to attend regular CME on hand washing in an effort to improve their practices and skills.
  2. Health workers should ensure that they strictly adhere to hand washing guidelines and ensure they wash their hands after examining each patient or after each procedure.
5.4 Implications to nursing practice

The implications of these findings to the nursing practice include the following:

Nurses and health attendants have an important role to play in improving the quality and safety of the health care services provided. This can be ensured through carrying out regular and effective hand disinfection which helps prevent spread of hospital acquire infections.


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