Hand Hygiene Education Research Articles

Auditing Hand Hygiene Compliance in Non-Traditional Care Areas

Many hospitals perform hand hygiene (HH) observations at entry to and exit from most inpatient rooms. In non-traditional care areas (e.g., psychiatric units, procedural areas and ambulatory clinics), this method of observation is impractical, as these areas may not have well defined patient rooms and fewer healthcare workers (HCW) to observe at any given time. We developed a process for observation HH compliance in these areas using the World Health Organization’s (WHO) 5 Moments for HH. An audit tool was developed for HH observations at the point of care, monitoring compliance with “before” (before patient contact and performing clean/aseptic tasks) and “after” (after risk for body fluid exposure and after contact with the patient or their environment) moments. The tool was trialed for 4 months in several areas. We modified the tool based on user feedback, and in August of 2013, the tool was implemented in 29 areas. The roll-out included staff HH education and in-depth observer training. Each observation set lasted 20 minutes or had a minimum of 10 observations, whichever came first. The results were shared monthly with each area. Between August 2013 and October 2014, 29 participating areas completed > 6 months of observations. Overall HH compliance was 85.2% (n= 4,486 observations). Compliance with the “before” moments was 85.4% (n=2,225) compared to 83.9% compliance (n= 2,261) with the “after” moments. Observed HH compliance for nurses (87.8%; n=2,006) was similar to observed compliance for other HCWs (83.1%; n=2,480 [P=0.2]). No statistical difference was noted in compliance between the areas (Ambulatory clinics =82.1%; n=1,062, psychiatric units =91.9%; n=1,006, Procedural areas = 84.6% n=2,695). This audit tool allowed efficient hh observations to be completed in non-traditional patient care areas.

Ni-Vanuatu health-seeking practices for general health and childhood diarrheal illness: results from a qualitative methods study.

BackgroundA local perspective on diarrheal illness has been shown to enhance control strategies for diarrheal disease in traditional rural settings. We aimed to assess caregivers’ understandings of childhood general and diarrheal illness, in one rural community in Vanuatu, to help formulate control strategies for preventing diarrheal disease.FindingsThis was a descriptive study using qualitative analysis of responses to open-ended questions to provide a fuller understanding of illness. Thematic analysis with categories derived from medical anthropology was used to analyse responses and draw conclusions. Twenty-nine participants were interviewed; 22 were maternal responses, three were traditional practitioners, two were rural health care workers, one was a spiritual healer and one had a caregiver role. Respondents categorised illness as biomedical or traditional. Explanations of illness were enmeshed in and derived from both the traditional and biomedical system as the illness experience in the child under their care unfolded. Diarrheal severity influenced treatment selection and respondents expressed a preference for biomedical assistance. Respondents articulated a preference for biomedicine as the primary help-seeking resort for small children. Exclusive reliance on either traditional or biomedical options was uncommon. Local herbal remedies were the preferred home treatment when illness was known or mild, while oral rehydration therapy was used when accessing biomedical practitioners.ConclusionsBelief about diarrheal illness was influenced by traditional medicine and biomedicine. New evidence points to a growing preference for biomedicine as the first choice for severe childhood diarrheal illness. Diarrheal illness could be countered by maternal hand hygiene education at the medical dispensary and rural aid post.

Self-reported hand hygiene practices, and feasibility and acceptability of alcohol-based hand rubs among village healthcare workers in Inner Mongolia, China

BackgroundGood hand hygiene is critical to reduce the risk of healthcare-associated infections. Limited data are available on hand hygiene practices from rural healthcare systems in China.AimTo assess the feasibility and acceptability of sanitizing hands with alcohol-based hand rubs (ABHRs) among Chinese village healthcare workers, and to assess their hand hygiene practice.MethodsFive hundred bottles of ABHR were given to village healthcare workers in Inner Mongolia, China. Standardized questionnaires collected information on their work load, availability, and usage of hand hygiene facilities, and knowledge, attitudes, and practices of hand hygiene.FindingsIn all, 369 (64.2%) participants completed the questionnaire. Although 84.5% of the ABHR recipients believed that receiving the ABHR improved their hand hygiene practice, 78.8% of recipients would pay no more than US$1.5 out of their own pocket (actual cost US$4). The majority (77.2%) who provided medical care at patients’ homes never carried hand rubs with them outside their clinics. In general, self-reported hand hygiene compliance was suboptimal, and the lowest compliance was ‘before touching a patient’. Reported top three complaints with using ABHR were skin irritation, splashing, and unpleasant residual. Village doctors with less experience practised less hand hygiene.ConclusionThe overall acceptance of ABHR among the village healthcare workers is high as long as it is provided to them for free/low cost, but their overall hand hygiene practice is suboptimal. Hand hygiene education and training is needed in settings outside of traditional healthcare facilities.

Evaluating the effectiveness of real-time feedback on the bedside hand hygiene behaviors of nursing students.

Traditional hand hygiene teaching methods lack long-term effectiveness. A longitudinal, within-subject design explored the influence of real-time hand microbe feedback and a critical-thinking decision exercise on nursing student hand hygiene behaviors. In three community hospitals, the students' (n = 68) hand swabs were tested for normal flora, methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant Enterococcus at three time points. Students completed the Partnering to Heal (PTH) online exercise on hospital-acquired infection prevention decisions. Normal flora colony counts decreased across the semester and MRSA-positive cultures increased in frequency and colony counts. MRSA-positive cultures were not associated with caring for patients in isolation precautions. Significantly higher colony counts were noted in the students who completed the PTH than those who did not complete the PTH. This study explores innovative pedagogy bringing the nonvisible microbial risk to the consciousness of nursing students in an attempt to change hand hygiene behaviors.

Hand-touch contact assessment of high-touch and mutual-touch surfaces among healthcare workers, patients, and visitors

Unlike direct contact with patients' body, hand hygiene practice is often neglected by healthcare workers (HCWs) and visitors after contact with patients' environment. Contact with hospital environmental items may increase risk of pathogen transmission. To enumerate the number of hand-touch contacts by patients, HCWs and visitors with any hospital environmental items. All contact-episodes between person and item were recorded by direct observation in a six-bed cubicle of acute wards for 33 working days. High-touch and mutual-touch items with high contact frequencies by HCWs, patients, and visitors were analysed. In total, 1107 person-episodes with 6144 contact-episodes were observed in 66 observation hours (average: 16.8 person-episodes and 93.1 contact-episodes per hour). Eight of the top 10 high-touch items, including bedside rails, bedside tables, patients' bodies, patients' files, linen, bed curtains, bed frames, and lockers were mutually touched by HCWs, patients, and visitors. Bedside rails topped the list with 13.6 contact-episodes per hour (mean), followed by bedside tables (12.3 contact-episodes per hour). Using patients' body contacts as a reference, it was found that medical staff and nursing staff contacted bedside tables [rate ratio (RR): 1.741, 1.427, respectively] and patients' files (RR: 1.358, 1.324, respectively) more than patients' bodies, and nursing staff also contacted bedside rails (RR: 1.490) more than patients' bodies. Patients' surroundings may be links in the transmission of nosocomial infections because many are frequently touched and mutually contacted by HCWs, patients, and visitors. Therefore, the focus of hand hygiene education, environmental disinfection, and other system changes should be enhanced with respect to high-touch and mutual-touch items.

The Effectiveness of Hand Hygiene Education Intervention for Medical Students in Primary Care Settings : Ismailia City , Egypt

Background: All medical students must be aware and practice hand hygiene procedures as one of the infection control measures that could lower health care acquired infections. Aims: to improve practice of hand hygiene among medical students in health care settings and to evaluate the effectiveness of educational training on hand hygiene among the medical students. Methods: The study is a prospective before-and-after trial of an educational intervention with longitudinal follow up. Pre-post intervention was between April and May 2014 with one month interval and the follow up was 6 months later. The pre post intervention included all the first year medical students with affiliation to Faculty of medicine, Suez Canal University in Ismailia city. The follow up included all the participants who continued their second educational year in the same faculty. The researchers used a validated questionnaire and observation checklist to collect data in all periods of the study. Educational training program was designed and conducted by the researchers on hand hygiene importance, measures, technique, time and compliance. Results: The educational intervention had a significant improvement in KAP, one and six months after the intervention (P <0.001). Non significant decrease in median scores of knowledge with no change in median scores of attitude but significant improvement of median scores of practice and overall KAP scores of hand hygiene in the follow up (P <0.001) was observed. Conclusion: The educational intervention was effective in improvement in KAP of hand hygiene in pre-post intervention with one month interval and in the follow up after six months after the intervention.

Behavior-based interventions to improve hand hygiene adherence among intensive care unit healthcare workers in Thailand.

To evaluate behavioral-based interventions to improve hand hygiene (HH) among healthcare workers (HCWs) at a Thai tertiary care center. A quasi-experimental study was performed in 6 intensive care units with computer-generated allocation. Baseline demographic characteristics, self-reported stage of HH behavioral commitment, and observed HH adherence were examined from January 1, 2012, through December 31, 2012 (preintervention), and from January 1, 2013, through December 31, 2013 (postintervention). Self-reported HH was categorized by the stages construct from the Transtheoretical Model of Health Behavior Change. The intensive care unit group randomization was to either standard-of-care HH education every 3 months (S1), intensified HH interventions (S2), or intensified HH interventions plus increased availability of alcohol-based handrub throughout the unit (S3). Among 125 HCWs from 6 intensive care units (42 in S1, 41 in S2, 42 in S3) there were 1,936 total HH observations; most HCWs (100 [ 80%]) were nurses or nurse assistants. Compared with preintervention, overall postintervention HH adherence improved in HCWs assigned to S2 (65% vs 85%; P=.02) and S3 (66% vs 95%; P=.005) but not S1 (68% vs 71%; P=.84). Improvement in HH adherence was demonstrated among HCWs who reported lower stages of HH commitment in S2 (21% vs 84%; P<.001) and S3 (24% vs 89%; P<.001) and in HCWs who self-reported higher stages of commitment in S3 (78% vs 96%; P<.001). HCW HH programs may benefit from stage-based tailored strategies to promote sustained HH adherence.

Analysis of object surface cleanness and relative factors in cardiac surgical ICU

Objective To assess the effect of existing cleaning methods applied in cardiac surgical intensive care unit, analyze potential danger and provide evidence to support clean processes in the future. Methods Each patient′s bed unit was defined as a sample and the frequency of hand-to-bed contact and the extent of patient-to-bed contact were assessed.Totals of 15 monitoring surface on each sheet were taken after sterilization within 24 hours and the Relative Light Units(RLU) of the monitoring surface values were compared with Adenosine Triphosphate (ATP) bioluminescence techniques. Results RLU values were more than 500 on bedside table surface, bed block, ECG buttons, micro pump surface, pressurized infusion ball surface and crank bed. RLU values were between 250 and 500 on nurses′ small table surface, breathing machine buttons, rulers and stethoscope surface. RLU values were less than 250 on treatment plate, footboard, pump lines and vacuum tube surface. Conclusions Hand hygiene plays a significant role in daily life. It is important to strengthen routine hand hygiene publicity and education, and monitoring and supervision can be used as an effective measure to improve the surface cleanliness of objects. Key words: ICU; Adenosine triphosphate bioluminescence techniques; Cleanliness

Knowledge of hand hygiene in undergraduate medical, dental, and nursing students: A cross-sectional survey.

Background:Hand hygiene is of paramount importance for the prevention of healthcare associated infections and the spread of antimicrobial resistance. There is a need to explore the concept of hand hygiene among the cross-disciplinary undergraduate healthcare students.Aim:To evaluate and compare the knowledge of hand hygiene among medical, dental, and nursing undergraduate students.Materials and Methods:A cross-sectional survey was conducted among 84 medical, 74 dental, and 40 nursing undergraduate students in a Tertiary Care Teaching Institute in Navi Mumbai, Maharashtra, India. Knowledge was assessed using the World Health Organization hand hygiene questionnaire. The scores for each were calculated and compared. The scores were further graded as low, moderate, and good.Results:Overall, only 7.5% of the participants had good knowledge regarding hand hygiene while majority (69.1%) had moderate knowledge. Medical students’ hand hygiene knowledge was significantly (P < 0.01) higher than that of dental and nursing students.Conclusion:The overall low scores on hand hygiene knowledge indicate that undergraduate healthcare students require increased emphasis on hand hygiene education, behavior, and improvement in their current primary training as well as undergraduate curricula.

1518Hand Hygiene for Patients: an Initiative to Study and Promote Hand Hygiene Practice for Hospitalized Patients

1518Hand Hygiene for Patients: an Initiative to Study and Promote Hand Hygiene Practice for Hospitalized Patients

Student Self-Screening for Methicillin-Resistant Staphylococcus Aureus (MRSA) Nasal Colonization in Hand Hygiene Education

To determine the feasibility and effectiveness of adding a hand hygiene exercise in self-screening for Methicillin-Resistant Staphylococcus Aureus (MRSA) nasal colonization to a health care delivery course for first-year pharmacy (P1) students. About one month after students were trained in hand hygiene technique and indications, faculty members demonstrated how to self-screen for MRSA nasal colonization. Students were then asked to screen themselves during the required class time. Aggregated class results were shared and compared to prevalence estimates for the general population and health care providers. The 71 students present in class on the day of the self-screening exercise chose to participate. A survey comparing presecreening and postscreening responses indicated incremental improvements in student knowledge and awareness of health care associated infections and motivation to perform hand hygiene. On the written exam, student performance demonstrated improved knowledge compared to previous class years. Self-screening for MRSA nasal colonization in a health care delivery course for P1 students increased students' motivation to perform hand hygiene techniques and follow indications promulgated by the World Health Organization.

Hand sanitiser provision for reducing illness absences in primary school children: a cluster randomised trial.

The potential for transmission of infectious diseases offered by the school environment are likely to be an important contributor to the rates of infectious disease experienced by children. This study aimed to test whether the addition of hand sanitiser in primary school classrooms compared with usual hand hygiene would reduce illness absences in primary school children in New Zealand. This parallel-group cluster randomised trial took place in 68 primary schools, where schools were allocated using restricted randomisation (1:1 ratio) to the intervention or control group. All children (aged 5 to 11 y) in attendance at participating schools received an in-class hand hygiene education session. Schools in the intervention group were provided with alcohol-based hand sanitiser dispensers in classrooms for the winter school terms (27 April to 25 September 2009). Control schools received only the hand hygiene education session. The primary outcome was the number of absence episodes due to any illness among 2,443 follow-up children whose caregivers were telephoned after each absence from school. Secondary outcomes measured among follow-up children were the number of absence episodes due to specific illness (respiratory or gastrointestinal), length of illness and illness absence episodes, and number of episodes where at least one other member of the household became ill subsequently (child or adult). We also examined whether provision of sanitiser was associated with experience of a skin reaction. The number of absences for any reason and the length of the absence episode were measured in all primary school children enrolled at the schools. Children, school administrative staff, and the school liaison research assistants were not blind to group allocation. Outcome assessors of follow-up children were blind to group allocation. Of the 1,301 and 1,142 follow-up children in the hand sanitiser and control groups, respectively, the rate of absence episodes due to illness per 100 child-days was similar (1.21 and 1.16, respectively, incidence rate ratio 1.06, 95% CI 0.94 to 1.18). The provision of an alcohol-based hand sanitiser dispenser in classrooms was not effective in reducing rates of absence episodes due to respiratory or gastrointestinal illness, the length of illness or illness absence episodes, or the rate of subsequent infection for other members of the household in these children. The percentage of children experiencing a skin reaction was similar (10.4% hand sanitiser versus 10.3% control, risk ratio 1.01, 95% CI 0.78 to 1.30). The rate or length of absence episodes for any reason measured for all children also did not differ between groups. Limitations of the study include that the study was conducted during an influenza pandemic, with associated public health messaging about hand hygiene, which may have increased hand hygiene among all children and thereby reduced any additional effectiveness of sanitiser provision. We did not quite achieve the planned sample size of 1,350 follow-up children per group, although we still obtained precise estimates of the intervention effects. Also, it is possible that follow-up children were healthier than non-participating eligible children, with therefore less to gain from improved hand hygiene. However, lack of effectiveness of hand sanitiser provision on the rate of absences among all children suggests that this may not be the explanation. The provision of hand sanitiser in addition to usual hand hygiene in primary schools in New Zealand did not prevent disease of severity sufficient to cause school absence. Australian New Zealand Clinical Trials Registry ACTRN12609000478213. Please see later in the article for the Editors' Summary.

The efficacy of alcohol-based hand sanitizers used in a series, modifying the ASTM E2755 method with a shorter hand sanitizer application time

&#x0D; Background: Alcohol-based hand sanitizers are becoming increasingly common in healthcare settings in an effort to control communicable bacteria, viruses and fungi of health significance. Much research has been done on the effectiveness of alcohol-based hand sanitizers but few studies look at the effectiveness when combined with more typical usage, such as varying application times and amounts. Methods: We looked at the efficacy of the microbial killing power of an alcohol-based hand sanitizer when used in a series of 5 applications. ASTM E2755 was used with the modification of a shorter application time (8 seconds from the recommended 30 seconds) of the sanitizer to better reflect actual healthcare worker usage. Results: We found an increase in the amount of indicator bacteria on the gloved hands of the subjects after repeated applications. However the increase was not significant enough in that a 2-log reduction of indicator bacteria was still achieved. Using a One Sample T-Test we found a very low probability value (&lt;0.00000), indicating that the results were statistically significant. Conclusions: There is an increase of bacteria on gloved hands after repeated use of alcohol-based hand sanitizers. The results show a decrease in their effectiveness, most likely due to a build up of various non-alcohol components in hand sanitizers. However even with the 8 second application time there was still a greater than two log reduction even after 5 serial contaminations and applications. This cautiously shows that there is significantly less danger posed by more common shorter application times than originally thought. These findings have a potential impact on hand hygiene education as other factors, such as frequency or sanitizer amounts can be safely emphasized over application times.&#x0D;

Effectiveness of hand hygiene teaching on knowledge and compliance of hand washing among the students at a selected school in Mugalivakkam village, Kancheepuram District

Background: One of the major health problems in our country is unsanitary conditions especially poor hand hygiene leads to a rigorous public health hazard to children in the school. Children are not aware of important of hand hygiene at school level. Health education is considered necessary for better knowledge. Materials and Methods: Quantitative quasi experimental randomized one group pretest and posttest design study was carried out to find out the effectiveness of hand hygiene teaching on knowledge, compliance and to correlate the level of hand hygiene knowledge with compliance of hand washing among the students. The knowledge was assessed by questionnaire and compliance was assessed by sterile hand swab collection to do bacteriological culture test in the microbiology laboratory. Among six primary schools in the Mugallivakkam village at Kancheepuram District one primary school was selected using simple lottery method. Five students from 2 nd , 3rd, 4th and 5 th standard were selected using simple random sampling. The total sample size was 20. The period of data collection was from 16-6-2012 to 13-7-2012. The 20 primary school students were split into four subgroups of each consisting of five school children. Then teaching programme on hand hygiene was given using laptop. Posttest was conducted on knowledge and compliance after three weeks. Results: The mean value of knowledge between the pretest and posttest showed a vast statistically significant difference at p<0.001 level and there was a extremely important difference in the mean score of the various pathogens in the hand flora which was estimated to assess the compliance indicators to hand hygiene between the pretest and posttest at p<0.001 level. Conclusion: This study imposes importance of suitable health teaching intervention through proper structure to the school children, for enhancement concerning hand hygiene among them, all over the country.

Teaching consistent hand hygiene: How can we improve?

Background: Hand hygiene is the simplest, most effective measure for preventing nosocomial infections. However, this technique is not consistently translated into clinical practice. Educators must first evaluate current practices to determine what has been effective, what changes need to occur, how to evaluate, and what evidence provides guidelines for best practices. Methods: This article examines current practices of instructing hand hygiene and describes teaching and evaluation strategies used in a nursing fundamental didactic and laboratory course. Instructors used educational strategies, lab practice, and mock hospital simulations to teach and evaluate hand hygiene compliance in the clinical setting. The authors used Kolb’s Experiential Learning Theory during both lecture and lab to analyze the effectiveness of hand hygiene education and compliance during evaluations of undergraduate nursing students. Different simulation techniques were evaluated to determine implementations for future improvement. Conclusion : Educators must continue to combine didactic courses and simulations labs to enhance the knowledge and improve skills of undergraduate nursing students. Educators must mentor each other and define clear objectives before teaching a lab simulation or lecture. More research is needed as to what specific concepts should be taught using learning and theoretical models that will ultimately improve patient safety through hand hygiene compliance when nurses go out into their practice settings.

병원실습 경험이 있는 간호 대학생의 손 위생 지식과 이행에 관한 연구

Purpose: The goal of the study was to investigate nursing students` knowledge and compliance with hand hygiene to find out the variables associated with compliance with hand hygiene. Methods: The participants were 1,020 nursing college students located in Seoul, Ansan and Suncheon. The variables analyzed in this study were; hand hygiene knowledge, hand hygiene compliance, hand washing habits, hand hygiene education with emphasis in school, emphasis on hand washing and role modeling in hospital, and hand hygiene beliefs. Data were analyzed by frequency, -test, t-test and Pearson correlation coefficient. Results: 1. The correct answer average percentage of hand hygiene knowledge was 78.4%. 2. The average rates of hand hygiene compliance rate was 78.0% 3. Compliance rate had significant correlation with variables such as hand washing habit, hand hygiene education with emphasis in school, emphasis on hand washing and role modeling in hospital, and hand hygiene belief. Conclusion: 1. It is nessassery for nursing students to receive proper educational on hand hygiene knowledge during practices in nursing school curriculum. 2. Nurses should be encouraged to be a good mentor to nursing students on appropriate hand hygiene compliance in clinical practice.

Impact of a multi-hospital intervention utilising screening, hand hygiene education and pulsed xenon ultraviolet (PX-UV) on the rate of hospital associated meticillin resistant Staphylococcus aureus infection

Standard approaches to meticillin resistant Staphylococcus aureus (MRSA) prevention have included hand hygiene and active surveillance. These approaches have shown mixed results. The addition of pulsed xenon ultraviolet (PX-UV) room disinfection for MRSA prevention is a novel approach. This new MRSA prevention method was implemented at an acute care hospital system in Greensboro, NC, USA. An MRSA screening programme was implemented over a six-month period from July 2011 to January 2012 to include all high-risk patients and the majority of surgical patients. A two-week hand hygiene education initiative was implemented in February 2011. The use of PX-UV for terminal cleaning of MRSA patient rooms was also implemented in February 2011. The rates of hospital associated MRSA (HA-MRSA) infections were monitored before and after implementation of all prevention efforts. The HA-MRSA rate decreased at the largest facility in the system by 57%, and for the entire healthcare system by 56% ( p=0.001). The two smaller hospitals saw reductions of 51% and 66%, but the results were not statistically significant ( p=0.1047 and p=0.2263). Implementing a PX-UV device in conjunction with active screening and hand hygiene was associated with a decrease in HA-MRSA rates. Studies on the individual effect of PX-UV on HA-MRSA rates are warranted.

A large-scale assessment of hand hygiene quality and the effectiveness of the “WHO 6-steps”

BackgroundHand hygiene compliance is generally assessed by observation of adherence to the “WHO five moments” using numbers of opportunities as the denominator. The quality of the activity is usually not monitored since there is no established methodology for the routine assessment of hand hygiene technique. The aim of this study was to objectively assess hand rub coverage of staff using a novel imaging technology and to look for patterns and trends in missed areas after the use of WHO’s 6 Step technique.MethodsA hand hygiene education and assessment program targeted 5200 clinical staff over 7 days at the National University Hospital, Singapore. Participants in small groups were guided by professional trainers through 5 educational stations, which included technique-training and UV light assessment supported by digital photography of hands. Objective criteria for satisfactory hand hygiene quality were defined a priori. The database of images created during the assessment program was analyzed subsequently. Patterns of poor hand hygiene quality were identified and linked to staff demographic.ResultsDespite the assessment taking place immediately after the training, only 72% of staff achieved satisfactory coverage. Failure to adequately clean the dorsal and palmar aspects of the hand occurred in 24% and 18% of the instances, respectively. Fingertips were missed by 3.5% of subjects. The analysis based on 4642 records showed that nurses performed best (77% pass), and women performed better than men (75% vs. 62%, p<0.001). Further risk indicators have been identified regarding age and occupation.ConclusionOngoing education and training has a vital role in improving hand hygiene compliance and technique of clinical staff. Identification of typical sites of failure can help to develop improved training.

How Collaboration with the Microbiology Laboratory Can Help to Improve Hand Hygiene Education

Education and monitoring of hand hygiene measures is one of the most important functions of the Infection Prevention Department. In an effort to optimize hand hygiene education as part of our hand hygiene campaign, the Infection Prevention Department and the Microbiology Laboratory worked together to design and coordinate a process to increase hospital staff awareness.

Physicians: The Forgotten Healthcare Professional Group in Hand Hygiene Education

Despite all efforts to educate and spread the culture of hand hygiene, there is still variation in the practice of hand hygiene among various healthcare professional categories and in the different healthcare areas. While hand hygiene usually depicted as the simplest way to prevent infection, some healthcare workers perceive that it needs high effort. This fact made understanding the perception and knowledge background imperative.