This study aimed to identify predictors of hand hygiene practice among Saudi nursing students. A survey of 198 nursing students assessed their knowledge, attitudes, and practices of hand hygiene. The students demonstrated moderate knowledge but most had moderate attitudes toward hand hygiene. Having a good attitude, being male, awareness that hand hygiene prevents infections, attending trainings, and being at a lower academic level predicted better hand hygiene practices. The study emphasizes the importance of ensuring positive attitudes and awareness to improve hand hygiene.
Inadequate management of asthma can lead to physical handicap and death. The study aimedto assess knowledge and practice of
asthmatic participants for use meter dose inhaler device. A descriptive study involved 105 participants, conducted at public
hospitals in Khartoum state from July to October2014. Questionnaire and observational check list were used for data collection.
The study enrolled (51%) female and (49%) male. Most of participants their age group ranged, between 36 to 45 years, (35%)
were workers and (31%) received University education while 44 % had a chronic asthma. Level of participant’s knowledge was a
very good regard care and storage of the device; sequent (77% - 79%). There were(64%) had moderate level of knowledge for
preparation dose (69%) replacing inhaler device and cleaning mouthpiece (60%), while 56% had very poor knowledge to rinse
mouth after puff. A highly significant difference between the level of knowledge and education (P value<0.001) regard replacing
the inhaler device, and cleansing mouthpiece. All participants demonstrated correct technique of using inhaler device, position,
removed, pressed replacement the cap, shaking inhaler device and took deep breath. While half of them had moderate skill level
for opened mouth technique, continuous breathing and rinsed mouth after puffuse, and fewer of participants had poor technique
during repeating the puff. Most of participants reflected moderate to poor level of knowledge and have very good practice for
correct used inhaler meter device; this reveals the discrepancy between knowledge and practice.
Inadequate management of asthma can lead to physical handicap and death. The study aimedto assess knowledge and practice of
asthmatic participants for use meter dose inhaler device. A descriptive study involved 105 participants, conducted at public
hospitals in Khartoum state from July to October2014. Questionnaire and observational check list were used for data collection.
The study enrolled (51%) female and (49%) male. Most of participants their age group ranged, between 36 to 45 years, (35%)
were workers and (31%) received University education while 44 % had a chronic asthma. Level of participant’s knowledge was a
very good regard care and storage of the device; sequent (77% - 79%). There were(64%) had moderate level of knowledge for
preparation dose (69%) replacing inhaler device and cleaning mouthpiece (60%), while 56% had very poor knowledge to rinse
mouth after puff. A highly significant difference between the level of knowledge and education (P value<0.001) regard replacing
the inhaler device, and cleansing mouthpiece. All participants demonstrated correct technique of using inhaler device, position,
removed, pressed replacement the cap, shaking inhaler device and took deep breath. While half of them had moderate skill level
for opened mouth technique, continuous breathing and rinsed mouth after puffuse, and fewer of participants had poor technique
during repeating the puff. Most of participants reflected moderate to poor level of knowledge and have very good practice for
correct used inhaler meter device; this reveals the discrepancy between knowledge and practice.
Health problems associated with the consumption of foods that do not meet the hygiene and epidemiological standards are not of recent date and have been occurring continuously throughout the history of human existence. The incidence of food poisoning and foodborne transmissible diseases is three times more common in-home kitchens and households. Restaurant poisoning generally involves a larger number of people, whereas a home-based one involves individuals or a small number of people, so its likelihood of identification by the competent authority or public health organizations and services are significantly smaller. The development of the household food safety questionnaire (HFSQ) for the general population went through five phases (preparation of the questionnaire, distribution of the questionnaire to panelists and then the respondents, statistical analysis and the formation of the final version of the validated questionnaire). A total of 58 particles that formed the basis of the questionnaire were divided into four segments: demographic (10), knowledge (17), opinion (14) and food safety practice (17). Overall, the validity of the questionnaire in examining practice, knowledge and attitude was determined with Cronbach’s alpha = 0.842. The total number of particles adequate for the questionnaire is 29 questions. This questionnaire is a good instrument for assessing the knowledge, attitudes and practices of food handlers in their households.
Daniel Maestro, Arzija Pašalić, Sabina Šegalo and Amar Žilić. “Development and Validation of the Household Food Safety Questionnaire” United International Journal for Research & Technology (UIJRT) 1.3 (2019): 24-32.
Journal Club presentation in Nursing ResearchDhara Vyas
Journal presentation in Nursing Research,
Study of knowledge, attitude, anxiety & perceived mental healthcare need in Indian population during COVID-19 pandemic
Covid-19
Abstract
Introduction
Methodology
samples
Analysis
This presentation highlighted the process that the MoH in Oman used to build consensus on the importance of establishing the role of NP in Oman. All of what has been presented could be used by other health systems especially in GCC
Knowledge and Practice of Documentation among Nurses in Ahmadu Bello Universi...iosrjce
IOSR Journal of Nursing and health Science is ambitious to disseminate information and experience in education, practice and investigation between medicine, nursing and all the sciences involved in health care. Nursing & Health Sciences focuses on the international exchange of knowledge in nursing and health sciences. The journal publishes peer-reviewed papers on original research, education and clinical practice.
By encouraging scholars from around the world to share their knowledge and expertise, the journal aims to provide the reader with a deeper understanding of the lived experience of nursing and health sciences and the opportunity to enrich their own area of practice. The journal publishes original papers, reviews, special and general articles, case management etc.
Audience of presentation learnt about the health care system in Oman with focus on the Health Vision 2050. Also, it delineated the six strategic directions of the vision of nursing services at the MoH in Oman.
A Study to Assess the Knowledge and Practices of Hand Hygiene among Nursing S...ijtsrd
Topic A study to assess the Knowledge, And Practice of Hand Hygiene among Nursing Staff in different department of the Hospitals in Uttar Pradesh. Background of the study Health care associated infections persist as amajor problem in health care settings especially Intensive Care Units. Hand hygiene is the most simple and effective method for the prevention of these healthcare associated infections. So, assess the reported hand hygiene practices and observing is very much important to find out gaps, plan remedial measure to reduce HAIs. Hand hygiene practice is still burdened by inadequate compliance, whether in the professional sphere by health professionals or in the non professional sphere by lay population Aims of the study A. To assess the hand hygiene practices among nurses B. To assess the reason for non compliance. Material and method This study was conducted in different department of Fatima hospital. It was an observational, study50 different professional categories nurses were taken for observational study, 50 for assess the reported hand hygiene practices. Questionnaire and observation tool were used for data collection. Result The study revealed that there is a corelation between the knowledge and the practices of hand hygiene among the nurses. The overall observed compliance was 58 50 nurses included in observation study, 308 number of opportunities are given only 180opportunities of hand hygiene being performed . The BSc nurses shows higher compliance rate 93.4 . The GNM nurses show 64 and the ANM show low rate 60 . The reported hand hygiene compliance among Questionnaire given to50 Nurses they were may or may not be included in observation study . Conclusion There were two studies conducted by the investigator. The observational study and reported study. The observational study shows that the overall hand hygiene compliance was58 and the reported study give more than 93.4 of compliance among different categories of nurses. The investigator found that the overall observed hand hygiene compliance among nurses was 58.4 , from that BSC Nurses have performed better. They reported the reason for noncompliance was that they were too busy 64 . Sister Ancy Varghese | Dr. Priyanka Chaudhary | Mrs. Ramanpreet Kaur "A Study to Assess the Knowledge and Practices of Hand Hygiene among Nursing Staff in Different Department of the Hospitals in Uttar Pradesh" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-6 | Issue-1 , December 2021, URL: https://www.ijtsrd.com/papers/ijtsrd47804.pdf Paper URL: https://www.ijtsrd.com/medicine/nursing/47804/a-study-to-assess-the-knowledge-and-practices-of-hand-hygiene-among-nursing-staff-in-different-department-of-the-hospitals-in-uttar-pradesh/sister-ancy-varghese
Running head hand hygiene compliance1hand hygiene compliance8.docxwlynn1
Running head: hand hygiene compliance1
hand hygiene compliance8Hand Hygiene Education Implementation and Nurses Compliance in Reducing Nosocomial Infections
Grand Canyon University NRS-490
March 31, 2019
Background
Hygiene is a very crucial factor in prevention of infection in any health care facility. Also, compliance of handwashing ensures patients safety, aids in the treatment and recovery of hospitalized patients. Hand hygiene is important action performed by healthcare works to prevent transmission of healthcare associated infection (Smiddy, O’Connell & Creedon, 2015). Health care professionals such as doctors, nurses, physical therapist and laboratory technicians, take the responsibility of providing efficient, effective and quality care that will improve the health of their patients.
The purpose of this paper is to discuss the change proposal project components the author has been working on throughout the course. The goal of health care works rendering a quality, effective and efficient care to their patient in the health care setting will be difficult to achieve if the rate handwashing adherence is below expectation. Unclean healthcare environments harbor germs that can cause disease, thereby placing the patient at risk of developing infection instead of recovering from their present health condition. Healthcare providers inability to comply with hand hygiene is one the main reason patient develop hospital acquired infections (HAIs). Healthcare employees have the lives of patient in their hands therefore, hand hygiene should not by any means be neglected or dominated out in any healthcare facility.
Approximately 250 health care specialists in a Metro Detroit facility happened to be watched and assessed directly; prior to the start of the exercise, participants were selected based on their hand washing comprehension and compliance. Partakers expresses that they observed improvement on handwashing practices and that most nurses complied to hand washing guidelines evidenced by some significant reductions in the rate of transmission of HAIs within the healthcare facility. HAIs are the infections a patient acquire during the period of hospitalization. The result of the research showed a huge decrease in the spread of nosocomial infections due to progress of hand hygiene training and nurses’ compliance to handwashing protocols. These infections mostly manifest during or after 48 hours of admission or thirty days after discharge from the hospital or health-care facility. The author of this research study sees HAIs as a dangerous disease with many complications. Because inadequate handwashing practices by healthcare workers are the main cause of spread of hospital acquire infections, it is important to educate staff members on proper hand hygiene, implement plan to encourage hand hygiene compliance in the healthcare settings. Blood-stream, ulcers / surgical wounds, CAUTI and respiratory infections are the most common types of HA.
Exploring Knowledge, Attitudes and Practices of ICU Health Workers Regarding ...QUESTJOURNAL
Background: Nosocomial Infection is a localized or systemic infection acquired at any health care facility including hospitals by a patient admitted for any reason other than the pathology present during admission. Including an infection acquired in a healthcare facility that manifest 48 hours after the patient's admission or discharge. Objective: Themain aim of this study is toassess the level of knowledge, attitudes and practice of ICU health personnel with regards to the spread of nosocomial infections. Methodology: A cross-sectional and facility based study was conducted from March to November 2016 at King Khalid hospital in Najran, Saudi Arabia. By adopting convenience technique, 50 subjects had been recruited to participate in this study. Results: 62% of respondentswere female. The mean age was 29 years. Concerning educational status, 54% of the participants have Bsc. professionally most of them (48%) were nurses. 60% of the participants have less than three year working experience in ICU.86% of them highlighted that hands must be washed with soap and water or even rubbed with alcohol before contacting with patients. Additionally, the result reveals that employees who had master degree or above displayed higher mean knowledge scores as compared to the other two groups (diploma or less & bachelor) (0.7147 & 4.6656) respectively. High significant statistical differences were found between the three academic groups in relation to sharp devices, personal protective equipment (gloves, gowns &masks), care of intravenous infusion therapy, central line care and urinary catheter care (F=4.594, F=7.982, F=5.539, F=4.471, F=15.310, F=4.345) respectively at p < 0.05. Recommendation & conclusion: Health workers in ICU (King Khalid hospital) showed adequate knowledge and faire attitude regarding universal precautions
Health problems associated with the consumption of foods that do not meet the hygiene and epidemiological standards are not of recent date and have been occurring continuously throughout the history of human existence. The incidence of food poisoning and foodborne transmissible diseases is three times more common in-home kitchens and households. Restaurant poisoning generally involves a larger number of people, whereas a home-based one involves individuals or a small number of people, so its likelihood of identification by the competent authority or public health organizations and services are significantly smaller. The development of the household food safety questionnaire (HFSQ) for the general population went through five phases (preparation of the questionnaire, distribution of the questionnaire to panelists and then the respondents, statistical analysis and the formation of the final version of the validated questionnaire). A total of 58 particles that formed the basis of the questionnaire were divided into four segments: demographic (10), knowledge (17), opinion (14) and food safety practice (17). Overall, the validity of the questionnaire in examining practice, knowledge and attitude was determined with Cronbach’s alpha = 0.842. The total number of particles adequate for the questionnaire is 29 questions. This questionnaire is a good instrument for assessing the knowledge, attitudes and practices of food handlers in their households.
Daniel Maestro, Arzija Pašalić, Sabina Šegalo and Amar Žilić. “Development and Validation of the Household Food Safety Questionnaire” United International Journal for Research & Technology (UIJRT) 1.3 (2019): 24-32.
Journal Club presentation in Nursing ResearchDhara Vyas
Journal presentation in Nursing Research,
Study of knowledge, attitude, anxiety & perceived mental healthcare need in Indian population during COVID-19 pandemic
Covid-19
Abstract
Introduction
Methodology
samples
Analysis
This presentation highlighted the process that the MoH in Oman used to build consensus on the importance of establishing the role of NP in Oman. All of what has been presented could be used by other health systems especially in GCC
Knowledge and Practice of Documentation among Nurses in Ahmadu Bello Universi...iosrjce
IOSR Journal of Nursing and health Science is ambitious to disseminate information and experience in education, practice and investigation between medicine, nursing and all the sciences involved in health care. Nursing & Health Sciences focuses on the international exchange of knowledge in nursing and health sciences. The journal publishes peer-reviewed papers on original research, education and clinical practice.
By encouraging scholars from around the world to share their knowledge and expertise, the journal aims to provide the reader with a deeper understanding of the lived experience of nursing and health sciences and the opportunity to enrich their own area of practice. The journal publishes original papers, reviews, special and general articles, case management etc.
Audience of presentation learnt about the health care system in Oman with focus on the Health Vision 2050. Also, it delineated the six strategic directions of the vision of nursing services at the MoH in Oman.
A Study to Assess the Knowledge and Practices of Hand Hygiene among Nursing S...ijtsrd
Topic A study to assess the Knowledge, And Practice of Hand Hygiene among Nursing Staff in different department of the Hospitals in Uttar Pradesh. Background of the study Health care associated infections persist as amajor problem in health care settings especially Intensive Care Units. Hand hygiene is the most simple and effective method for the prevention of these healthcare associated infections. So, assess the reported hand hygiene practices and observing is very much important to find out gaps, plan remedial measure to reduce HAIs. Hand hygiene practice is still burdened by inadequate compliance, whether in the professional sphere by health professionals or in the non professional sphere by lay population Aims of the study A. To assess the hand hygiene practices among nurses B. To assess the reason for non compliance. Material and method This study was conducted in different department of Fatima hospital. It was an observational, study50 different professional categories nurses were taken for observational study, 50 for assess the reported hand hygiene practices. Questionnaire and observation tool were used for data collection. Result The study revealed that there is a corelation between the knowledge and the practices of hand hygiene among the nurses. The overall observed compliance was 58 50 nurses included in observation study, 308 number of opportunities are given only 180opportunities of hand hygiene being performed . The BSc nurses shows higher compliance rate 93.4 . The GNM nurses show 64 and the ANM show low rate 60 . The reported hand hygiene compliance among Questionnaire given to50 Nurses they were may or may not be included in observation study . Conclusion There were two studies conducted by the investigator. The observational study and reported study. The observational study shows that the overall hand hygiene compliance was58 and the reported study give more than 93.4 of compliance among different categories of nurses. The investigator found that the overall observed hand hygiene compliance among nurses was 58.4 , from that BSC Nurses have performed better. They reported the reason for noncompliance was that they were too busy 64 . Sister Ancy Varghese | Dr. Priyanka Chaudhary | Mrs. Ramanpreet Kaur "A Study to Assess the Knowledge and Practices of Hand Hygiene among Nursing Staff in Different Department of the Hospitals in Uttar Pradesh" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-6 | Issue-1 , December 2021, URL: https://www.ijtsrd.com/papers/ijtsrd47804.pdf Paper URL: https://www.ijtsrd.com/medicine/nursing/47804/a-study-to-assess-the-knowledge-and-practices-of-hand-hygiene-among-nursing-staff-in-different-department-of-the-hospitals-in-uttar-pradesh/sister-ancy-varghese
Running head hand hygiene compliance1hand hygiene compliance8.docxwlynn1
Running head: hand hygiene compliance1
hand hygiene compliance8Hand Hygiene Education Implementation and Nurses Compliance in Reducing Nosocomial Infections
Grand Canyon University NRS-490
March 31, 2019
Background
Hygiene is a very crucial factor in prevention of infection in any health care facility. Also, compliance of handwashing ensures patients safety, aids in the treatment and recovery of hospitalized patients. Hand hygiene is important action performed by healthcare works to prevent transmission of healthcare associated infection (Smiddy, O’Connell & Creedon, 2015). Health care professionals such as doctors, nurses, physical therapist and laboratory technicians, take the responsibility of providing efficient, effective and quality care that will improve the health of their patients.
The purpose of this paper is to discuss the change proposal project components the author has been working on throughout the course. The goal of health care works rendering a quality, effective and efficient care to their patient in the health care setting will be difficult to achieve if the rate handwashing adherence is below expectation. Unclean healthcare environments harbor germs that can cause disease, thereby placing the patient at risk of developing infection instead of recovering from their present health condition. Healthcare providers inability to comply with hand hygiene is one the main reason patient develop hospital acquired infections (HAIs). Healthcare employees have the lives of patient in their hands therefore, hand hygiene should not by any means be neglected or dominated out in any healthcare facility.
Approximately 250 health care specialists in a Metro Detroit facility happened to be watched and assessed directly; prior to the start of the exercise, participants were selected based on their hand washing comprehension and compliance. Partakers expresses that they observed improvement on handwashing practices and that most nurses complied to hand washing guidelines evidenced by some significant reductions in the rate of transmission of HAIs within the healthcare facility. HAIs are the infections a patient acquire during the period of hospitalization. The result of the research showed a huge decrease in the spread of nosocomial infections due to progress of hand hygiene training and nurses’ compliance to handwashing protocols. These infections mostly manifest during or after 48 hours of admission or thirty days after discharge from the hospital or health-care facility. The author of this research study sees HAIs as a dangerous disease with many complications. Because inadequate handwashing practices by healthcare workers are the main cause of spread of hospital acquire infections, it is important to educate staff members on proper hand hygiene, implement plan to encourage hand hygiene compliance in the healthcare settings. Blood-stream, ulcers / surgical wounds, CAUTI and respiratory infections are the most common types of HA.
Exploring Knowledge, Attitudes and Practices of ICU Health Workers Regarding ...QUESTJOURNAL
Background: Nosocomial Infection is a localized or systemic infection acquired at any health care facility including hospitals by a patient admitted for any reason other than the pathology present during admission. Including an infection acquired in a healthcare facility that manifest 48 hours after the patient's admission or discharge. Objective: Themain aim of this study is toassess the level of knowledge, attitudes and practice of ICU health personnel with regards to the spread of nosocomial infections. Methodology: A cross-sectional and facility based study was conducted from March to November 2016 at King Khalid hospital in Najran, Saudi Arabia. By adopting convenience technique, 50 subjects had been recruited to participate in this study. Results: 62% of respondentswere female. The mean age was 29 years. Concerning educational status, 54% of the participants have Bsc. professionally most of them (48%) were nurses. 60% of the participants have less than three year working experience in ICU.86% of them highlighted that hands must be washed with soap and water or even rubbed with alcohol before contacting with patients. Additionally, the result reveals that employees who had master degree or above displayed higher mean knowledge scores as compared to the other two groups (diploma or less & bachelor) (0.7147 & 4.6656) respectively. High significant statistical differences were found between the three academic groups in relation to sharp devices, personal protective equipment (gloves, gowns &masks), care of intravenous infusion therapy, central line care and urinary catheter care (F=4.594, F=7.982, F=5.539, F=4.471, F=15.310, F=4.345) respectively at p < 0.05. Recommendation & conclusion: Health workers in ICU (King Khalid hospital) showed adequate knowledge and faire attitude regarding universal precautions
PRACTICE OF FIVE MOMENTS OF HAND HYGIENE AMONGTHE NURSES IN SELECTED HOSPITAL...AJHSSR Journal
ABSTRACT :A Quantitative Research approach with a Cross sectional descriptive survey design was used in
the study. 100 Nurses from Thumbay University Hospital, Ajman, UAE who met the sampling criteria were
selected. Written consent was taken. A structured questionnaire to elicit the demographic profile, as well as a
modified Self-reported hand hygiene practice scale, was used online to assess the practice of five moments of
hand hygiene.The majority of the nurses 94-99 % of them had moderate to adequate hand hygiene practice
during the five moments of hand hygiene of which 99% before touching the patients, 95 % before carrying out
clean and aseptic procedures, and after body fluid exposure, 96 % after touching patient unit and 94 % after
touching patient surroundings. Overall, 90 % of the nurses had good hand hygiene practice. No significant
association was found between hand hygiene practices among the nurses with their demographic variables.
KEYWORDS: Five moments, Hand Hygiene, Infection, Nurses.
Evaluation of infection control at Butiru Chrisco Hospital in Manafwa Distric...PUBLISHERJOURNAL
Infection prevention and control is important for the improvement of quality care in hospital. This study aimed to identify risk associated with infection control, and to determine which infection control measures are available at Butiru Chrisco hospital and how these measures are put to use by the staff working in the hospital. This descriptive cross-sectional study was conducted at Butiru Chrisco hospital in Manafwa District. The study involved 100 respondents who were staff employed by Butiru Chrisco hospital. With different educational standards, awareness of infection control was assessed through a structured questionnaire that was administered to those who consented to participate. Random sampling was done on 10 staff, this helped correct the questionnaire making it suitable for the study but the results were not included in this study. The study revealed that out of 100 respondents, 72(72%) were nurses, 60(60%) were females and 78(78%) had been employed by the hospital for less than four years. Half 50(50%) revealed that airborne infections are the commonest infections in the hospital. The study also reveals that more than 80% reported positive response to infection control tasks with 80(80%) agreeing that practice of infection control reduces likelihood of infection spread to patients. From the study, it was concluded that, there is moderate awareness of infection control with more than half of the respondents having positive ideas about infection control and use of available measures like glove, apron, and hand washing. However, practice and compliance with standard precautions was less than optimal. The researcher recommends continuous health visits by ministry of health (MOH) of Uganda to the hospital and evaluation of the practices to ensure that the health workers practice infection control following the standard guidelines. Also, hand washing or use of hand sanitizers with alcohol or other antiseptics as a measure of disinfecting the hands before or after handling a patient is encouraged.
Keywords: Infection, health workers, hand washing, Manafwa District
Evaluation of infection control at Butiru Chrisco Hospital in Manafwa Distric...PUBLISHERJOURNAL
Infection prevention and control is important for the improvement of quality care in hospital. This study aimed to identify risk associated with infection control, and to determine which infection control measures are available at Butiru Chrisco hospital and how these measures are put to use by the staff working in the hospital. This descriptive cross-sectional study was conducted at Butiru Chrisco hospital in Manafwa District. The study involved 100 respondents who were staff employed by Butiru Chrisco hospital. With different educational standards, awareness of infection control was assessed through a structured questionnaire that was administered to those who consented to participate. Random sampling was done on 10 staff, this helped correct the questionnaire making it suitable for the study but the results were not included in this study. The study revealed that out of 100 respondents, 72(72%) were nurses, 60(60%) were females and 78(78%) had been employed by the hospital for less than four years. Half 50(50%) revealed that airborne infections are the commonest infections in the hospital. The study also reveals that more than 80% reported positive response to infection control tasks with 80(80%) agreeing that practice of infection control reduces likelihood of infection spread to patients. From the study, it was concluded that, there is moderate awareness of infection control with more than half of the respondents having positive ideas about infection control and use of available measures like glove, apron, and hand washing. However, practice and compliance with standard precautions was less than optimal. The researcher recommends continuous health visits by ministry of health (MOH) of Uganda to the hospital and evaluation of the practices to ensure that the health workers practice infection control following the standard guidelines. Also, hand washing or use of hand sanitizers with alcohol or other antiseptics as a measure of disinfecting the hands before or after handling a patient is encouraged.
Keywords: Infection, health workers, hand washing, Manafwa District
Article Type: Editorial
Title: Patient Safety: Paradigm shift of modern healthcare delivery and research
Year: 2022; Volume: 2; Issue: 1; Page No: 1 – 2
Author: Dr. Mohammed Imran
10.55349/ijmsnr.20222112
Affiliation: Associate Professor, Medical Pharmacology, College of Medicine and Health Sciences, Sohar, National University of Science and Technology, Sultanate of Oman.
Email ID: imran@nu.edu.om
Article Summary:
Submitted : 10-February-2022
Revised : 26-February-2022
Accepted : 12-March-2022
Published : 31-March-2022
Preventative Healthcare Associated Infections Through Hand Hygiene- Training ...Innovations2Solutions
Implementation of hand hygiene programs has traditionally been the responsibility of healthcare infection prevention staff and was focused on the clinical staff. The following discussion will describe
why comprehensive awareness and education training for infection prevention is necessary for Infection Prevention Managers, and how a multidisciplinary approach can achieve hand hygiene compliance and sustained reductions in HAIs. This type of approach involves including not just clinical staff, but also other healthcare staff members, patients and visitors, as key audiences for the hand hygiene program and campaign.
Hand Hygiene: Impact of Educational Training and Awareness Programmeiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
1
Quantitative Synopsis and Appraisal
Studentfirstname Studentlastname, Studentfirstname Studentlastname, Studentfirstname
Studentlastname, Studentfirstname Studentlastname
College of Nursing, Resurrection University
NUR4440: Research in Nursing
Professor Carina Piccinini
February 14, 2020
2
Quantitative Appraisal and Synopsis
The purpose of this paper is to summarize and appraise a research study testing the use of
disinfectant caps on intravenous (IV lines) to reduce the rate of hospital associated bloodstream
infections (BSI). The Centers for Disease Control and Prevention (CDC, 2019) reports that
central line associated bloodstream infections (CLABSI) remain a major concern in hospital
settings causing fatalities, increased length of stay, and increased costs. The CDC (2019)
recommends proper maintenance of intravenous lines to reduce the risk of infection. Current
research is still looking to define what proper maintenance should be, including whether
disinfectant caps influence rates of infection for intravenous (IV) lines.
Summary of the Study
The CDC recommends that healthcare workers disinfect all needleless connectors for
peripheral and central IVs prior to connection to reduce the risk of CLABSIs without further
recommendation on the type or length of disinfections. The authors of this study note other
studies have tested disinfecting caps and sought to confirm those results.
Merrill et al. (2014) conducted a quasi-experimental study to identify if disinfectant caps
reduce CLABSI incidence and the relationship between nursing compliance with the caps and
CLABSI rates. This study was held in a single Trauma 1 hospital with 430 beds in the United
States.
The researchers obtained their sample through nonrandom convenience sampling by
including all patients meeting inclusion criteria at the hospital starting January 2012. Participants
were included if they had a central or peripheral intravenous line, of any age, and were admitted
to 13 specific hospital floors. Subjects were excluded if they were on the following floors:
emergency department; labor, delivery or post-partum; ambulatory care, surgical services; and
3
well-baby nursery. The study did not report any demographic information about participants, the
number of participants, or attrition or loss to follow up.
The intervention involved applying a Curos brand disinfectant cap to all ports on
peripheral lines, central lines, and IV tubing when not in use on patients. The nurses on the
involved units were trained on the use of the disinfectant caps with a 1:1 follow up by the
researchers. Nurses were then responsible for placing caps. The researchers intermittently
observing nurses for compliance to the intervention and reporting compliance to nursing
departments twice a week.
CLABSIs were defined as a positive blood culture drawn within 48 hours symptom onset,
and C ...
1
Quantitative Synopsis and Appraisal
Studentfirstname Studentlastname, Studentfirstname Studentlastname, Studentfirstname
Studentlastname, Studentfirstname Studentlastname
College of Nursing, Resurrection University
NUR4440: Research in Nursing
Professor Carina Piccinini
February 14, 2020
2
Quantitative Appraisal and Synopsis
The purpose of this paper is to summarize and appraise a research study testing the use of
disinfectant caps on intravenous (IV lines) to reduce the rate of hospital associated bloodstream
infections (BSI). The Centers for Disease Control and Prevention (CDC, 2019) reports that
central line associated bloodstream infections (CLABSI) remain a major concern in hospital
settings causing fatalities, increased length of stay, and increased costs. The CDC (2019)
recommends proper maintenance of intravenous lines to reduce the risk of infection. Current
research is still looking to define what proper maintenance should be, including whether
disinfectant caps influence rates of infection for intravenous (IV) lines.
Summary of the Study
The CDC recommends that healthcare workers disinfect all needleless connectors for
peripheral and central IVs prior to connection to reduce the risk of CLABSIs without further
recommendation on the type or length of disinfections. The authors of this study note other
studies have tested disinfecting caps and sought to confirm those results.
Merrill et al. (2014) conducted a quasi-experimental study to identify if disinfectant caps
reduce CLABSI incidence and the relationship between nursing compliance with the caps and
CLABSI rates. This study was held in a single Trauma 1 hospital with 430 beds in the United
States.
The researchers obtained their sample through nonrandom convenience sampling by
including all patients meeting inclusion criteria at the hospital starting January 2012. Participants
were included if they had a central or peripheral intravenous line, of any age, and were admitted
to 13 specific hospital floors. Subjects were excluded if they were on the following floors:
emergency department; labor, delivery or post-partum; ambulatory care, surgical services; and
3
well-baby nursery. The study did not report any demographic information about participants, the
number of participants, or attrition or loss to follow up.
The intervention involved applying a Curos brand disinfectant cap to all ports on
peripheral lines, central lines, and IV tubing when not in use on patients. The nurses on the
involved units were trained on the use of the disinfectant caps with a 1:1 follow up by the
researchers. Nurses were then responsible for placing caps. The researchers intermittently
observing nurses for compliance to the intervention and reporting compliance to nursing
departments twice a week.
CLABSIs were defined as a positive blood culture drawn within 48 hours symptom onset,
and C ...
Literature Evaluation TableStudent Name Joyce NwakorPIC.docxcroysierkathey
Literature Evaluation Table
Student Name: Joyce Nwakor
PICOT Question: For patients and healthcare workers in the hospital (p) does hand washing protocol (I) compared to an alcohol-based solution (C) reduce hospital-acquired infection (O) within a period of stay in the hospital (T)
Criteria
Article 1
QUANT
Article 2
QUANT
Article 3
QUANT
Article 4
REVIEW
Author, Journal (Peer-Reviewed), and
Permalink or Working Link to Access Article
Daisy, V. T., & Sreedevi, T. R.
Link:
http://eds.a.ebscohost.com.lopes.idm.oclc.org/eds/detail/detail?vid=4&sid=72619044-c224-4bc5-9982-cf6c3953f7d2%40sessionmgr4007&bdata=JnNpdGU9ZWRzLWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#AN=110819455&db=ccm
Fox, C., Wavra, T., Drake, D. A., Mulligan, D., Bennett, Y. P., Nelson, C., … Bader, M. K. (2015). Use of a Patient Hand Hygiene Protocol to Reduce Hospital-Acquired Infections and Improve Nurses' Hand Washing. American Journal of Critical Care, 24(3), 216-224. doi:10.4037/ajcc2015898
Knighton, S. (2017). The Use of Instructional Technology to Increase Independent Patient Hand Hygiene Practice of Hospitalized Adults in an Acute Care Setting. Open Forum Infectious Diseases, 4(suppl_1), S411-S412. doi:10.1093/ofid/ofx163.1029
João Manuel Garcia do Nascimento Graveto, Rita Isabel Figueira Rebola, Elisabete Amado Fernandes, & Paulo Jorge dos Santos Costa. Link:
https://doi-org.lopes.idm.oclc.org/10.1590/0034-7167-2017-0239
Article Title and Year Published
Effectiveness of a Multi-Component Educational Intervention on Knowledge and Compliance with Hand Hygiene among Nurses in Neonatal Intensive Care Units. 2015Use of a Patient Hand Hygiene Protocol to Reduce Hospital-Acquired Infections and Improve Nurses' Hand Washing
Published May 2015
The Use of Instructional Technology to Increase Independent Patient Hand Hygiene Practice of Hospitalized Adults in an Acute Care Setting. Open Forum Infectious Diseases.
Published in 2017
Hand hygiene: nurses’ adherence after training.
2018
Research Questions (Qualitative)/Hypothesis (Quantitative), and Purposes/Aim of Study
The study was aimed to assess the effectiveness of a multi-component educational intervention on the knowledge and compliance with handhygiene guidelines among nurses working in Neonatal Intensive Care Units.
The research investigated the reduction of infections in the hospital through observation of hand hygiene.
What handwashing procedures were performed by the medical personnel before patient contact part 1.
What is the level of effectiveness of training (I) in improving nurses’(P) adherence to hand hygiene(O)?”.
Design (Type of Quantitative, or Type of Qualitative)
A pre-experimental pre-test post-test design was adopted for the study. QUANT
Pre-experimental study design
. QUANT
A quantitative study was done using quasi observational data
Qualitative/ quantitative studies
This is a review
Setting/Sample
This study was conducted in 3 level III NICUs of selected private hospitals in Kerala
Total sample compri ...
Running Head HEALTH PROBLEMS IN U.S.A 1 HEALTH PROBLEMS I.docxwlynn1
Running Head: HEALTH PROBLEMS IN U.S.A
1
HEALTH PROBLEMS IN U.S.A
8
HEALTH PROBLEM IN U.S.A AND OTHER NATIONS
Student’s Name:
Institution:
Instructor:
Date:
Abstract
This paper addresses the cognitive abilities that enhance hand hygiene acquiescence while backing the inhibition of healthcare associated to the contagions and how they have been widely acknowledged. It is also acknowledged that great hand cleanliness alone cannot impress difficult risk influences, such as elder age, immune-suppression, entrance fee to the serious care part, a lengthier span of stay, and indwelling strategies. The participants used in this study were selected from were randomly selected from public places through observation of their actions and how they took care of their hands especially before eating, after eating and also engaging in hand cleanness in public places. The main methods used for the research are qualitative studies through the use of observation models. In sum, it was found that hand sanitation involvements are concomitantly assumed with other monotonous or superior preventive approaches, there are a probable for these simultaneous policies to confuse the result of the hand sanitation package. Therefore, the direct comment of hand cleanliness likelihoods and movements; microelectronic nursing of hand hygiene actions and valuation of liquor created hand rub ingesting strength also be used as accidental methods and supernumerary indicators. In addition to these studies specifically focused on hand hygiene treatments, hand hygiene was in the center of numerous studies applying broader transmission control treatments and demonstrating the effect on healthcare-associated infection rates. So, hand hygiene is the fundamental part of proper recommendations for the prevention of the most common healthcare-associated infections.
Keywords: hand hygiene, hand sanitation, qualitative studies
Significance and Background of the Study
The study is significant because it will have an impact on improving the healthcare and also the welfare of the poor populations in terms of improving their health. Therefore, those with previous illness situations anxiety that they might lose assurance attention if they modification occupations. Central income person terror that decrease insurance welfares might energy them to recompense extra and more of the prices of health care, accumulative their unwillingness to search for maintenance when they necessity it. Urged in portion by the misconduct assurance crisis, obstetrical amenities are described to be in small source in certain areas. Inhabitants of this nation's rural zones are aggressive a hard fight to save hospitals exposed so that, at a smallest, they consume admission to alternative facilities and vital main care. To evade consuming to admit extra room patients who might not have assurance, mounting numbers of clinics have stopped offering crisis amenities.
This study was informed by a number of factors suc.
Proposed Protocol for Improving Staff Nurses` Awareness and Self – Efficacy w...ijtsrd
The awareness and preparedness in managing Novel Coronavirus SARS CoV 2 Outbreak infection are most important to prevent the further spread. Aim This study aimed to propose a protocol for improving staff nurses` awareness and self – efficacy with Novel Coronavirus SARS CoV 2 Outbreak. Subjects and Method A descriptive design was utilized in this study that was conducted in the units of Critical Care and Emergency for adults surgery, medicine and pediatrics at El Sayed Galal and Ain Shams University Hospitals. A random sample was composed of 180 nurses with different ages, gender, education and experiences were recruited from the above mentioned settings. The study tools were 1 Self administered questionnaire sheet to assess nurses awareness about Novel Coronavirus SARS CoV 2 Outbreak. 2 General self efficacy scale. 3 Ways of Coping Questionnaire for Staff Nurses. 4 Competency obstacles assessment sheet. Results Mean age of studied nurses was 33.4±27.2 added to their awareness and self efficacy need for improvement. Moreover, there were many obstacles affecting their competency. Conclusion Overall, the current study concluded that nearly half of studied nurses had satisfactory awareness about Novel Coronavirus SARS CoV 2 and their role during the outbreak. Meanwhile, less than half of them had high self – efficacy and positive coping. In addition, majority of them had competency obstacles during their work on outbreak time. Recommendations Further research study should be done to implement and nvestigate the effect of this proposed protocol for such group of nurses. Lamiaa A. Elsayed | Soad M. Hegazy | Rania M. Abueldahab | Manal A. Ahmed | Salwa O. Elkhattab "Proposed Protocol for Improving Staff Nurses` Awareness and Self – Efficacy with Novel Coronavirus SARS-Cov-2 Outbreak" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-4 | Issue-5 , August 2020, URL: https://www.ijtsrd.com/papers/ijtsrd31871.pdf Paper Url :https://www.ijtsrd.com/medicine/other/31871/proposed-protocol-for-improving-staff-nurses`-awareness-and-self-–-efficacy-with-novel-coronavirus-sarscov2-outbreak/lamiaa-a-elsayed
2. Please cite this article in press as: Cruz JP, Bashtawi MA. Predictors of hand hygiene practice
among Saudi nursing students: A cross-sectional self-reported study. J Infect Public Health (2015),
http://dx.doi.org/10.1016/j.jiph.2015.11.010
ARTICLE IN PRESSJIPH-505; No. of Pages 9
2 J.P. Cruz, M.A. Bashtawi
Introduction
Regarded as the simplest yet most cost-effective
intervention in reducing healthcare-associated
infections (HAIs), hand hygiene is important in
any healthcare concern around the world. Hand
hygiene is an essential component of infection
control, which is critical to ensuring patients’
safety in hospitals [1]. Due to the increasing
incidence rate of HAIs and the growing burden
accompanying them, the increasing complexity
of illnesses and their complications, the soaring
cost of hospitalization, and the occurrence of
multiple-resistant pathogens causing new types of
infections, the necessity for strict and effective
compliance with hand hygiene has been empha-
sized [2]. A wide array of studies supports evidence
of the effectiveness of hand hygiene, if accurately
implemented, in reducing cross-contamination and
infection in a healthcare facility [2—4]. Various
studies have reported that good compliance with
hand hygiene significantly decreases the number of
Methicillin-resistant Staphylococcus aureus (MRSA)
infections in various units of the hospital, such
as in the adult Intensive Care Unit (ICU), Neona-
tal Intensive Care Unit, and neurosurgery units
[5,6].
Similar to the rest of the world, HAIs in Saudi
Arabia are a great concern. In a previous study,
668 of 1382 patients were reported to contract
HAIs during the study period in a military hos-
pital [7]. Furthermore, a study conducted from
2010 to 2011 reported that 48.3% of 170 inves-
tigated patients developed HAIs. From the total
number of HAIs reported, 32.3% were respira-
tory tract infections, 25.3% were urinary tract
infections, 18.2% were blood infections and 12.9%
were surgical site infections [8]. The literature
on hand hygiene strongly supports the evidence
that strict hand hygiene practice can significantly
decrease the incidence of HAIs [9—11]. Another
issue of concern relevant to Saudi Arabia is the
occurrence of the new disease called Middle East
Respiratory Syndrome coronavirus (MERS-CoV). The
majority of laboratory-confirmed cases have been
associated with healthcare settings through human-
to-human transmission [12]. This poses a threat
to the members of a healthcare team. Because
of this, the WHO and the CDC have issued rec-
ommendations for the prevention and control of
this novel infection in healthcare settings that
include standard, contact, and airborne precau-
tions [13].
One of the key responsibilities of health-
care workers is to prevent cross-contamination
within the healthcare facility. Nurses in par-
ticular have the highest risk of transmitting
infection-causing microorganisms within the hos-
pital premises because of their high visibility.
Moreover, nurses often come in contact with
contaminated objects. Most nursing interventions
require direct or close contact with the patient,
which can become an avenue for the transfer of
pathogens if hand hygiene is not properly observed
[14,15]. However, compliance with hand hygiene
remains a great challenge in healthcare settings,
most especially in limited-resource countries [16].
It has been suggested that interventions be multi-
dimensional to attain a sustainable improvement in
compliance with hand hygiene in healthcare sett-
ings. An example is the International Nosocomial
Infection Control Consortium (INICC) Multidimen-
sional Hand Hygiene Approach (IMHHA), which
includes administrative support, availability of sup-
plies, education and training, reminders, process
surveillance, and performance feedback. Previous
studies have reported significant improvement in
adherence to hand hygiene with the implemen-
tation of the IMHHA in ICUs in various countries
[17—23].
Nursing students are regarded as healthcare
workers in training. Because these students have
direct contact with patients during their tour
of duty, they can also be vehicles of cross-
contamination within the hospital. Various studies
have been conducted regarding hand hygiene prac-
tices of nursing students. It has been reported
that nursing students have a low level of knowl-
edge of infection control and poor application of
such knowledge to their clinical practice [24].
Low knowledge, understanding, and skills regarding
hand hygiene were reported to have a negative
effect on the students’ compliance with hand
hygiene practice [25]. Studies on infection con-
trol, including predictors of hand hygiene among
undergraduate nursing students, are lacking in the
literature [24,25]. Hand hygiene practices also vary
depending on the individual, institution, culture,
and many other factors. It has also been suggested
that further studies investigate the factors that
modify hand washing among professional groups
[15]. There have been a limited number of studies
conducted in Saudi Arabia that focus on this topic
[26]. It is therefore difficult to draw a clear picture
of hand hygiene practices and the factors that tend
to influence compliance with hand hygiene among
nursing students in the Kingdom of Saudi Arabia.
This study was conducted to examine the predic-
tors of hand hygiene practice among Saudi nursing
students.
3. Please cite this article in press as: Cruz JP, Bashtawi MA. Predictors of hand hygiene practice
among Saudi nursing students: A cross-sectional self-reported study. J Infect Public Health (2015),
http://dx.doi.org/10.1016/j.jiph.2015.11.010
ARTICLE IN PRESSJIPH-505; No. of Pages 9
Predictors of hand hygiene practice among Saudi nursing students 3
Methods
Design
This study employed a descriptive, cross-sectional,
self-reported design in examining the predictors of
hand hygiene practice among the Saudi nursing stu-
dents.
Participants and settings
This study was conducted in the Nursing Depart-
ment of the College of Applied Medical Sciences of
a government-run university situated in the cen-
tral region of Saudi Arabia. The nursing program
in the university is composed of 4 academic years
with 2 semesters (levels) each year. A convenience
sample of 223 nursing students was included in the
study. Inclusion criteria were set, which included
being (1) a Saudi national, (2) male or female nurs-
ing student, (3) enrolled in the second semester of
academic year 2014—2015, (4) registered for levels
3—8 (2nd—4th year of the BSN program), and (5)
enrolled in courses with clinical or Related Learning
Experiences (RLE) laboratory exposure.
Instruments
This study utilized a self-administered question-
naire to gather data from the respondents. The
survey tool has four parts, each measuring specific
variables in the study. Part one elicited informa-
tion on the respondents’ characteristics such as (1)
gender, (2) age, (3) academic level, (4) training or
seminars attended about hand hygiene in the past
6 months, (5) awareness of the risk that they can
be the source of cross-contamination in the hospi-
tal, and (6) awareness of the effectiveness of hand
hygiene to prevent HAIs.
Knowledge of hand hygiene was assessed using
the WHO Hand Hygiene Knowledge Questionnaire
for Health-Care Workers. Some modifications were
made to suit the respondents and the current study.
This tool has both multiple choice questions and
‘yes or no’ questions. The questionnaire includes
questions about possible routes of contamination
in healthcare facilities, most frequent sources of
germs that can cause HAIs, hand hygiene actions
that prevent transmission of germs to patients and
healthcare workers, hand hygiene using soap and
water and by alcohol-based hand rub, and actions
that can increase colonization of germs in the hands
[27]. Correct responses were counted and recorded
for each respondent. Computed scores higher than
75% were considered good, scores between 50% and
74% were considered moderate, and scores lower
than 50% were interpreted as poor.
Attitude toward hand hygiene and hand hygiene
practice were measured in parts three and four,
respectively. These tools have 10 and six items,
respectively, that were adopted from an earlier
study, and each item involves a 1—5-point Likert
scale ranging from ‘strongly disagree’ to ‘strongly
agree’. The attitude scale assesses the attitude
of the respondents toward adherence, importance,
priorities, and practices of hand hygiene of the
respondents. The practice scale assesses the self-
reported practices of hand hygiene in general.
Maximum scores of 50 and 30 for attitude and
practice, respectively, can be obtained from each
scale. Higher scores indicate a positive attitude
and better practice of hand hygiene among nursing
students. Computed scores higher than 75% were
considered good, scores between 50% and 74% were
considered moderate, and scores lower than 50%
were interpreted as poor [28,29].
For the purpose of this study, the instrument was
translated into Arabic using the forward-backward
translation method. The questionnaire was pre-
sented to three bilingual (Arabic and English)
members of the faculty of nursing. They were asked
to translate the English version into Arabic. The Ara-
bic version was then presented to another three
bilingual nurses who translated it back into English.
After consensus was reached, the final Arabic ver-
sion was produced. The translated questionnaire
was subjected to validity and reliability testing
in a sample of 100 nursing students. The result
demonstrated an acceptable validity and reliabil-
ity with a Cronbach’s alpha ranging from 0.78 to
0.84.
Ethical considerations
The researchers sought approval and permission to
conduct the study from the Office of the Dean of the
College of Applied Medical Sciences of the univer-
sity. Proper conduct was observed in the collection
of data from the female campus with respect to
Saudi culture. A cover letter explaining the pur-
pose of the study and the expected participation
of the respondents was attached to each ques-
tionnaire. Additionally, a written informed consent
form was attached to each questionnaire. The
respondents were asked to sign the informed con-
sent form before they were allowed to answer the
questionnaire to signify their understanding and
voluntary participation. No incentive was offered
to the respondents. For the questionnaire, permis-
sion was sought and was granted from the original
authors.
4. Please cite this article in press as: Cruz JP, Bashtawi MA. Predictors of hand hygiene practice
among Saudi nursing students: A cross-sectional self-reported study. J Infect Public Health (2015),
http://dx.doi.org/10.1016/j.jiph.2015.11.010
ARTICLE IN PRESSJIPH-505; No. of Pages 9
4 J.P. Cruz, M.A. Bashtawi
Data collection
Collection of data was conducted during the sec-
ond semester of the 2014—2015 academic year. The
researchers visited the respondents in their respec-
tive classrooms during their scheduled classes
to administer the questionnaire. The respondents
were given 15—20 min to answer the questionnaire.
For the female respondents, the questionnaires
were administered by their lecturers following the
same procedure.
Data analysis
All data analyses were carried out using the SPSS
version 21. Frequency count, percentage, and mean
values were used to analyze the knowledge of,
attitude toward and practice of hand hygiene. A
stepwise multiple linear regression analysis was
employed to identify the significant independent
variables that could predict the practice of hand
hygiene among the respondents. Significance was
set at the 0.05 level (2-tailed).
Results
From the 223 questionnaires distributed to the
respondents (112 males and 111 females), 198 (107
males and 91 females) were sufficiently answered
and retrieved (88.8% response rate). The mean age
of the respondents was 21.77 ± 1.26 years, and
the majority of respondents were male (54.0%).
Regarding levels, 10.1% were registered in level 3,
13.1% in levels 4 and 5, 19.2% in level 6, 29.8% in
level 7, and 14.7% in level 8 during the course of the
study. The majority of the respondents (60.6%) had
attended trainings or a seminar on hand hygiene in
the last 6 months. Furthermore, more than half of
the respondents (67.2%) answered ‘yes’ when asked
if they were aware that they could possibly cause
cross-contamination in the hospital. The major-
ity of the respondents (57.1%) agreed that hand
hygiene is effective in preventing HAIs (Table 1).
Hand hygiene knowledge, attitude, and
practice
Table 2 indicates the self-reported knowledge, atti-
tude toward and practice of hand hygiene of the
respondents. Using the WHO Hand Hygiene Knowl-
edge Questionnaire for Health-Care Workers, the
knowledge of the nursing students was evaluated
as moderate (mean 13.20 ± 2.80; range 6—23 out
of the total score of 25). Most of the respon-
dents (58.6%) demonstrated moderate knowledge,
and very few respondents (5.1%) showed good
knowledge of hand hygiene. Furthermore, more
than half of the respondents showed a moderate
attitude (52.1%), while very few of the respon-
dents reported a poor attitude (13.1%) toward hand
hygiene. Regarding the practice of hand hygiene,
68.7% of the respondents reported moderate
Table 1 Characteristics of respondents (N = 198).
Characteristics Mean SD
Age 21.77 1.26
n %
Gender Males 107 54.0
Females 91 46.0
Academic level Level 3 20 10.1
Level 4 26 13.1
Level 5 26 13.1
Level 6 38 19.2
Level 7 59 29.8
Level 8 29 14.7
Training/Seminars in hand hygiene in the
last 6 months
Yes 120 60.6
No 78 39.4
Aware that they can possibly cause
cross-contamination in the hospital
Yes 133 67.2
No 65 32.8
Aware of the effectiveness of hand hygiene
in preventing HAIs
Yes 113 57.1
No 85 42.9
5. Please cite this article in press as: Cruz JP, Bashtawi MA. Predictors of hand hygiene practice
among Saudi nursing students: A cross-sectional self-reported study. J Infect Public Health (2015),
http://dx.doi.org/10.1016/j.jiph.2015.11.010
ARTICLE IN PRESSJIPH-505; No. of Pages 9
Predictors of hand hygiene practice among Saudi nursing students 5
Table 2 Knowledge, attitude and practice of hand hygiene among (N = 198).
Study variables n % Range Mean ± SD
Knowledge on
hand hygiene
Good 10 5.1
6—23 13.20 ± 2.80Moderate 116 58.6
Poor 72 36.3
Attitude
toward hand
hygiene
Good 69 34.8
12—50 34.38 ± 7.79Moderate 103 52.1
Poor 26 13.1
Practice of
hand hygiene
Good 59 29.8
10—30 20.37 ± 4.19Moderate 136 68.7
Poor 3 1.5
practice, 29.8% reported good practice, and only
1.5% had poor practice.
Predictors of hand hygiene practice
A stepwise multiple regression analysis was
employed to identify the predictors of hand hygiene
practice by the Saudi nursing students. The respon-
dents’ characteristics as well as their knowledge
and attitude toward hand hygiene were analyzed to
determine the factors that predicted their practice
of hand hygiene. Of the eight factors, five were
included in the prediction model that reached five
steps with none of the variables being removed. The
model was statistically significant (F(5, 192) = 8.68,
p < 0.001). It accounted for 50.5% of the variance of
the practice of hand hygiene, R2 = 0.517, Adjusted
R2 = 0.505. As reflected in Table 3, academic level,
attendance at a training or seminar in the last 6
months, awareness of the effectiveness of hand
hygiene in preventing HAIs, attitude toward hand
hygiene, and gender were identified as predictors
of hand hygiene practice among the respondents.
The hand hygiene practices of Saudi nursing stu-
dents were primarily influenced by having a good
attitude toward hand hygiene, followed by being
male, being aware that hand hygiene is an effec-
tive intervention in preventing HAIs, and, to a
lesser extent, attendance at hand hygiene train-
ings and seminars and being in the lower academic
level of nursing education. Having a positive atti-
tude toward hand hygiene resulted in the largest
beta weight (ˇ = 0.281, p < 0.001), demonstrating
the largest contribution to the regression equa-
tion while controlling all of the other predictor
variables as constants. Gender received the sec-
ond largest contribution (ˇ = −0.227, p < 0.001),
followed by awareness of the effectiveness of hand
hygiene (ˇ = 0.218, p < 0.001) and attendance at
hand hygiene trainings and seminars (ˇ = 0.215,
p < 0.05); academic level exhibited the lowest
contribution to the regression model (ˇ = −0.208,
p < 0.05). With the sizeable correlation among
the predictors of hand hygiene practices, the
unique variance of each of the predictors identi-
fied (as demonstrated by the squared semi-partial
Table 3 Predictors of the practice of hand hygiene among Saudi nursing students (N = 198).
Model b SE-b Beta sr2
t p-value
Academic level −0.555 0.175 −0.208 0.025 −3.167 0.002*
Training/Seminars in hand
hygiene in the last 6 months
1.836 0.527 0.215 0.031 3.481 0.001*
Aware of the effectiveness of
hand hygiene in preventing
HAIs
1.838 0.503 0.218 0.033 3.656 <0.001*
Attitude toward hand hygiene 0.151 0.036 0.281 0.045 4.228 <0.001*
Gender −1.903 0.469 −0.227 0.041 −4.055 <0.001*
Note: Practice of hand hygiene was the dependent variable; b is the unstandardized coefficients; SE-b is the standard error; and
sr2 is the squared semi-partial correlation.
R2 = 0.517; adjusted R2 = 0.505.
* p < 0.05.
6. Please cite this article in press as: Cruz JP, Bashtawi MA. Predictors of hand hygiene practice
among Saudi nursing students: A cross-sectional self-reported study. J Infect Public Health (2015),
http://dx.doi.org/10.1016/j.jiph.2015.11.010
ARTICLE IN PRESSJIPH-505; No. of Pages 9
6 J.P. Cruz, M.A. Bashtawi
correlations) was relatively low. Attitude toward
hand hygiene and gender uniquely accounted for
4.5% and 4.1% of the variance of hand hygiene
practice, respectively. Moreover, awareness of the
effectiveness of hand hygiene, attendance at hand
hygiene trainings or seminars and the academic
level uniquely accounted for 3.3%, 3.1% and 2.5%
of the variance of the practice of hand hygiene,
respectively.
Discussion
This study investigated the knowledge, attitude,
and practice of hand hygiene in a sample of nurs-
ing students at a Saudi university. Predictors of the
practice of hand hygiene were identified based on
the self-reported responses of the participants.
As reported, 60.6% of the respondents had
attended hand hygiene trainings or seminars in
the past 6 months. Although this is a majority of
the respondents, we cannot neglect the fact that
approximately 39.4% of the respondents did not
receive any training or educational intervention
about hand hygiene in the last 6 months. Addi-
tionally, approximately 32.8% of the respondents
were unaware that cross-contamination in hospi-
tals can be caused by healthcare workers, including
themselves, and 42.9% were unaware of the effec-
tiveness of hand hygiene in preventing HAIs. These
are significant numbers and should not be ignored.
Further analyses revealed that awareness of the
effectiveness of hand hygiene in preventing HAIs
and attendance at trainings or seminars were iden-
tified as predictors for the practice of hand hygiene.
This implies that being aware of the preventive
role of hand hygiene and attending hand hygiene
educational interventions may have influenced the
practice of hand hygiene among the respondents.
The significance of educational interventions in
improving the practice of hand hygiene has been
well documented [30,31]. Educational interven-
tions regarding hand hygiene, such as educational
campaigns, reminders, and in-service training, can
significantly enhance the practice of hand hygiene
[32]. These educational interventions may increase
the awareness of hand hygiene and thus improve
its practice. Nursing education plays a signifi-
cant role in improving the awareness of nursing
students about the role of hand hygiene in pre-
venting the incidence of HAIs. However, a previous
study conducted to examine the effectiveness of
basic nursing education on hand hygiene revealed
a significant deficit in the quality of information
provided. This deficit was shown to be directly cor-
related with low levels of hand hygiene knowledge
and poor compliance to hand hygiene practice dur-
ing the clinical training of nursing students [25].
Moderate knowledge regarding hand hygiene was
also reported in this study. This result is simi-
lar to previous studies that reported a moderate
level of knowledge about hand hygiene by nursing
students [29,33]. Increased knowledge about hand
hygiene was reported to have a positive correlation
with a decreased risk of cross-contamination among
healthcare workers [34]; however, in this study,
knowledge was not identified as a significant predic-
tor of hand hygiene practice. Earlier studies have
noted that an increased level of knowledge of hand
hygiene does not necessarily result in improvement
in hand hygiene practice [35,36]. This could sug-
gest that continuous reinforcement programs in the
clinical setting should be initiated to support knowl-
edge acquired in the classroom [37]. Nonetheless,
having adequate knowledge about hand hygiene
coupled with continuous training and seminars
could have a positive impact on the practice of hand
hygiene.
In this study, the majority of the nursing stu-
dents reported a moderate attitude toward hand
hygiene, and approximately 34.8% reported a good
attitude, which is consistent with other studies
[38,39]. This can be attributed to the respondents’
positive perception of hand hygiene, as interpreted
by the positive responses regarding their awareness
of the importance of hand hygiene in HAI pre-
vention, and their belief that cross-contamination
could be caused by healthcare workers. This could
be supported by different behavioral theories,
which explain that good perception of some action
can result in a more positive display of attitude
[40]. Furthermore, a positive attitude was iden-
tified as the strongest predictor of the practice
of hand hygiene, accounting for 4.5% of the vari-
ance. Having a good attitude toward hand hygiene
may increase the hand hygiene practice of nursing
students. Similar findings were reported by previ-
ous studies [33,41]. Nursing students practice hand
hygiene more effectively when they have positive
beliefs about the benefits of hand hygiene and
understand the risks of poor compliance with this
practice [33].
Finally, this study also reported that gender
and academic level were significant predictors of
the practice of hand hygiene among Saudi nursing
students. According to the findings, both gender
and academic levels were negatively related to
the practice of hand hygiene. This finding suggests
that being male and being in the early academic
levels of nursing education can be associated
with better practice of hand hygiene. Conversely,
previous studies reported better adherence to
7. Please cite this article in press as: Cruz JP, Bashtawi MA. Predictors of hand hygiene practice
among Saudi nursing students: A cross-sectional self-reported study. J Infect Public Health (2015),
http://dx.doi.org/10.1016/j.jiph.2015.11.010
ARTICLE IN PRESSJIPH-505; No. of Pages 9
Predictors of hand hygiene practice among Saudi nursing students 7
hand hygiene by females [42,43]. However, other
previous studies examining the gender differences
in hand hygiene among Saudi nursing and medical
students reported that male students have signif-
icantly better hand hygiene practice compared to
female students [15,44]. The results supporting
‘‘being male’’ may be due to the influence of
culture on gender differences in the Kingdom,
where males are socially dominant compared to
females [15]. Consequently, males in the Kingdom
are expected to display a positive image with every
action. Gender role differences are distinct within
Saudi Arabia. As reported in a previous study, male
Saudis have a considerably more stable and clearer
personal identity compared to females. They have
higher confidence in accomplishing tasks and worry
less about their behavior and style of doing things.
On the other hand, female Saudis have lower self-
confidence and are more emotionally vulnerable
than males [45]. These may explain the better
hand hygiene practice reported by male Saudis.
However, this influence of gender on hand hygiene
needs to be validated in future studies. Hand
hygiene is an important component of infection
control and is aligned with academic level; the
topic is a part of the Fundamentals of Nursing
course taught in the earlier years of the nursing
program. It is covered in classroom lectures and
is reinforced in the nursing laboratories through
continuous demonstration. In addition, students in
the lower years are more exposed to trainings and
seminars about infection control in the hospital.
This can be related to the higher level of practice
of nursing students in the lower academic levels of
the nursing program. Furthermore, most courses
offered in the latter years of nursing programs
include clinical exposure. Training in the clinical
setting was shown to have a contextual influence
that weakens the students’ performance [46].
Moreover, the clinical set-up represents a very
complex and dynamic environment, which can
have a significant effect on students’ learning and
skills, including hand hygiene practice [47].
This study has some limitations. One of the
limitations is using self-reports to gather data on
the practice of hand hygiene among the respon-
dents. Although self-reporting is the easiest way
to collect data, bias can be introduced as respon-
dents may report better practice than their actual
practice. Furthermore, this study was conducted
using a convenience sampling technique and with
a small sample size. This limits the generalizability
of the results. Careful interpretation and use of the
findings are recommended as a result of this limi-
tation. Further, the study was conducted in a single
nursing department of a Saudi university. Future
research should explore a broader setting to obtain
a clearer picture about hand hygiene practice in
Saudi Arabia. Nevertheless, this study has substan-
tially contributed to the limited literature on this
topic in the Kingdom. The results were validated
by other similar studies elsewhere, and these new
findings regarding the perception of Saudi nurs-
ing students about hand hygiene can reinforce the
existing knowledge on this topic.
Conclusion
This study was conducted to identify factors that
can predict the practice of hand hygiene among
Saudi nursing students. Five factors were deter-
mined that can significantly predict the practice
of hand hygiene, which include positive attitude
toward hand hygiene, being male, being aware
of the effectiveness of hand hygiene in preven-
ting HAIs, attendance at hand hygiene trainings
or seminars, and academic level. The importance
of ensuring a positive attitude of nursing students
toward hand hygiene, improving awareness of hand
hygiene, and educational interventions are under-
scored. Educational interventions such as trainings
and seminars on hand hygiene should be imple-
mented to reinforce knowledge and instill a positive
attitude toward hand hygiene. Reinforcement and
support of nursing students by clinical instructors
and staff nurses are likewise encouraged to pro-
mote better practice of hand hygiene in the latter
years of the nursing program. Gender-specific edu-
cational interventions should also be planned and
implemented to meet the gender-specific needs of
the students regarding hand hygiene.
Funding
No funding sources.
Competing interest
None declared.
Ethical approval
Not required.
Acknowledgments
The authors would like to acknowledge the valu-
able contributions of the following individuals: the
8. Please cite this article in press as: Cruz JP, Bashtawi MA. Predictors of hand hygiene practice
among Saudi nursing students: A cross-sectional self-reported study. J Infect Public Health (2015),
http://dx.doi.org/10.1016/j.jiph.2015.11.010
ARTICLE IN PRESSJIPH-505; No. of Pages 9
8 J.P. Cruz, M.A. Bashtawi
respondents who spared some of their time to
answer the questionnaire, the Dean of the College
of Applied Medical Sciences of the university for
allowing the research to be conducted, Dr. Char-
lie P. Cruz for his contribution to editing the paper,
and Mr. Erwin Sean I. Coronel for his expert advice
on enhancement of the paper.
References
[1] Colet PC, Cruz JP, Cruz CP, Al-otaibi J, Qubeilat H, Alquwez
N. Patient safety competence of nursing students in Saudi
Arabia: a self-reported survey. Int J Health Sci (Qassim)
2015;9:417—25.
[2] Mathur P. Hand hygiene: back to the basics of infection
control. Indian J Med Res 2011;134:611—20.
[3] Kampf G, Kramer A. Epidemiologic background of hand
hygiene and evaluation of the most important agents for
scrubs and rubs. Clin Microbiol Rev 2004;17:863—93.
[4] Boyce JM, Pittet D. Guideline for hand hygiene in
health-care settings: recommendations of the Health-
care Infection Control Practices Advisory Committee
and the HICPAC/SHEA/APIC/IDSA Hand Hygiene
Task Force. Am J Infect Control 2002;30:S1—46,
http://dx.doi.org/10.1067/mic.2002.130391.
[5] Lederer JW, Best D, Hendrix V. A comprehensive hand
hygiene approach to reducing MRSA health care-associated
infections. Jt Comm J Qual Patient Saf 2009;35:180—5.
[6] Allegranzi B, Pittet D. Role of hand hygiene in
healthcare-associated infection prevention. J Hosp
Infect 2009;73:305—15.
[7] Abdel-Fattah MM. Surveillance of nosocomial infections at
a Saudi Arabian military hospital for a one-year period. Ger
Med Sci 2005;3. Doc06.
[8] Sabra SM, Abdel-Fattah MM. Epidemiological and microbio-
logical profile of nosocomial infection in Taif hospitals, KSA
(2010—2011). World J Med Sci 2012;7:1—9.
[9] Al-Tawfiq JA, Abed MS, Al-Yami N, Birrer RB. Promoting
and sustaining a hospital-wide, multifaceted hand hygiene
program resulted in significant reduction in health care-
associated infections. Am J Infect Control 2013;41:482—6.
[10] Mestre G, Berbel C, Tortajada P, Alarcia M, Coca R, Gallemi
G, et al. The 3/3 strategy: a successful multifaceted hos-
pital wide hand hygiene intervention based on WHO and
continuous quality improvement methodology. PLoS ONE
2012;7:e47200.
[11] Rosenthal VD, Guzman S, Safdar N. Reduction in nosoco-
mial infection with improved hand hygiene in intensive care
units of a tertiary care hospital in Argentina. Am J Infect
Control 2005;33:392—7.
[12] World Health Organization. Middle East respiratory syn-
drome coronavirus (MERS-CoV): summary of current
situation, literature update and risk assessment — as of
5 February 2015; 2015. http://www.who.int/csr/disease/
coronavirus infections/mers-5-february-2015.pdf?ua=1.
[13] McIntosh K, Hirsch MS, Thorner AR, http://www.
uptodate.com/contents/middle-east-respiratory-syndrome-
coronavirus Middle East respiratory syndrome coronavirus;
2015. UpToDate.
[14] Mani A, Shubangi AM, Saini R. Hand hygiene among health
care workers. Indian J Dent Res 2010;21:115—8.
[15] Cruz JP, Cruz CP, Al-Otaibi ASD. Gender differences on hand
hygiene among Saudi nursing students. Int J Infect Control
2015;11, http://dx.doi.org/10.3396/IJIC.v11i4.029.15.
[16] Rosenthal VD, Pawar M, Leblebicioglu H, Navoa-Ng JA,
Villamil-Gómez W, Armas-Ruiz A, et al. Impact of the Inter-
national Nosocomial Infection Control Consortium (INICC)
Multidimensional Hand Hygiene Approach over 13 years
in 51 cities of 19 limited-resource countries from Latin
America, Asia, the Middle East, and Europe. Infect Control
2013;34:415—23.
[17] Chakravarthy M, Myatra SN, Rosenthal VD, Udwadia FE,
Gokul BN, Divatia JV, et al. The impact of the International
Nosocomial Infection Control Consortium (INICC) multicen-
ter, Multidimensional Hand Hygiene Approach in two cities
of India. J Infect Public Health 2015;8:177—86.
[18] Medeiros EA, Grinberg G, Rosenthal VD, Bicudo Angelieri
D, Buchner Ferreira I, Bauer Cechinel R, et al. Impact of
the International Nosocomial Infection Control Consortium
(INICC) Multidimensional Hand Hygiene Approach in 3 cities
in Brazil. Am J Infect Control 2015;43:10—5.
[19] Leblebicioglu H, Koksal I, Rosenthal VD, Akan QA, Ozgul-
tekin A, Kendirli T, et al. Impact of the International
Nosocomial Infection Control Consortium (INICC) Multidi-
mensional Hand Hygiene Approach, over 8 years, in 11 cities
of Turkey. J Infect Prev 2015;16:146—54.
[20] Miranda-Novales MG, Sobreyra-Oropeza M, Rosenthal VD,
Higuera F, Armas-Ruiz A, Perez-Serrato I, et al. Impact of
the International Nosocomial Infection Control Consortium
(INICC) Multidimensional Hand Hygiene Approach during 3
years in 6 hospitals in 3 Mexican cities. J Patient Saf 2015,
http://dx.doi.org/10.1097/PTS.0000000000000210.
[21] Rosenthal VD, Viegas M, Sztokhamer D, Benchenrit G, San-
toro B, Lastra CE, et al. Impact of INICC Multidimensional
Hand Hygiene Approach in ICUs in four cities in Argentina.
J Nurs Care Qual 2015;30:E17—25.
[22] Su D, Hu B, Rosenthal VD, Li R, Hao C, Pan W, et al. Impact
of the International Nosocomial Infection Control Consor-
tium (INICC) Multidimensional Hand Hygiene Approach in
five intensive care units in three cities of China. Public
Health 2015;129:979—88.
[23] Barahona-Guzman N, Rodriguez-Calderon ME, Rosenthal VD,
Olarte N, Villamil-Gomez W, Rojas C, et al. Impact of
the International Nosocomial Infection Control Consortium
(INICC) Multidimensional Hand Hygiene Approach in three
cities of Colombia. Int J Infect Dis 2013;19:67—73.
[24] Wu CJ, Gardner GE, Chang AM. Taiwanese nursing students’
knowledge, application and confidence with standard and
additional precautions in infection control. J Clin Nurs
2009;18:1105—12.
[25] Kelcíkova S, Skodova Z, Straka S. Effectiveness of hand
hygiene education in a basic nursing school curricula. Public
Health Nurs 2012;29:152—9.
[26] Al Kadi A, Salati SA. Hand hygiene practices among medical
students. Interdiscip Perspect Infect Dis 2012;2012:6,
http://dx.doi.org/10.1155/2012/679129. Article ID
679129.
[27] World Health Organization. Hand Hygiene Knowledge Ques-
tionnaire for Health-Care Workers; 2009.
[28] Shinde MB, Mohite VR. A study to assess knowledge, attitude
and practices of five moments of hand hygiene among nurs-
ing staff and students at a tertiary care hospital at Karad.
Int. J. Sci. Res 2014;3:311—21.
[29] Nair SS, Hanumantappa R, Hiremath SG, Siraj MA, Raghu-
nath P. Knowledge, attitude, and practice of hand hygiene
among medical and nursing students at a Tertiary Health
Care Centre in Raichur, India. ISRN Prev Med 2014,
http://dx.doi.org/10.1155/2014/608927.
[30] Chhapola V, Brar R. Impact of an educational intervention
on hand hygiene compliance and infection rate in a devel-
oping country neonatal intensive care unit. Int J Nurs Pract
9. Please cite this article in press as: Cruz JP, Bashtawi MA. Predictors of hand hygiene practice
among Saudi nursing students: A cross-sectional self-reported study. J Infect Public Health (2015),
http://dx.doi.org/10.1016/j.jiph.2015.11.010
ARTICLE IN PRESSJIPH-505; No. of Pages 9
Predictors of hand hygiene practice among Saudi nursing students 9
2014, http://dx.doi.org/10.1111/ijn.12283 [Epub ahead of
print].
[31] Randle J, Metcalfe J, Webb H, Luckett JCA, Nerlich B,
Vaughan N, et al. Impact of an educational intervention
upon the hand hygiene compliance of children. J Hosp Infect
2013;85:220—5.
[32] Shlomai NO, Rao S, Patole S. Efficacy of interventions to
improve hand hygiene compliance in neonatal units: a sys-
tematic review and meta-analysis. Eur J Clin Microbiol
Infect Dis 2015;34:887—97.
[33] Al-Khawaldeh OA, Al-Hussami M, Darawad M. Influence of
nursing students handwashing knowledge, beliefs, and atti-
tudes on their handwashing compliance. Health 2015;7:572,
http://dx.doi.org/10.4236/health.2015.75068.
[34] McLaughlin AC, Walsh F. Individual differences in judgments
of hand hygiene risk by health care workers. Am J Infect
Control 2011;39:456—63.
[35] Ward DJ. The role of education in the prevention and con-
trol of infection: a review of the literature. Nurse Educ
Today 2011;31:9—17.
[36] Vandijck DM, Labeau SO, De Somere J, Claes B, Blot SI, Exec-
utive Board of the Flemish Society of Critical Care Nurses.
Undergraduate nursing students’ knowledge and percep-
tion of infection prevention and control. J Hosp Infect
2008;68:92—4.
[37] Creedon SA. Healthcare workers’ hand decontamination
practices: compliance with recommended guidelines. J Adv
Nurs 2005;51:208—16.
[38] Ho SE, Ho CC, Hng SH, Liu CY, Jaafar MZ, Lim B. Nurses com-
pliance to hand hygiene practice and knowledge at Klang
Valley hospital. Clin Ther 2012;164:407—11.
[39] Nasirudeen AMA, Koh JW, Lau ALC, Li W, Lim LS, Ow CYX.
Hand hygiene knowledge and practices of nursing students
in Singapore. Am J Infect Control 2012;40:e241—3.
[40] Ajzen I, Fishbein M. Attitude-behavior relations: a theoret-
ical analysis and review of empirical research. Psychol Bull
1977;84(5):888—918.
[41] Pessoa-Silva CL, Posfay-Barbe K, Pfister R, Touveneau S, Per-
neger TV, Pittet D. Attitudes and perceptions toward hand
hygiene among healthcare workers caring for critically ill
neonates. Infect Control Hosp Epidemiol 2005;26:305—11.
[42] Kinnison A, Cottrell RR, King KA. Proper hand-washing tech-
niques in public restrooms: differences in gender, race,
signage, and time of day. Am J Health Educ 2004;35:86—9.
[43] Anderson JL, Warren CA, Perez E, Louis RI, Phillips S,
Wheeler J, et al. Gender and ethnic differences in hand
hygiene practices among college students. Am J Infect Con-
trol 2008;36:361—8.
[44] al Kadi A, Salati SA. Hand hygiene practices among
medical students. Interdiscip Perspect Infect Dis 2012,
http://dx.doi.org/10.1155/2012/679129.
[45] Alanazi FM. The Revised Self-consciousness Scale: an assess-
ment of factor structure, reliability, and gender differences
in Saudi Arabia. Soc Behav Personal 2001;29:763—76.
[46] Ginsburg LR, Tregunno D, Norton PG. Self-reported patient
safety competence among new graduates in medicine, nurs-
ing and pharmacy. BMJ Qual Saf 2013;22:147—54.
[47] de Feijter JM, de Grave WS, Dornan T, Koopmans RP, Scherp-
bier AJ. Students’ perceptions of patient safety during the
transition from undergraduate to postgraduate training: an
activity theory analysis. Adv Health Sci Educ Theory Pract
2011;16:347—58.
Available online at www.sciencedirect.com
ScienceDirect