Effect Of Hand Washing On The Prevention Of Infectious Diseases In Public Secondary Schools

Medical and Health Science Project and Seminar Material

Effect Of Hand Washing On The Prevention Of Infectious Diseases In Public Secondary Schools


Abstract


The purpose of the work was to study the effect of hand washing on the prevention of infectious disease among secondary school students in Kaura Ward, Zaria L.G.A. Kaduna. The goal was to know how well the knowledge of hand hygiene is known to the students and their attitudes towards maintaining good hand hygiene and to find possible ways for better adherence. The quantitative research method was used. Questionnaire was divided in 4 sections and distributed to students who were used for the study as respondents. Results from the findings indicated that majority of the students maintained good hygiene prior and after eating. The students also maintain good hand hygiene after using the restroom.The results revealed that although majority of the students wash hands during these cases most of them do not fully know or understand the right procedures and techniques of proper and effective hand hygiene and the right use of alcohol hand rub in the prevention of illness. In the conclusion it came to attention that there is the need for further education for the students on the various procedures of proper hand and personal hygiene to effectively prevent the spread of infection and diseases. It was recommended to hold hand hygiene educational events interesting enough to attract students from all the various fields of study to participate.


Chapter One


Introduction

1.1 Background of the Study

Hand washing is one of the most important aspects of preventing diseases in our country Nigeria; thousand of lives have been lost as a result of diseases caused by in adequate washing of hands. Hand washing or hygiene is the act of cleaning hand with the use of water and soap or other liquid for the purpose of removing soil, dust and or micro-organisms (Centre for Disease Control and Prevention) (CDC) (2013).

CDC (2013) states that hand washing are the act of washing hand with plane soap or detergent containing and antiseptic.

World Health Organization (WHO) (2013), Hand washing is the act of reducing or inhibiting the growth of micro-organism by the application of an antiseptic hand drop or by performing an antiseptic hand washing.

WHO also define hand washing as an act of performing hand hygiene for the purpose of physically or mechanically removing dust, organic materials and micro-organisms.

Hand washing is the first and foremost way of preventing disease which is said to remove or inhibit the growth of micro-organisms as indicated on WHO (2002), hand washing often act of vectors that carry disease causing pathogenic from person to person either through direct contact or indirect contact via surface. Humans can spread bacteria by touching other people’s hands, hair, nose and face. Hand that have been in contact with human faces, bodily fluids like nasal excretion and contaminated food or water can transport bacteria, virus and parasite to unveiling host. Hand washing with soap works by interpreting the transmission of diseases. Washing hand with water alone is significantly less than washing hands with soap in terms of removing germs.

Using soap also means additional time consume during the massaging, rabbis and friction to dislodge them from fingers – tips and between the fingers. In comparing just using water for hand washing, Effective hand washing with soap takes 8 – 15 seconds followed by through rising with running water. According to CDC (2013), your hands are your primary ways of physical interaction with the world around you. As you touch things you pick up germs with hand and touch your face. You may inertly introduce disease causing germs into your body. Hand washing is a simple and effective way to prevent catching or spreading many communicable diseases which include, common cold, food poisoning, respiratory illness and diarrhoea and vomiting etc.

CDC (2013) further indicated that hand washing is one of the best way to prevent the spread of infection and illness in all. Settings and work places to child’s are facilities and Hospitals. Clean hand can stop germs from spreading from one person to another and throughout the community.

According to WHO (2010) in the mid-1800s studies by Igan Z Semmel Wels, in Vierina, Australia and Oliver Wenden Holmes in Boston USA established that hospital acquired diseases were transmitted via the hand of health community workers. In 1847 Semmel Wels was appointed as a house officer in one of the two obstetric clinics at the University of Vienna Allgemeino Kranken (General Hospital). He observed that maternal mortality rate mostly attributed to Puerperal fever, were substantially higher in one clinic compared with other (in 16 percent versus 2 percent).

He also noted that Doctors and Medical students often go directly to the delivery suit after performing autopsies and had a disagreeable odour on their hands despite hand washing with soap and water before entering the clinic.

He Hypothesized therefore, that cadaverous paticidts were transmitted via the hands of doctors and student from autopsy room to the delivery theatre and cause the puerperal.

As a consequence Semmel Wels recommended that hand be scribed in chlorinated line solution before every patient contact particularly after living the autopsy room following the implementation of these measures, the mortality rate fall dramatically to 33% in the clinic most affected and remain low thereafter.

As general rule, hand washing protect people poorly or not at all from drops lifts and airborne diseases such as measles, chicken pox, influenza and tuberculosis. It protects best against diseases transmitted through oral routes.

Certain materials or substances are used in hand washing and preventing diseases spread of illness includes:

  1. Soap and detergent
  2. Ash and mould
  3. Hand antiseptic
  4. Solid antiseptic
  5. Anti bacterial soap
  6. Alcohol – gel

Hand washing with soap (H.W.W.SP) is among the most effective and expensive ways of preventing diarrhea and pneumonia which together are responsible for majority of child death. This behaviour is projected to become a significant contributor to meeting the millennium Development Goals of reducing death among children under the age of five by to third by the year, 2015 October, 15 has been appointed to become global hand washing day in accordance with year 2008 as the International Year of Sanitation by the United Nation & (WHO, 2013).


1.2 Statement of the Problem

Many illness occur unnecessarily since the faces-oral route of disease transmission can be easily prevented (WHO, 2013). Infectious diseases that commonly spread through hand to hand include the common cold and severe gastro-intestinal disorders e.g. diarrhoea, ebola, vomiting (Water Aid. 2006).

Hygiene is without doubt a very important component in the reduction of global diseases burden. Hand washing as an aspect of hygiene has been highly recommended as a simple but effective way of hygiene (hand washing) has a measurable impact on reducing the burden of infection in the developing countries.

Correct hand washing is the single most effective ways to prevent the spread of communicable diseases. Good hand washing techniques are easy to learn and can significantly reduce to spread of infection disease among both adults and children. Hand washing is one of range of hygiene promotions internationally. This research will focus attention on the effects of hand washing in public schools in Kaura Ward of Zaria Local Government Area of Kaduna State.


1.3 Objective of the Study

The aim of the research work is to find out the effect of hand washing on the prevention of infectious diseases in Public Secondary Schools. The specific objectives include:

  1. To find out the level of awareness on the affects of hand washing in prevention of diseases in public secondary schools in Kaura Ward.
  2. To Zaria LGA identify hand washing practices among students in public schools.
  3. To determine the diseases associated with poor hand washing in public secondary schools in Kaura Ward of Zaria Local Government Area Kaduna State.

1.4 Research Questions

  1. What is the level of awareness of the effects of hand washing in prevention of diseases in public secondary schools in Kaura Ward in Zaria Local Government Area of Kaduna State?
  2. What are the hand washing practices among students in public schools in Kaura Ward of Zaria Local Government Area?
  3. What are the diseases associated with poor hand washing practices among students in Public Secondary School in Kaura Ward of Zaria Local Government Area?

1.5 Significance of the Study

The study intends to correct awareness on the effectiveness of hand washing among the students in public secondary schools in Kaura Ward in Zaria Local Government Area of Kaduna State, the following people will benefit from the study.

  1. School children, if the findings of this study are adopted and implemented, this awareness on hand washing will improved and reduce the rate of illness among students in public secondary schools.
  2. To the public when awareness is improved and better hand washing practices adopted it will reduce the rate of transmission of diseases related to poor hand washing among the students and consequently reduce the instance of extending to the public.
  3. To the community the death rate as a result of diseases related to hand washing will fall, the cost of treatment will reduce and the rate of poverty will also reduce. Is there difference between the public/community?
  4. To the Government, the cost of treatment will reduce, their will be reduction in mortality and it will also serve as a literature material in library and instrument for passing information to the general public to know the effect of hand washing.

1.6 Scope of the Study

This study is delimited to the effect of hand washing in prevention of diseases in public secondary schools in Kaura Ward of Zaria Local Government Area of Kaduna State.


1.7 Limitations to Study

The study faced some challenges, however, the major constraints of the study include:

Time:

The researcher did not have enough time to carry out this study coupled with other academic activities. There was constraint of time in going to places where data and information relevant to the study could be obtained.

Finance:

A lot of money is required in data collection, analysis and interpretation. The researcher is constrained financially. Owing to this constraint, the researcher had to select secondary schools in Kaura Ward, Zaria in Kaduna.

Attitude of Respondents:

Some of the respondents showed lukewarm attitude towards the study. This is because there was no financial benefit attached to it. A few others withheld certain information due to confidentiality.


1.8 Operational Definition of Terms

Beliefs:

Belief has been defined as; Mental reliance on or acceptance of a particular concept, arrived at by weighing external evidence, facts, and personal observation and experience. Belief is essentially a subjective feeling about the validity of an idea or set of facts. It is more than a mere suspicion and less than concrete knowledge. Unlike suspicion, which is based primarily on inner personal conviction, belief is founded upon assurance gained by empirical evidence and from other people. (“Belief,” 2008, para. 1)

Hand Hygiene:

PHAC (2012, p. 5) has defined HH as: Encompasses hand washing, hand antisepsis and actions taken to maintain healthy hands and fingernails. Hand washing is the process of using soap and water to remove soil and transient microorganisms from the hands. Hand antisepsis includes either rubbing the hands with alcohol-based hand rub or hand washing with antiseptic soap, to destroy resident and transient microorganisms on the hands.

Health Infections:

The can be defined as; an infection occurring in anyone during the process of exposure to germs, virus or other communicable diseases carriers, which affects the wellbeing of a person as well as hinder participation in productive activities.

Prevention:

The act of stopping something from happening or of stopping someone from doing something.


Chapter Five


Summary of Findings, Conclusion and Recommendation

5.1 Summary of Findings

Hand hygiene is the active process of practically performing hand washing, antiseptic hand-wash, and alcohol-based hand rub. It is also described to be the efficient yet short rubbing of all surfaces of the hands with lathered soap which is then followed with rinsing and cleansing under flowing streaming water (CDC 2013).

The determining purpose of the study was to ascertain the connected amount of knowledge and practice that students in Kaura Ward have although advantages of hand hygiene is obviously known and available information on the topic is easy to find. The pre-dominant goal of the research work is to study the possible problems with proper hand hygiene. In addition, reducing and preventing spread of infections amongst students in the school. In achieving this it became necessary to grasp an understanding of the knowledge of the students in the school related to proper hand hygiene. In order to gain a full scope of the level of knowledge of the school students it was important to develop a layout to embody all departments, year level, age, and gender.

The research method chosen was a quantitative research method and this method of research is used by a range of intellectual fields and disciplines which comprise science, epidemiology and medicine. Depending on the kind and level of precision and incisiveness researchers collect or gather the numbers manually or automatically. In the case of this research the numbers were gathered automatically (Balnaves & Caputi 2001.)

Data was collected through the distribution of questionnaires to the respondents. 285 Questionnaires were sent to the students and 280 responses were received. All questions were closed ended questions. The Theoretical background was based on the recommended criteria which was used and this involves the limitation of the publishing year being in a range of 5 years, how relevant the article chosen was to the study topic, the reliability of the articles, and the key words chosen which were hand hygiene, prevention infectious disease and secondary school students. Hence questions made were supported by relevant articles. The students were asked questions about their age, gender, year of study, and degree program.

Finding articles on hand hygiene and infection prevention in hospitals, health centers and elderly homes were easy since they were related to nurses. Finding articles on hand hygiene in relation with students in the school seemed quite a difficult task. This was because there are very few previous articles to gain knowledge from relating to hand hygiene promotion in universities. Most articles found where those of elementary schools and secondary schools. Few articles in secondary schools are available and this makes this research work one of its kind. It would further go to benefit other researchers who would find interest in looking into the topic further to get previous studies on similar topics. It would also go to help the students and school body identify the minute problems with hand hygiene in secondary schools.

Due to various limitations in the author’s personal life it led to delay in the process management. Although the study delayed, the information derived is of great use and importance, and remains very reliable. The author through the research process has gained a great deal of knowledge pertaining to hand hygiene which will be used in personal life to prevent the spread of illnesses to family, colleagues and all others around. The information in the study goes to benefit the students in the schools and can also benefit any student since it gives general important information on hand hygiene in general and the prevention of infection in universities.

The first research question stated was under what circumstances students in Kaura Ward maintain their hand hygiene. The answer was derived from the questionnaire which indicated that majority of the students in the schools washed hands prior to eating and after eating. The results from the questionnaire also indicated that majority of the participants washed their hands after using the rest room. Majority of the respondents stated that hand washing is a habit but from the results of the questionnaire it was noted that although most of the students understand the importance of hand hygiene majority lack informed methods and procedures in performing proper and effective hand hygiene in the prevention of infection.

The second research question stated was under what circumstances do the students need to maintain their hand hygiene. On a regular day, certain activities require an individual to perform hand hygiene. These activities include changing a baby or elderly diapers, using the toilet, before and after handling food, after sneezing, coughing, or blowing nose, after taking care of someone who is ill or being around them, after throwing garbage away, and after smoking (SAH 2014). Furthermore, there are certain situations and moments in which hand hygiene must be maintained at all cost. Judgement on whether to wash hands in these moments depends on the individual. In situations where there is an instinctual or real danger of transferring microbes from one point of contact to the other by aid of the hands must be assessed by the student since the individual at most times know what he or she has come in contact with during school hours. Having contact with contaminants from infected environment is one of the reasons that leads to the moments when an individual needs to clean the hands by proper hand washing and using alcohol hand rub to prevent carrying harmful pathogens from the hands to other surfaces and objects in the school environment (WHO 2016). Another instance is when there is contact with body fluids such as urine or blood. Hands then must be washed clean and disinfected to prevent spreading any microbes and this is to protect the individual and the school environment from contamination (WHO 2016).


5.2 Conclusion

According to the data received through the questionnaires that were conveyed, students in the school maintained their hand hygiene under three circumstances. These circumstances include maintaining hand hygiene prior to eating or dining, and maintaining hand hygiene after using the restroom. A considerable amount of the students responded that they maintain their hand hygiene prior to eating or dining. This goes to show that majority of the student population are conscious about washing hands and maintaining good hand hygiene before eating. There are situations and moments in which hand hygiene must be maintained at all cost. These moments are situations where there is an instinctual or real danger of transferring microbes from one point of contact to the other by aid of the hands. Having con-tact with contaminants from infected environment is one of the reasons that leads to the moments when an individual needs to clean the hands by proper hand washing and using alcohol hand rub to prevent carrying harmful pathogens from the hands to other surfaces and objects in the school environment (WHO 2016). Another instance is when there is contact with body fluids such as urine or blood. Hands then must be washed clean and disinfected to prevent spreading any microbes and this is to protect the individual and the school environment from contamination (WHO 2016). On a regular day, certain activities require an individual to perform hand hygiene. These activities include changing a baby or elderly diapers, using the toilet, before and after handling food, after sneezing, coughing, or blowing nose, after taking care of someone who is ill, after throwing garbage away, and after smoking (SAH 2013).

It is advised that further education, encouragement and motivation needs to be implemented to get a much higher amount of students to comply to hand washing. Although a majority of the population of students answered yes to washing hands prior to dining it is still necessary that it is enforced into the attitudes of all students. A study on the proper hand washing practices among elementary school students in Selat Nasik-district Indonesia by Setyautami et al. 2015. The study noted that 9 groupings related to hand washing surfaced which connected students washing hands with the use of soap and water in connection with 2 significant incidents. These incidents include moments before the students had to eat and moments after using the restroom. Findings of the study indicated that only a percentage of 40.5 of the respondents performed proper hand washing. It was observed that the obtainability or accessibility of clean water and soap being available at hand washing posts were viewed to be substantial predictors of washing hands properly in occasions when adapted with other influences. The results of the study showed that there was a very low occurrence of proper hand washing amongst the elementary students and hence there is a need of more effective hand washing promotions in schools and the need of better services to boost the prevalence on the right way of washing hands among the students (Setyautami et al 2014).

In regard to the information derived from the questionnaire, a high percentage of the students are informed on circumstances where hand hygiene needs to be maintained. Data showed those students who agreed to wash hands prior to eating or dining which is a positive sign of good hand hygiene amongst the students and ought to be maintained. Maintaining good hand hygiene after eating is also essential but it most depends if the student’s hands, during eating or dining, came in contact with any food or fluids. Students are also advised to maintain their hand hygiene after covering their mouths when coughing. Circumstances where students cover their nose when sneezing require the individual to wash hands immediately, if possible, to avoid being a mode of spread of infection. Students are advised to stay home when ill. Instances and certain situations also tend to be barriers and or levers to the maintaining or performance of proper and effective hand hygiene. These barriers or levers include environmental factors, social/cultural factors, knowledge or skills of students, aftermath consequences, student’s study profession, individual motivation towards hand hygiene, student’s attitude, and memory lapses. These levers or barriers also have an effect on respiratory hygiene in situations where students are ill with a cough or flu. The fundamentals of respiratory hygiene comprise protecting or covering ones mouth or nose by the use of a tissue paper or handkerchief when coughing or sneezing. Also the bending of the elbow into a crook could be improvised to hold back respiratory droplets from contaminating surrounding surfaces (DHS 2016).

Furthermore, tissue papers used in holding respiratory droplets or secretions must be discarded into any close by waste bin immediately after use. It is important to also maintain hand hygiene by washing hands with non-antimicrobial soap and water, using alcohol hand rub, or performing an antiseptic hand wash as soon as hands come in contact with items or surfaces contaminated with respiratory droplets or secretions. Surfaces visible with respiratory secretions should be cleaned with tissue. Alcohol based disinfectants should then be used in cleaning the surfaces after it has been wiped with the tissue (DHS 2016).

There has to be more information and education on the modes and ways microbes are spread and how effective proper washing of hands is in preventing the spread of infections like flu, cold, noro-virus, hepatitis A, viral meningitis and others. Students need to be informed on the minimal time required for alcohol-based hand rub to kill most germs on the hands after use. This information would aid students in the proper application of alcohol based hand rub. Applying and maintaining alcohol hand rub on hands for at least 20 seconds after application is necessary to fully kill any existing germs and transferred infection. Students also need to be informed on the importance of washing and drying between the fingers when washing hands since it is essential for getting rid of moist areas where microbes can hide. Using the same paper for drying of hands after washing to close the tap should be one of the in-formation stressed on for students in the prevention of spread of microbes. Infections or bacteria that cause illness could be spread through several means and ways. There are 5 common ways in which bacteria that cause infection can be spread. Infections can be spread through intestinal action or through faeces.

This is common in cases such as a student having diarrhoea or Hepatitis A. The second most common is by the respiratory tract. This is usually accompanied with lungs, nose, eyes, and mouth secretion most commonly in disease cases such as common cold or influenza. The third common way is through direct or indirect contact. This occurs in a situation where there is skin contact, coming in contact with infected body fluids, or through sexual contact. This is most common in in-stances where the infected individual is suffering from bacterial skin infections like scabies, or impeti-go. Indirect contact involves the contracting of infection by means of coming in contact which inani-mate object infected with the bacteria. These inanimate objects may include pencils, handkerchiefs, cutleries, door knobs, tables, chairs and other surfaces that have been contaminated by infections such as the influenza virus and the common cold. The forth way of being infected is by coming in contact with contaminated blood with illness such as HIV AIDS, Hepatitis B, and Hepatitis C. The fifth is by eating or swallowing contaminated food or water in cases of food poisoning (PHMCDG 2014).

Hand washing may seem to be an easy task but certain measures are essential to follow in order to decrease the amount of microbes on hands in preventing infection. The steps necessary to be followed includes first to take away any rings or bracelets from the wrist or fingers and wet the hands with water. Then soap is added and all folds and surfaces of the hands including the back of the hand nails must be lathered and cleaned with the soap for not less than 15 seconds. The hands are then rinsed under flowing water in a rubbing movement. Once all visible foam or slippery soapy feeling on the hands is off, dry hands gently to prevent breaking the skin with paper towel or any clean towel. The tap is then turned off using the paper towel to prevent recontamination of your fingers after wash. In cases where public restrooms are used the paper towel can be used to open the door on your way out after washing hands (Health Canada 2014).

Further studies can be done on researching on which group of students in the school require more education and knowledge on these hand hygiene facts in respect to study courses. This could help narrow down and bring more light on which campus, department or bachelor degree students require further education and motivation in maintaining hand hygiene.


5.3 Recommendations

Based on the findings of the study, the following recommendations are made

  1. The awareness of hand hygiene as a means of disease prevention and other benefits should be made known to students, via seminars, conferences, workshops; sharing of informative materials etc. This is to help make the necessary information available to the students.
  2. Health related information should be made compulsory for students on campus to enable a better living and learning environment.
  3. Students should be properly informed and encouraged to make use of certain health materials such as hand sanitizers, hand towels, tissues etc. for better hand hygiene. This should be accompanied by provision of the necessary materials by the school authorities sufficiently for the students use.

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