Knowledge of hand hygiene and evaluation of hand washing technique among nurses at the University of Nigeria Teaching Hospital

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BACKGROUND: Healthcare worker's hands are route for cross-transmission of potentially harmful germs between patients in a healthcare facility. As hand washing is an established cost-effective measure for infection control, hand hygiene knowledge and compliance with the recommended steps are essential to control healthcare-associated infections (HCAI). We assessed the knowledge and practice of hand hygiene among nurses at the University of Nigeria Teaching Hospital (UNTH), Enugu. METHODS: A cross-sectional study was carried out from 14th September to 24th December 2023 on all consenting nurses in UNTH. A modified World Health Organization (WHO) knowledge questionnaire structured to collect demographics and assess hand hygiene knowledge expressed as good(> 75%), moderately good(50-74%) and poor(< 50%) knowledge. Duration to completion of hand washing was timed while Glo germ gel with ultraviolet lamp were used to assess effectiveness of hand washing. Ineffective hand washing was graded as fair, poor, or very poor. The WHO checklist was used to assess steps in hand washing technique performed. RESULT: A total of 395 nurses participated in the study (mean age and standard deviation, 41.40 ± 8.82 years). Most were females (93.2%), married (80.8%), and functioned in the surgery department (38.5%). Moderately good knowledge of hand hygiene was demonstrated by 58.2% while effective hand washing occurred in 29.2% of them. Steps of hand washing technique most frequently missed were the use of towel to turn off faucet (94.3%), rubbing backs of fingers to opposing palms with fingers interlocked (89.8%), and wetting hands with water before applying soap(55.9%). Zones of hands not adequately washed were mainly the fingernails and perimeter of fingernails (38.4%), the palm (28.6%), and the dorsum of hand (22.9%). There was no significant difference in hand hygiene knowledge and effective hand washing across the different age groups, sex, nursing cadre, educational qualifications, and departments. CONCLUSION: Nurses at the UNTH had fair hand hygiene knowledge with the majority demonstrating ineffective hand washing; a finding suggesting sub-optimal infection prevention and control. Periodic hand hygiene training targeting nurses and other health personnel engaged in patient care while emphasizing frequently missed areas is paramount to improving hand hygiene knowledge and effectiveness. CLINICAL TRIAL NUMBER: Not applicable.

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