KNOWLEDGE AND PRACTICE OF PROPER HAND WASHING TECHNIQUES IN PREVENTION OF INFECTIOUS DISEASES AMONG STAFF OF GENERAL HOSPITAL BAJOGA
CHAPTER ONE: INTRODUCTION
1.1 Background to the Study
Healthcare-associated infections (HAIs) represent a significant global public health challenge, contributing substantially to morbidity, mortality, and increased healthcare costs worldwide. The hands of healthcare workers serve as the primary vehicle for the transmission of pathogenic microorganisms between patients, healthcare personnel, and the healthcare environment. Hand hygiene, particularly proper hand washing technique, remains the single most effective, inexpensive, and evidence-based intervention for preventing the spread of infectious diseases within healthcare settings.
The World Health Organization (WHO) has championed hand hygiene as a cornerstone of infection prevention and control (IPC) strategies globally. The WHO's "My 5 Moments for Hand Hygiene" framework provides healthcare workers with clear guidance on when hand hygiene should be performed: before touching a patient, before clean/aseptic procedures, after body fluid exposure risk, after touching a patient, and after touching patient surroundings. These moments are designed to interrupt the chain of infection transmission and protect both patients and healthcare providers.
Despite the established importance of hand hygiene, global compliance rates remain suboptimal. The WHO reports that average compliance in intensive care units stands at just 59.6%, indicating significant gaps in practice even in resource-rich settings. In low- and middle-income countries, these challenges are compounded by infrastructural deficits, inadequate supplies, and limited training opportunities.
Nigeria, like many developing nations, faces considerable challenges in maintaining optimal infection prevention and control practices in healthcare facilities. Studies conducted across Nigerian hospitals have revealed troubling patterns: although most healthcare workers demonstrate awareness of hand hygiene principles, actual knowledge levels and practical compliance often fall short of acceptable standards. At the University of Nigeria Teaching Hospital, only 29.2% of nurses demonstrated effective hand washing technique despite moderately good knowledge levels. Similarly, at the University of Benin Teaching Hospital, only 37.0% of healthcare workers showed good knowledge, and compliance with WHO's Five Moments was just 45.7%.
General Hospital Bajoga, located in Gombe State, Nigeria, serves as a critical healthcare facility providing essential services to the local population. As a secondary-level facility, it faces the typical challenges common to Nigerian public hospitals—high patient load, limited resources, and infrastructural constraints. Understanding the knowledge and practice of hand hygiene among its staff is essential for developing targeted interventions to reduce infection rates and improve patient safety.
1.2 Statement of the Problem
Healthcare-associated infections pose a serious threat to patient safety in Nigerian hospitals. Inadequate hand hygiene practices among healthcare workers contribute significantly to the transmission of infectious agents, leading to prolonged hospital stays, increased healthcare costs, avoidable morbidity, and preventable mortality.
Despite national and international guidelines emphasizing the importance of proper hand washing, evidence from Nigerian healthcare settings suggests a persistent gap between knowledge and practice. Research across various Nigerian institutions reveals that while awareness of hand hygiene is high, practical compliance remains low. Frequently missed steps include proper rubbing of finger webs, cleaning fingernails and periungual areas, and appropriate drying and faucet-turning techniques.
General Hospital Bajoga, as a typical Nigerian secondary healthcare facility, likely experiences these same challenges. There is currently limited empirical data on the specific knowledge, attitudes, and practices of hand hygiene among staff at this hospital. This lack of evidence hinders the development of context-specific interventions needed to improve IPC practices and reduce infection rates.
Furthermore, infrastructural challenges such as inconsistent water supply, inadequate hand washing stations, and limited availability of alcohol-based hand rubs have been documented in similar Nigerian hospitals. These factors may significantly influence hand hygiene compliance regardless of knowledge levels.
This study seeks to address this gap by systematically assessing the knowledge and practice of proper hand washing techniques among staff at General Hospital Bajoga, identifying factors that influence compliance, and informing evidence-based recommendations for improvement.
1.3 Objectives of the Study
General Objective
To assess the knowledge and practice of proper hand washing techniques in the prevention of infectious diseases among staff of General Hospital Bajoga.
Specific Objectives
1. To determine the level of knowledge of proper hand washing techniques among staff of General Hospital Bajoga.
2. To assess the practice of proper hand washing techniques among staff of General Hospital Bajoga.
3. To identify the factors influencing the practice of proper hand washing techniques among staff of General Hospital Bajoga.
4. To determine the association between knowledge and practice of proper hand washing techniques among staff of General Hospital Bajoga.
5. To identify challenges and barriers to proper hand washing practices among staff of General Hospital Bajoga.
1.4 Research Questions
1. What is the level of knowledge of proper hand washing techniques among staff of General Hospital Bajoga?
2. What is the practice of proper hand washing techniques among staff of General Hospital Bajoga?
3. What factors influence the practice of proper hand washing techniques among staff of General Hospital Bajoga?
4. Is there an association between knowledge and practice of proper hand washing techniques among staff of General Hospital Bajoga?
5. What are the challenges and barriers to proper hand washing practices among staff of General Hospital Bajoga?
1.5 Research Hypotheses
H₀: There is no significant association between knowledge and practice of proper hand washing techniques among staff of General Hospital Bajoga.
H₁: There is a significant association between knowledge and practice of proper hand washing techniques among staff of General Hospital Bajoga.
1.6 Significance of the Study
This study is significant for several reasons:
To Healthcare Practitioners and Hospital Management: The findings will provide empirical data on current knowledge and practice gaps, enabling hospital management to develop targeted training programs and allocate resources effectively. It will also highlight specific areas of hand washing technique requiring emphasis during IPC training.
To Infection Prevention and Control Programs: The study will contribute to the evidence base on hand hygiene in Nigerian healthcare settings, supporting the design of more effective IPC interventions tailored to local contexts and challenges.
To Policymakers: The findings will inform health policy decisions at both institutional and governmental levels, particularly regarding resource allocation for IPC infrastructure, supplies, and training.
To the Academic Community: This research will add to the growing body of knowledge on hand hygiene in Nigerian healthcare settings and serve as a reference for future studies in similar contexts.
1.7 Scope of the Study
This study focuses on assessing the knowledge and practice of proper hand washing techniques in the prevention of infectious diseases among staff of General Hospital Bajoga. The study includes all categories of healthcare workers who have direct patient contact, including doctors, nurses, laboratory scientists, pharmacists, and other allied health professionals. The study examines both the cognitive aspects (knowledge of hand hygiene principles, indications, and technique) and behavioral aspects (actual practice, compliance, and technique proficiency) of hand hygiene.
1.8 Operational Definition of Terms
Knowledge: The theoretical understanding of hand hygiene principles, including knowledge of the WHO's Five Moments for Hand Hygiene, the correct steps of hand washing technique, the importance of hand hygiene in infection prevention, and appropriate product use.
Practice: The actual performance of hand hygiene behaviors, including frequency of hand washing, adherence to the correct steps of hand washing technique, compliance with the WHO's Five Moments, and appropriate use of hand hygiene products.
Hand Washing Technique: The correct sequence of steps for effective hand hygiene, including wetting hands, applying soap, rubbing all surfaces (palms, backs, interdigital spaces, fingernails, thumbs, and wrists) for the recommended duration (20-30 seconds for hand rubbing, 40-60 seconds for hand washing), rinsing, drying, and turning off faucets without recontaminating hands.
Proper Hand Washing: Hand washing performed using the correct technique as recommended by WHO guidelines, including all necessary steps and appropriate duration.
Healthcare-Associated Infections (HAIs): Infections acquired by patients during the course of receiving healthcare treatment that were not present or incubating at the time of admission.
Infection Prevention and Control (IPC): Evidence-based practices and procedures designed to prevent the transmission of infectious agents in healthcare settings.
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CHAPTER TWO: LITERATURE REVIEW
2.1 Introduction
This chapter reviews existing literature relevant to the study of knowledge and practice of proper hand washing techniques among healthcare workers. It examines the theoretical foundations, historical development, current evidence, and contextual factors that influence hand hygiene practices in healthcare settings. The review is organized under thematic sections covering the concept of hand hygiene, global and national guidelines, empirical evidence on knowledge and practice, factors influencing compliance, and barriers to implementation.
2.2 Conceptual Framework
Hand hygiene in healthcare settings encompasses a range of practices designed to reduce the bioburden on healthcare workers' hands and prevent transmission of pathogens. The concept has evolved significantly over the past century, from early recognition of the link between hand contamination and puerperal fever to the current comprehensive guidelines developed by the World Health Organization.
The conceptual framework for this study is built on the understanding that effective hand hygiene practice is influenced by multiple interacting factors: individual knowledge and attitudes, institutional policies and culture, availability of resources and infrastructure, and organizational support. The WHO Multimodal Hand Hygiene Improvement Strategy provides a comprehensive framework addressing these multiple levels.
This framework comprises five key components:
1. System change: Ensuring that necessary infrastructure and supplies are available
2. Training and education: Providing healthcare workers with knowledge about hand hygiene
3. Evaluation and feedback: Monitoring practices and providing performance feedback
4. Reminders in the workplace: Reinforcing hand hygiene through visual cues
5. Institutional safety climate: Creating an environment that prioritizes patient safety
2.3 Historical Development of Hand Hygiene
The recognition of hand hygiene as a critical infection prevention measure has a rich history. In the mid-19th century, Ignaz Semmelweis demonstrated that hand washing with chlorinated lime solution dramatically reduced mortality from puerperal fever in obstetric wards. His observations established the link between healthcare workers' hands and transmission of infectious agents, providing the first evidence-based argument for hand hygiene in healthcare settings.
Subsequent discoveries in microbiology by Louis Pasteur, Joseph Lister, and Robert Koch reinforced the importance of aseptic techniques in healthcare. The development of antiseptic agents, antibiotic therapy, and modern infection control practices built upon this foundation. Despite this historical knowledge and evidence, hand hygiene compliance has remained consistently suboptimal across global healthcare settings.
2.4 The WHO's Five Moments for Hand Hygiene
The World Health Organization's "My 5 Moments for Hand Hygiene" approach provides a standardized framework for when hand hygiene should be performed in healthcare settings. These five moments are:
1. Before touching a patient: To protect the patient from harmful germs carried on the healthcare worker's hands.
2. Before clean/aseptic procedures: To protect the patient from potential pathogen transmission during procedures.
3. After body fluid exposure risk: To protect both healthcare workers and the healthcare environment from contamination.
4. After touching a patient: To protect healthcare workers and the healthcare environment from patient-derived pathogens.
5. After touching patient surroundings: To protect healthcare workers and other patients from pathogens present in the patient's environment.
This framework is designed to be practical, memorable, and applicable across all healthcare settings and professional categories. The WHO emphasizes that hand hygiene should be performed at these critical moments regardless of whether gloves are worn.
Date: 2026-09-09 00:00:00.000000