1. Hand Hygiene Knowledge & Practices Among
Healthcare Providers in a Tertiary Hospitals
Author:
Timothy A Ekwere
Ifeoma P Okafor
Presented By :
Dr. Md. Masum Billah
PG11-30-14-020

2. Mr. X was admitted into hospital with severe
abdominal pain and vomiting. He had to undergo
emergency operation. The surgeon conclude
that the operation was successful. Mr. X was
counting days to go home. Unfortunately, on the
4th
post operation days, he developed fever and
need to stay longer in the hospital. He was
suspected to get hospital acquired infection –
nosocomial infection, which is more difficult to
treat even with the newest antibiotic.

3. Research Questions
• How doctors/nurses perceived hand washing
practice during their work?
• What are factors related to hand washing
practice?
• What are the barriers of hand washing
practice for HCPs in hospitals?

4. Objectives
• To assess the knowledge , attitude and practice
of this simple intervention “hand washing ”.
• To explore doctors’ understanding about hand
washing practice and hospital acquired infection
• To identify the hand-drying methods commonly
used by the Health Care Providers.
• To identify factors that motivate and militate
against hand washing practices amongst HCPs in
hospitals.

5. Background
• Proper Hand Hygiene is an important for
prevention of Nosocomial Infections:
 Study giving a response rate  86%
 Had good knowledge : 83% Good Attitude
97.6% , good Hand washing practices  69.9%
Hand washing →After contact with patient 97.7%
And Before 61.4%

6. Background
• Reason for Improve hand hygiene among
health workers (physicians, nurses, medical
residents & medical students):
 Training on infection control on HCPs knowledge
and practices.
 Most commonly used Running tap water with
antiseptic rub (68.4%), Air dry (29.5%) , Personal
handkerchief (28.8%), Common cloth towel
(22.6%).

7. Background
• Lagos University Teaching Hospital launched
Infection Control Committee which is chaired
by the Head of Microbiology Department:
 effort to reduce nosocomial infections.
 Organizes seminars , training on various
aspects of infection control.
→Provide hand drying facilities : wash basin put
in accessible location to encourage HCPs wash
their hand, a poster was placed near basin as
a reminder of ideal way of washing hand.

8. Knowledge “gap”

9. Conceptual Framework

10. Conceptual Framework
LOGISTIC
• Number of
water point
• Access to
water point
• Water
availability
• Soap
availability
TIME
• number
of patient
• working
hours
ENVIRON-
MENTAL
• different
stressor to
hand washing
practice
between
departments
(ex: surgical VS
medical)
PSYCHOLO-
GICAL
• ignorance
• doubting
the
necessity
of practice

11. Study Sites & Duration
• Study was conducted at the Lagos University
Teaching Hospital (LUTH).
• Reason to select a foremost tertiary referral
centre providing patient care to residents of
Lagos & neighbouring states.
• The hospital has 761 Bed spaces ,25 in-patient
wards including ICU, 654 Doctors & 734 Nurses
at the time of study.
• Study time : August 2011

12. Methodology
• Each wards provided Running Tap Water,
Soap, Cloth Towel for hand drying.
• Stored water in plastic drums and buckets are
provided as alternative source of water
supply.
• Organizes Individual Departments seminars/training
on infection control of their staff.

13. Study Design and Population
→ This was a Cross-Sectional Descriptive Study.
●Study Population were Health Care Providers
working in LUTH :
Only Doctors and Nurses who were working
minimum one year with hospital.
Other medical & non-medical personnel were
excluded.

14. Sampling Method
• Sample Size was calculated using the Formula
for Descriptive Studies :
 Equal proportion of Doctors And Nurses were recruited .
 List of all doctors & nurses who were on duty in the wards in
the month of study.
 By Simple Random Sampling , using computer generated
random numbers,20HCPs (10+10) X 25 in-patient wards.
 Total Sample size (n)=500

15. Data Collection
Data Collection was done in August 2011 using
• Pretested.
• Structured.
• Self administered Questionnaire.
Questionnaires delivered to the respondents
and instructed to drop them at a designed
collection point in the ward.

16. Data Analysis
 Used SPSS software Version 11.5 and Microsoft Excel.
 Used Chi Square and Student t-test (level of significance at
5% )
 Knowledge & Practice scored in Percentages and Grade .
 Score 0-33.3% Poor ; 33.3%-≤66.6% Fair ; 66.6% Good.˃ ˃
 Attitude was assess with Liker items ; rated scale –Strongly
agree =5 ,Agree=4, Neutral=3, Disagree=2, Strongly
disagree=1.

17. Ethical Issue
• Ethical approval obtained from the Ethics &
Research Committee (ERC) of the hospital.
• Formal consent obtained from the
respondents prior to research.

18. Predetermined categories
Predetermined
categories /
templete as shown
in conceptual
framework
Templete
TEXT
Identify units
Revise Categories
Interpretively determine
connections
verify
REPORT

19. Timeline
Task
month
1 2 3 4 5 6 7 8 9 10 11 12
Approval for ERC
Instrument development
Recruitment and training
Data collection
Pretested
Structured
Administered Questionnaire
Observation
Data transcription
Data coding & analysis
summary report writing
Draft manuscript
Final report

20. Budget
item US$/month No. of staff month amount (US$)
Personnel
principle investigator 1,000 1 12 12,000
senior research officer 700 2 12 16,800
field research officer 500 3 12 18,000
Logistic* 5,000
Travelling 4,000
Total direct budget 55,800
20% overhead of direct
budget 11,160
TOTAL BUDGET 66,960
*logistic: computer, software, recorder, portable HD, camera, mobile bill,
stationaries

21. References
• 1. Pittet D, Hugonnet S, Harbarth S, et al. Effectiveness of a hospital-wide
programme to improve compliance with hand hygiene. Infection control
Programme. Lancet 2000; 356: 1307-1312.
http://dx.doi.org/10.1016/S0140-6736(00)02814-2
• 2. Albert RK, Condie F. Hand washing pattern in medical intensive care units. N
Engld Med 1981; 304: 1465-1466.
http://dx.doi.org/10.1056/NEJM198106113042404
• 3.Pittet D, Mourouga P, Pemeger TV. Compliance with hand washing in a teaching
hospital infection control programme. Ann Intern Med 1999; 130: 126-130.
http://dx.doi. org/10.7326/0003-4819-130-2-199901190-00006
• 4. World Health Organization (WHO). Practical guidelines for infection control in
health care facilities. Geneva, WHO 2004; Annex 1: 76-80.

22. Acknowledgement
Professor Dr. Harun-Ar-Rashid
MD, MSc, MPH, PhD, FRCP Edin, MBA
Professor of Public Health & Research Management
and Director, Research & International Collaboration
State University of Bangladesh
Former Director Bangladesh Medical Research Council
and
All Participants