HAND HYGIENE PRACTICES AMONGST HEALTH CARE WORKERS AND THE
CONTROL
OF
HOSPITAL
ACQUIRED
INFECTION
IN
HOSPITAL,EKPAN.
BY
SHOKARE FAVOUR OGHENERIOBORUE
STATE SCHOOL OF NURSING WARRI,DELTA STATE.
JULY, 2020.
i
GENERAL
HAND HYGIENE PRACTICES AMONGST HEALTH CARE WORKERS AND THE
CONTROL
OF
HOSPITAL
ACQUIRED
INFECTION
IN
GENERAL
HOSPITAL,EKPAN.
BY
SHOKARE FAVOUR OGHENERIOBORUE
STATE SCHOOL OF NURSING WARRI,DELTA STATE.
IN PARTIAL FULFILLMENT OF THE REQUIREMENT OF NURSING AND MIDWIFERY COUNCIL OF NIGERIA FOR THE AWARD OF REGISTERED NURSE.
JULY, 2020.
ii
DECLARATION
This is to declare this research project titled : HAND HYGIENE PRACTICES AMONGST
HEALTH CARE WORKERS AND THE CONTROL OF HEALTH CARE ACQUIRED
INFECTION
IN
GENERAL
HOSPITAL,
EKPAN,
DELTA
STATE.
was carried out by:SHOKARE FAVOUR OGHENERIOBORUE is solely the result of my work except where
acknowledged as being derived from other person(s) or resources.
EXAMINATION NUMBER:________________________________
DEPARTMENT/SCHOOL:____________________________________
SIGNATURE:____________________________________________
DATE:_________________________________________________
iii
CERTIFICATION
This is to certify that this research project by SHOKARE FAVOUR OGHENERIOBORUE
with examination number______________ has been examined and approved for the award of
registered nurse certificate.
SIGNATURE:_________________________
NAME: Mrs.ESHEGBE BETTY CHRISTABEL
Date:_____________
(Project supervisor)
SIGNATURE:_____________________________
NAME :Mrs.CHRISTIANA OTERI
Date:______________
(principal,state school of nursing)
SIGNATURE:_____________________________
NAME:_____________________________
Date:______________
(chief examiner)
SIGNATURE:_____________________________
iv
ABSTRACT
Hand hygiene has achieved the reputation of being a convenient means of preventing
communicable diseases. Hand hygiene is a milestone of infectious disease control, and
promotion of improved hand hygiene has been recognized as an important public health measure.
It has long been recognized to be a convenient, effective, and also cost-effective means of
preventing communicable diseases. Despite the proven importance and benefits of washing hand,
proper hand washing is not as pervasive as desired to prevent infections until now, especially in
the developing countries that bear the greatest burden of infectious diseases. It is observed that
hand hygiene is not properly practiced amongst nurses, doctors and health assistants, especially
in the out-patient department. This study focuses on Hand hygiene practices amongst health
personnel’s in the control of health care acquired infection among health workers in central
hospital warri. A total of 100 participants were used for the study which included Physicians,
Nurses, and Health attendants and data was gathered using a structured questionnaire. 100% of
the respondents practice proper hand hygiene in the course of clinical practice, Majority (91.0%)
of respondents wash their hands before attending to each patient. Also 55.20% of respondents
practice the use of alcohol hand rubs. A total of 94.1% of respondents are positive about hand
washing helping to limit spread of infections generally. Hand hygiene practices will help reduce
the stress of hospital acquired infections as well as in a way reduces the length of stay of patients
in the hospital that is related to acquiring hospital related infections/diseases. It is recommended
that hand hygiene should be practiced in every unit in the hospital and health
workers/personnel’s should make it a habit as they practice.
v
ACKNOWLEDGEMENT
My colossal gratitude goes to God Almighty for his protection, provision , love , mercy and
grace throughout my training.
My heartfelt gratitude goes to my project supervisor, Mrs. Betty Okiti for her guidance, patience
encouragement and contribution in writing this research work.
My genuine appreciation goes to my research supervisor Mr. Lewis Ejigue, my principal Mrs..
Christiana oteri and the entire staff of State School of Nursing Warri.
My profound gratitude goes to my wonderful parents Mr. and Mrs. Jonathan Shokare, and my
siblings, Engr. Shokare Irikefe Valentine, Mrs. Agbongze Elona Oghenekaro, Shokare
Emmanuella Akpevweoghene.
Lastly special appreciation to Ajosibe Favour Tamaralayefa and my friends Onovughe
Jesutekpevwe, Aliandu victory, Obi Ngozi, Onome Gift Ese, Kokuma Oghenemine,Aiwanlenose
Momoh, OkpakoObiku divine , Timishere mabel ,Ohwhoria ruth, and the entire grace breeds set
2017,may the good lord bless you all abundantly, Amen.
vi
TABLE OF CONTENT
Title page
i
Declaration page
iii
Certification page
iv
Abstract
v
Acknowledgement
vi
Table of content
vii
List of table
x
List of figure
xi
CHAPTER ONE
1.0 Introduction
1
1.1 Background to the study
1
1.2 Statement of the problem
2
1.3 Objective of the study
3
1.4 Research question
3
1.5 Significance of the study
4
1.6 Scope of the study
4
1.7 Operational definition
4
CHAPTER TWO
2.0 Literature Review
6
2.1 Conceptual Review
6
2.2 Theoretical Review
17
2.3 Empirical Review
19
vii
CHAPTER THREE
3.0 Research Methodology
22
3.1 Research design
23
3.2 Research setting
23
3.3 Target population
23
3.4 Sample size determination
23
3.5 Sampling technique
24
3.6 Instruments for data collection
24
3.7 Validity of instrument
24
3.8 Reliability of instrument
25
3.9 procedure for data analysis
25
3.10 Ethical consideration
25
CHAPTER FOUR
4.0 Data analysis and presentation
26
4.1 Socio demographic data
26
4.2 Proportion of health care workers that practice hand hygiene
29
4.3 Forms of hand hygiene practiced among health care workers
30
4.4 Impact of hand hygiene prac5tices in the prevention of hospital acquired infection
31
4.5 Factors militating against hand hygiene practices
33
4.6 Answering of research questions
35
viii
CHAPTER FIVE
5.0 Discussion of findings
38
5.1 Implications of findings to nursing
39
5.2Limitations of the study
40
5.2 Summary of the study
40
5.3 Conclusion
41
5.4 Recommendations
42
5.5 Suggestions for further studies
42
References
43
ix
LIST OF TABLES
TABLE 1: Demographic data
26
TABLE 2: Proportion of health care workers that practice hand hygiene
29
TABLE 3: Forms of hand hygiene practiced among health care workers
30
TABLE 4: Impact of hand hygiene practices in the prevention of hospital acquired infections 31
TABLE 5: Factors militating against hand hygiene practice
x
33
LIST OF FIGURES
Figure 1: Impact of hand hygiene practices in the prevention of hospital acquired infection 31
xi
CHAPTER ONE
1.0
INTRODUCTION
1.1
BACKGROUND TO THE STUDY
Hand hygiene has achieved the reputation of being a convenient means of preventing
communicable diseases. Hand hygiene is a milestone of infectious disease control and promotion
of improved hand hygiene has been recognized as an important public health measure. It has
long been recognized to be a convenient¸ effective ,and also cost effective means of preventing
communicable diseases.
According to the definition of World Health Organization, hand hygiene is a general term
referring to any action of hand cleansing, that is, it is the act of cleaning one’s hands with or
without the use of water or another liquid, or with the use of soap, for the purpose of removing
soil , dirt, or microorganisms. A casual link between hand hygiene and rates of infectious illness
has also been established earlier.
Globally,73.5 million children younger than five(50)years ,mainly concentrated in developing
countries including Bangladesh ,die from diarrhea and acute lower respiratory tract infections.
The transmission of communicable diseases is responsible for more than 164[one hundred and
sixty four ]lost school days per school year among students up to twelfth grade world wide.
Approximately 2.4 million deaths can be prevented annually by good hygiene practice ,reliable
sanitation
,and
drinking
water
(Rabbi,2013).
.
An analysis on thirty hand hygiene studies found that improvements in hand washing reduced
the incidence of upper respiratory tract infection by twenty one percent and gastrointestinal
illnesses by thirty one percent .Evidence showed that hand washing with soap could reduce the
1
risk of diarrhea diseases by forty two percent ,and hand washing promotion could save millions
of lives Hossain and kamaru (2013).
Despite the proven importance and benefits of hand washing ,proper hand washing is not as
pervasive as desired to prevent infections until now,especially in the developing countries that
bear the greatest burden of infectious disease. it is observed that hand washing is not properly
practiced among health care workers especially in the out patient department (OPD) during
immunization routine ,during ward round and ward medications .in various ward, that health
personnel do not practice proper hand hygiene before care and after care ,they only wash their
hands after care ,the researcher wonders and this stimulated the researcher to carry out this
study. Hand hygiene should start from health care workers,they are expected to portay a good
example to other’s because client and patient’s look up to health care workers.
1.2
STATEMENT OF THE PROBLEM
According to centers for disease control(CDC)cited by Elvin(2012)hand washing is the simplest
most effective measure for preventing the spread of pathogens and virus even with knowledge,
world health organization (WHO,2016)states that health care workers fail to practice proper
hand hygiene(hand washing).Hand hygiene dramatically decreases the potential pathogens on
hands and is considered the first measure for decreasing the risk of transmitting organisms to
patients ,health care workers and family members. studies conducted by center for disease
control and several others found that health care workers fail to wash their hands properly of the
recommended sixty percent of the time between patient contact and before patient contact .which
cause extended care and treatment of patient .based on these ,the researcher seeks to find out
2
the extent of hand hygiene practices among health care workers in the control of hospital
acquired infection .
1.3
OBJECTIVES OF THE STUDY
The broad objective of this study is to ascertain the control of health care acquired
infections among health care workers in General hospital Ekpan. The specific objectives
includes;

To identify the proportion of health care workers that practice hand hygiene in
General hospital Ekpan.

To ascertain the impact of hand hygiene practice in the prevention of health care
acquired infection among health workers.

To determine the various forms of hand hygiene practices carried out by health
care workers in General hospital Ekpan.

1.4
To elucidate on the factors militating against hand hygiene practices.
RESEARCH QUESTIONS

What is the proportion of health care workers that practice hand hygiene?

What is the impact of hand hygiene practice in the prevention of health care
acquired infection among Health care workers?

What are the various forms of hand hygiene practices carried out by health
personnels?

What are the factors militating against hand hygiene practices?
3
1.5
SIGNIFICANCE OF THE STUDY

SIGNIFICANCE OF THE STUDY TO THE SOCIETY: In the view of the pre sent
problem of failure to practice proper hand washing ,the research study will help to
provide adequate information on measures to promote hand hygiene practices .Data
provided by the study will
help policy makers in planning health care
interventions

SIGNIFICANCE OF THE STUDY TO HEALTH CARE PROVIDERS: This study
will help health care workers to adopt practices that will reduce the risk of health
care acquired infection to patients and themselves

SIGNIFICANCE OF THE STUDY TO THE PROFESSION :This study will
enlighten
1.6
nurses on
the
dangers
and
benefits of
hand washing
practice.
SCOPE OF THE STUDY/DELIMITATION
This study focuses on hand hygiene practice among health care workers in the control of
health care acquired infection in General hospital Ekpan
1.7
OPERATIONAL DEFINITION OF TERMS

HAND HYGIENE: This
is
a
general
term
that
applies
to
hand
washing
,Antisepeptic hand wash, hand disinfectant and surgical hand antiseptic

HEALTH CARE WORKERS: This refers to anybody who is directly or indirectly
related to patient and client care that works in the hospital
4

NURSES: The Nurse is a person who has completed a program of basic
generalized nursing education and is authorized by the appropriate regulatory
authority to practice nursing in his or her country.

DOCTORS;A person who is qualified to treat ill people.

HEALTH ASSISTANTS: Health care assistants is a support worker in a clinical area
who works under the supervision of a registered practitioner who is accountable for the
support workers standards and activities.

PRACTICES: To perform an activity regularly in order to improve or maintain one’s
proficiency.

CONTROL; The power to reduce the course of events

HEALTH CARE ACQUIRED INFECTIONS[HCAI]:These are infections patients get
while receiving treatment for medical or surgical conditions
5
CHAPTER TWO
2.0
LITERATURE REVIEW
2.1
CONCEPTUAL REVIEW
 Overview of Hand Hygiene Practice
Hand hygiene is the act of cleaning one’s hands with or without the use of water or another
liquid or without the use of soap, for the purpose of removing soil, dirt and/or microorganism.
Medical hand hygiene pertains to the hygiene practices related to the administration of medicine
and medical care that prevents or minimizes disease and spread of disease. The main medical
purpose of washing hands is to clean the hands of pathogens (including bacteria or viruses) and
chemical which can cause personal harm or disease. This is especially important for people who
handle food or health care personnel in the medical field. But it is also important practice for the
general public, nurses, doctors and health assistants can become infected with respiratory illness,
such as influenza or the common cold, for example, if they don’t wash their hands before
touching their eye, nose or mouth (CDC, 2012).
It is well documented that one of the most important measure for preventing the spread of
pathogens is effective hand washing. As a general rule, hand hygiene protect people poorly or
not all from droplet and air borne diseases, such as measles, chicken pox, influenza and
tuberculosis it protect best against disease transmitted through fecal oral route. For this reason
the center for disease control and prevention (CDC) now recommends that you wash your hands
thoroughly for at least 20 seconds with clean, running water and soap, using warm water if it is
available. If clean water is not available, an alcohol based hand sanitizer can be substituted, but
6
not that these types of product don’t remove dirt or soil, soap and water really is the best option.
CDC reporting that up to 80% of all infections are transmitted by hands. (Vincent 2013).
Proper hand washing is an important way to stay healthy year-round. Hand hygiene practice is
the main player in prevention of cross of infection (WHO, 2014). Hand washing is the simplest,
easy to implement and good practices that can reduce the risk of cross infection (Storr,
2015).Low staff compliance with hand hygiene practices remains a major problem in most health
care settings worldwide, indeed, when appropriate methodology is used to assess compliance, it
rarely exceed 30% (Didier Pittet, 2015).
Chilarra and colleagues found from their study that the compliance with hand hygiene practices
after contacts with patients or exposure to their body fluids is always higher than before touching
a patient or device use to patient. Implementation of the five moments of hand hygiene is the best
ways of enhancing patient care and no shortage of important health care legislators emphasizing
the basic five, hand hygiene practices (Jarves, 2014).
The National Audit Office (2000, cited by Jarves, 2014) provides incontrovertible evidence that
infection control is a cornerstone of good clinical practice of hand hygiene and quality patient
care (Storr, 2015). The provision of healthcare worldwide is always associated with a potential
range of safety problems, yet, despite advances in healthcare systems, patients remain vulnerable
to unintentional harm in hospitals (Storr, 2015).
One of the most significant, current discussions in healthcare delivery in hospitals is healthcare
acquired infection (HCAI), which is ‘any infection that a person develops as a result of treatment
in hospital’. Hand hygiene was thought to be a key factor in reducing hospital acquired infection
during the initial development of healthcare systems (Akyol 2007 cited by Ott & French 2016).
7
The battle with HCAI started when the Hungarian obstetrician, Semmelweis (1847), observed
that puerperal fever was more common on a maternity ward, where physicians and medical
students provided care to women in labour, than it was on the ward where midwives assisted
deliveries. He noted that physicians and medical students were contaminating their hands while
performing autopsies and later attending the examination of women without hand washing.
Arguably, he was the first to recognize the importance of hand washing in controlling the
transmission of infection. Despite the magnitude of HAI problems and the importance of
adherence to infection control policies, hand hygiene practice has remained unacceptably low.
Hence, poor compliance has resulted in high morbidity and mortality. The situation is even
worse in developing countries, where resources and facilities are limited. (Rabbi, 2013)
 Health care Acquired Infection
Health care acquired infection are those infection contact or required beyond 48 hour of
admission that are not originally the health problem that brought the patient to the hospital or
course of admission, 3 days after discharge or 30 days after an operation.
Many healthcare acquired infection are caused by pathogen transmitted from one patient to
another patient by health care personnel who did not wash their hands between patient or health
care personnel who do not practices control measure such as the use of glove and hand
disinfectant. Centre for Disease Control and Infection Prevention (2013).
Most common health acquired infections, are surgical wound infections, urinary tract infection
and respiratory tract infection, and bacteremia (bloodstream infection) many of these infectious
are by antibiotic resistant bacteria, known as superbugs, and can often have serious consequences
for the individual and hospital community. These infections result in an estimated 90,000 deaths,
8
immeasurable suffering and disability and are associated with billions of dollars in increased
health care cost (Rabbi, 2013).
Health care acquired infection Causes significant concern regarding the safety and quality of
health care quality worldwide, the world health organization launched the world alliance for
patient safety in October 2004 and health care acquired infection have been identified as a
fundamental priority and were selected as the topic of the first Global patient safety challenge.
Hand hygiene was identified as the core component of this strategy because it is a simple,
standardized low cost measure based on solid scientific evidence of infection control. (WHO
2004, cited by Rabbi, 2013).
 The Impact of Hand Hygiene Practices
The impact of hand hygiene before patient contact for infection prevention was demonstrated
160 years ago when Semmel Weis studied the relationship between improved hand antisepsis
and reduced mortality from puerperal Sepsis, since then, it has been reported that improved hand
hygiene practices reduces health care acquired infection rates. Hand hygiene was stated to be the
effective practices for health care personnel and has a significant impact in reducing the spread
of health care acquired infection in the hospital. Hand hygiene is an effective way of thinking
about safety and patient care and involved everyone in the hospital, including patients and health
care personnel effective hand hygiene practice in the hospitals play a key role in improving
patient and health care personnel safety and preventing spread of health care acquired infection.
Improved compliance in hand hygiene, can reduce health care acquired infection rate by as much
as 40%, at Geneva University Hospital improvement of hand hygiene practice compliance rate
from 48%, 66% over 5 years period lowered the frequency of health care acquired infection by
9
methicillin resistance aureus was reduced by more than 50% about 80% of common infection are
spread by health care person (workers), patient and visitor, proper hand hygiene can significantly
reduce the spread of infection, best practices of hand hygiene can reduce the spread of infection
close to zero percent (Zoutman and Ford, 2008, cited by WHO, 2011).
Some of the impact mention are:

Prevent fecal oral infection

It helps to keep many ailment at bay.

It prevent prolong hospital stay of patient, rescue cost of treatment to patient and family.

It helps to achieved development and growth of a healthier society.

It helps prevent germs causing health care acquired infection to patient and health care
personnel.
 Indication for hand hygiene practice
The indication for hand hygiene includes the following:

Before and after treating each patient e.g. before glove placement and after glove
removal.

After bare handed touching in animate object likely to be contaminated by blood, saliva
or respiratory secretion.

When hands are visibly soiled.

Before re-gloving, after removing gloves that are torn, cut or puncture.

Before and after touching wound, whether surgical, traumatic or associated with invasive
device.
10

Before and after suction during which microbial contamination of hands is likely to occur
especially those involving contact with mucous membranes, blood or body fluid
(secretion and excretion).

After taking care of an infected patient or on who is likely to be colonized with
microorganisms of special clinical or epidemiologic significance, for example multiple
resistant bacteria.


Between patient contact and patient in high risk unit. (Isolation unit) (WHO 2011).
The importance of hand hygiene
Hand hygiene substantially reduces potential pathogen on the hands and is considered as primary
measures, because it is the simplest and most effective way we all have for preventing the spread
of infections to contribute to reducing of health care acquired infections . WHO and CDC (2010,
2011)

Types of hand hygiene measures
There are different types of hand hygiene practices they include the following:

Routine hand wash (Social hand washing) with plain soap and water removes most
transient micro organisms from moderately soiled hands.

Alcoholic hand rub: which is also known as hygiene hand washing or disinfectant is a
procedure in which antiseptic detergent preparation is used for washing hands, it is more
effective method to remove and kill transient micro-organisms.
11

Surgical hand hygiene:This is the use of water and antimicrobial soap (e.g chlorhexidine,
iodine, iodophors, chloroxylenol, triclosan)for the purpose of removing or destroying
transient micro organisms and reduce resident flora.

Antiseptic handwash:Use of water and anti microbial soap for the purpose of removing
micro organisms.
 Guidelines for proper hand hygiene practice
The proper guideline for hand hygiene is also known as the indication for hand hygiene and the
right way to wash the hands.
The right way to hand hygiene practices are followed:

At first wet the hands with clean running water (warm or cold) and apply soap.

Rub the hands together to make lather and scrub them well, be sure to scrub the backs of
the hands between the fingers and under the nails.

Continue rubbing the hands for at least 20 seconds, need a timer? Timed oneself by the
“Happy Birthday” song from beginning to the end twice.


After that rinse the hands well under running water

Dry the hands using a clean towel or air dry them. (WHO and CDC, 2011)
Barrier to hand hygiene practices or factors affecting hand hygiene practices.
The rate of adherence to hand hygiene practices is so low especially among health care provides,
who should be the most diligent. These are some of the reason health care personnel gave;

Inaccessible hand hygiene product
12

Skin irritation caused by hand hygiene agent

Lack of knowledge of the guidelines.

Insufficient time for hand hygiene and forgetfulness.

High work load and understaffing.

Lack of scientific information about health care related infection rates

Disagreement with guideline and protocols and lack of motivation have all contributed to
poor compliance with hand hygiene practices and infection control measures Akyol
(2007), Mani (2010), Karabay (2015)

Factors Influencing Hand Hygiene Practices
To decrease health care acquired infection and increase adherence to hand hygiene protocol,
barriers to adherence must be adhered.

Place dispensers of skin cleaning and emollient agents in accessible in locations.

Minimize hand hygiene dermatitis by providing emollient agents.

Educate care giver (health personnel about infection rates and hand hygiene protocols)

Increase health care personnel-patient ratios..

Hand hygiene facilities should be made accessible to health personnel

Sink or washing hand basin should be made available at patient room side at the door
way.

Soap dispensers should be placed beside sink and also alcohol-based cleaner dispenser
should be placed some distance from the sink.

Selecting less irritating hand hygiene products.
13

Encouraging health care personnel to use moisturizing skin product after hand cleaning.

Notice to remind health care personnel about hand hygiene practices. (Smith and
Coichorst, 2012).

Intervention to improve nurses, doctors, and health assistants’ hand hygiene practices
Ogunsola and Adesiji (2014) report that most wards in Nigerian hospital lack adequate facilities
for effective hand hygiene and uses the bucket and bowl method as an alternative to running
water. For health care personnel to improve on hand hygiene practices the factor that influence
hand hygiene practices should be consider and there should be turn to enhance these factors. For
example staff education, proper follow up training in hand hygiene is reasonable; the infection
control team can be involved in attaining this.
The unit or ward manager is responsible for ensuring that hand hygiene products are always
available and are in accessible places inside or outside of every patient room, nursing station,
offices etc. Smith Lokhorst (2016) suggest that promotional material, such as posters can placed
in noticeable arrears of hospital to remind health care personnel, patient and visitors about hand
hygiene.

The role of nurses, doctors and health assistants in health care acquired infection
control
Nurses’ hands come into close contact with patients and are frequently contaminated during
routine patient care: e.g. auscultation and palpation or while touching contaminated surfaces,
devices or materials such as changing of dressing. Therefore, hand hygiene is considered an
essential, cheap and most effective means of preventing cross infection. The aim of hand hygiene
is to remove dirt and limit the microbial counts on the skin, to prevent cross transmission of
14
pathogens between patients. Since nurses are present 24 hours a day, 7 days a week in the
healthcare setting, it is essential to comply with hand hygiene policy and maintain patient safety.
Nurses often fail to practice hand hygiene because they are busy and they feel hand hygiene
takes up precious time. In addition, nurses often perceive that gloves can be used as an
alternative to hand hygiene. They usually tend to remove the gloves without washing their hands.
Even when nurses spend a longer time on hand hygiene, their technique is often poor in terms of
leaving large areas unwashed effectively, i.e. wrists, thumbs, nail beds and between fingers.
Hand hygiene compliance is seen more in junior nurses and newly recruited staff. Hand hygiene
is not only the nurses’, doctors’ and health assistants responsibility, it is a shared responsibility
between hospital administration, key leaders, patients and others stakeholders. Patient usually
feels reassured if he/she observes Nurses, Doctors and health assistants practice proper hand
hygiene in the hospital environment.
Other steps (role) nurses, doctors and health assistants can take include:

Covering coughs and sneezes

Staying up to date with immunization

Using gloves, makes and protective clothing

Making tissues and hand cleaners available (tissues as paper towels)

Following hospital guideline when dealing with blood or contaminated items. WHO
(2014)

The role of patient toward their own safety
Hand hygiene involves everyone in the hospital, including patient, patient attendance and even
visitor because hand hygiene practices is one of the best way to prevent the spread of many
15
infection, so patients and their visitors should also practices good hygiene before and after
entering patient rooms, patient should wash their hands before and after eating, after contact with
their body fluid, after making use of the toilet. In other to prevent germs causing hospital
acquired infection to themselves, this will be a measure to prevent the spread of germs. (PessoaSilva, 2014).
 Misconceptions of hand hygiene practices
Misconception is something people believe to be true or an idea that is not based on correct
information. Misconceptions of hand hygiene practice are followed.
1.
Hand hygiene is designed only to protect clinicians; Hand hygiene is just as integral to
protecting patient as it is to protecting health care personnel because the moment before
treatment begins pivotal in the prevention of microbial transmission because health care
personnel could easily passion a pathogen to an unsuspecting patient, as such health care
personnel hands must be clean before any type of contact with patient is initiated.
2. Gloving is an effective substitute for hand washing. Thorough and regular hand hygiene
is one of the most important strategies for reducing the number of pathogens in health
care setting minimizing the risk of their transmission. Gloves do not provide complete
protection form pathogenic contamination; they can be become contaminated after
contact with patient. (James, 2011).
16
2.2
THEORETICAL FRAMEWORK

DOROTHEA OREM’S THEORY OF SELF CARE
Self care as a human need and nurses design intervention to provide or manage self care action
for persons to recover or maintain health. Orem’s general theory of nursing is in three related
parts


Theory of self care

Theory of self care deficit

Theory of nursing system.
Theory of Self Care
Deals with measures or actions taken to provide self care. There are three categories of self care
needs universal needs are common to all people. They include maintaining intake and elimination
of air, water and food, balancing rest, solitude and social interaction, preventing hazards
promoting normal human functioning. Developmental need result from maturation or are
associated with condition or events such as adjusting to a change in body image or to loss of a
spouse. Health deviation needs results from illness, injury or disease or its treatment. They
include actions as seeking health care assistance carrying out prescribed therapies and learning to
live with the effects of illness or treatment.

Theory of Self Care Deficits
It results when self care agency is not adequate to meet the known self care demand. Orem’s self
care deficit theory explains not only when nursing is needed but also how people can be assisted
17
through five method of helping, acting or doing for, guiding, teaching, supporting and providing
an environment that promotes the individual’s abilities to meet current and future demands.

Theory of Nursing System
Dorothea Orem identifies three types of nursing systems:
Wholly compensatory systems are required for individuals who are unable to controls and
monitor their environment and process information partly compensatory system are designed for
individuals who are unable to perform some, but not all, self care activities support educative
(developmental) systems are designed for persons who need to learn to perform self care
measures and need assistance to do so. The five methods for helping discussed for self care
deficit can be used in each nursing system.
Orem’s work which interpret the concepts of human beings, health, nursing and society defined
the three steps of nursing processes.

Diagnosis and prescription

Design of nursing system and planning for the delivery and care

Production and management of nursing system
This is closely parallel to the nursing process of assessment, planning, implementation
and evaluation.

APPLICATION OF THE THOERY TO THE STUDY
Dorothea Orem’s self care theory self care refers to those individual practices that are done
independently to promote the general good health of the person. Hand hygiene is one of those
18
practices. General well being of individual can be enhanced by regular hand hygiene(hand
washing) practices. Many people take it as triviality however it can save them many costs self
care can only be achieved when the individuals have agency with self care. This is the personal
initiative to pursue the self care practices when individual do not have the initiative to perform
self care practices, then a deficit arises in self care and this may lead to ill health of the
individual.
When the individuals are ill, this is the point at which the health care needs of such individuals,
by teaching, supporting, guiding, providing and environment for the patients to achieve self care
practice. The health care personnel can also offer a full compensatory assistance to the patient to
enable them to fully recover and not to promote illness, however as the old saying goes, when an
hungry man requests for a fish from you, you should also provide him with a fishing rid and also
teach hum how to fish, this way you would have fully assisted him, this should also be case with
health care personals and the patient on self care. This can be achieved by nurses offering what is
referred to as the partial compensatory assistance where the patient also plays some role in
his/her recovery process; he or she will subsequently be able to develop a self care program to
safe guard himself/herself. Healthcare personnel especially nurses should therefore offer
education to patients on self care practices.
Another way of assisting the patient achieve self care is by setting a good example to them.
Health care personnel should be among the first to embrace self care practices. It is unexpected
of them to forsake this and to suffer from infections related to lack of proper safe care practices.
19
2.3
EMPIRICAL REVIEW
In a study by Glad Mohesh, Abinaya Dandapani (2013) on the knowledge, Attitude and practice
of hand hygiene among Medical students-a questionnaire based survey. Ninety six students
reported that they are aware of hand hygiene practices, but 3/4th of them said that they had no
formal training on the same. 50% of them accepted that, hand hygiene practices before and after
handling a patient will prevent health care associated infections. Although 94% agreed, 6%
disagreed hand hygiene as an important preventive measure for cross infections. 95%of them
washed their hands before and after their food intake.70% of them used soap and water whereas
only 6.36% used alcohol based agents.1/4th of the students didn’t have a habit of washing their
hands after handling a patient.
In a study by Timothy A Ekwere, Ifeoma P Okafor (2013) on Hand hygiene knowledge and
practices among healthcare providers in a tertiary hospital, South West Nigeria
Simple random sampling was used to select 500 HCPs (250 doctors and 250 nurses). Data
collection was done with self-administered structured questionnaires. Data obtained were
analyzed with SPSS version 11.5. A total of 430 HCPs (230 doctors and 200 nurses) participated
in this study giving a response rate of 86%. Eighty-three percent had good knowledge; 97.6%
had good attitude and 69.9% had good hand washing practices. Hand washing after contact with
patient (97.7%) was better than before contact (61.4%). Nurses had better hand washing
practices than doctors (Fisher’s exact p<0.001) and were more likely to wash their hands before
patient contact than doctors (p<0.001). Training on infection control had a significant positive
influence on HCPs knowledge and hand washing practices (Fisher’s exact p<0.001 and Fisher’s
exact p<0.001 respectively). The commonly used hand-drying methods were personal
handkerchief (28.8%), common cloth towel (22.6%) and natural air drying (29.5%)
20
The major motivation for hand washing was fear of contracting disease while the major
constraint was busy work schedule in-between patient care
In another study among health workers in a Tertiary Hospital in North-Eastern Nigeria, training
on standard precautions was predictive of correct knowledge of standard precaution. [22] The
identified gaps in knowledge and practice of hand hygiene in this study despite regular training,
is alarming. Ogoina et al reported the poor practice of hand hygiene despite good knowledge
among HCW in two tertiary hospitals in Nigeria. Insufficient water supply among others has
been shown to affect the practice of hand hygiene among HCW in Nigeria.
A study done in general hospital.Ikot Ekpene ,akwa ibom state, Nigeria, revealed that 82.4%
of respondents had good knowledge of hand washing and 17.6% had poor knowledge.
observations on the practice of hand washing revealed that 42.2% of respondents always
practiced hand washing and 34.3% practiced occasionally,while 23.5% never practiced hand
washing.
A study conducted in Jiimma University hospital in south west Ethopia also showed that hand
washing practice by the nursing staff was inadequate .This study demonstrated that only 43.2%
of the nursing staff practice adequate hand washing .While 56.8% of them practice inadequate
hand washing.

SUMMARY OF REVIEW
Hand hygiene is one self care practices that can go long way in keeping most many ailments at
bay. Nurses, doctors and health assistants should work relentlessly in promoting the self care
practices, they need to set a good example by themselves adhering to hygienic practices like
hand washing. This way a healthier population will be achieved and greater economic growth
realized from energy of the citizens and resources which will not be channeled to healthcare.
21
Therefore cleaning hands is one of the most important steps health care personnel and all of us
can take to prevent the spread of infection causing germs. Numerous studies shows that health
care acquired infection can be prevented in the hospital of health care personnel use proper hand
hygiene practice.
22
CHAPTER THREE
3.0
RESEARCH METHODOLOGY
This chapter deals with the methods that was used in this study, which includes the
following:
RESEARCH DESIGN
RESEARCH SETTING
TARGET POPULATION
SAMPLE SIZE DETERMINATION
SAMPLING TECHNIQUE
INSTRUMENT FOR DATA COLLECTION
VALIDITY AND RELIABILITY
PROCEDURE FOR DATA ANALYSIS
ETHICAL CONSIDERATION
3.1
RESEARCH DESIGN
This study will employ the descriptive survey research design. it was used to assess hand
hygiene practices amongst health care workers in the control of health care acquired
infection in General Hospital Ekpan.
23
3.2
RESEARCH SETTING
The research was carried out in General Hospital Ekpan ,Warri, Delta state .The Hospital is
under hospital management board and is owned by Delta state Government and is located
in uvwie local government Area of Delta state. The hospital is being head by a chief
medical director .it is made up of different wards which includes the maternity ward,
record unit, account department, dental clinic ,eye clinic ,family planning clinic ,heart to heart
centre .laboratory ,dietician clinic , male ward, female ward ,emergency ward, theatre and
pharmacy department .The hospital is bounded in the west by Agadaga road, in the east by
jakpa road, in the south by the church of the lattar days and in the north by line road.
3.3
TARGET POPULATION
The population used for this study is the health care workers which includes(Doctors ,nurses
,and health assistants).who work in General hospital Ekpan.The total number of these
health care workers at the time of this study is ninety(90).
3.4
SAMPLE SIZE DETERMINATION
The sample size was determined by using 75% workers population. sixty seven(67) health care
workers where used.
3.5
SAMPLING TECHNIQUE
The simple random sampling technique was used. Where by the researcher gave
opportunity to all the health care workers.
24
3.6
INSTRUMENT FOR DATA COLLECTION
A well structured questionnaire was used as the instrument for study.The questionnaire
consist of five(5) sections
SECTION A:Demographic data
SECTION B:Proportion of health care workers that practice hand hygiene
SECTION C:Forms of hand hygiene practices carried out by health care workers
SECTION D:Impact of hand hygiene practices in the
prevention of hospital acquired
infections
SECTION E:Factors militating against hand hygiene practices
3.7
VALIDITY AND RELIABILITY OF INSTRUMENT:
VALIDITY: To ensure the validity of the research instrument, the questionnaire was
given to the research supervisor who made necessary corrections and suggestions which
was implemented .The supervisor also confirmed face and content validity of the
instrument.
RELIABILITY: Reliability was achieved through pilot study method using a test retest
method by administering 10 questionnaires to the subjects(four nurses, four doctors and two
health assistants)outside the target population (General hospital Ekpan.)The response was in
line with the study.
25
3.8
PROCEDURE FOR DATA ANALYSIS
The data was analyzed using tables, chart and percentages. spss(statistical pacakage for
social science)version 20 was also used to analyze the data collected.
3.9
ETHICAL CONSIDERATION
The researcher obtained an introductory letter from her school which enabled her to seek
permission from the medical director in charge and the nurse in charge in the hospital
.For this study ,verbal consent was voluntarily obtained from the respondents .The
respondents were
also
informed
that
participation
was
voluntary. The
autonomity and confidentiality was maintained in the course of the study.
26
respondents
CHAPTER FOUR
4.0
DATA ANALYSIS AND PRESENTATION
This chapter presents the data analysis for the responses of the respondents .Data collected for
the study were statistically analyzed and presented in tables and bar charts for clarity and better
understanding of the research findings. The result is presented with respect to the research
questions stated in the study.
4.1
SOCIO-DEMOGRAPHIC DATA
TABLE 4.1: Socio-Demographic Data
Variable
Classification
Frequency
Percentage (%)
Age
20-30
7
10.4
31-40
37
55.2
41 – 50
21
31.3
51 above
2
2.9
Total
67
100
Male
23
34.3
Female
44
65.7
Total
67
100
Sex
27
Marital status
Profession
Years in service
Ward/unit
Single
4
5.9
Married
62
92.5
Separated
1
1.6
Total
67
100
Nurses
39
58.2
Physician
21
31.3
Health Assistants
7
10.4
Total
67
100
1-10 years
62
92.5
11-20 years
2
2.9
21 years above
3
4.5
Total
67
100
Men’s ward
3
4.5
Women’s ward
18
26.9
Pediatrics ward
4
5.9
OPD
27
40.3
28
Religion
Obstetrics unit
4
5.9
Others
11
16.4
Total
67
100
Christian
57
85.0
Muslim
10
14.9
Others
-
-
TOTAL
67
100
Table4.1: shows the socio demographic characteristics of the respondents,out of the 67
respondents studied,7(10.4% )of the respondents are within the age of 20- 30years,37( 55.2%)
are within the age of 31-40 years,21( 31.3% )are within the age of 41-50years and 2( 2.9%) are
above the age of 51 years and above.23( 34.3%) are Males and 44( 65.7%) of respondents are
female.4( 5.9%) are single,62( 92.5%) are married and 1(1.6%) of respondents are separated.
The table also shows that39( 58.2%) of respondents are Nurses,21( 31.3%) are physicians and
7(10.4%) are health assistants.62( 92.5%) of respondents have spent 1-10 years in service,
2( 2.9% )have 11-20 years of service and 3( 4.5%) have had over 21 years in service.
The table also shows that,3(4.5% )of the respondents work in the male ward,18(26.9%) of
respondents work in the women’s ward4(5.9%) work in the pediatrics ward,27( 40.3% )work in
the Outpatient department (OPD),4( 5.9%) work in the Obstetrics unit and 16.4% of respondents
work in other units.
29
The table also shows that 57( 85.0%) of the respondents are Christians and 10(14.9%) of the
respondents are muslim,while nil(0%)worship other religion.
4.2
PROPORTION OF HEALTH CARE WORKERS THAT PRACTICE HAND
HYGIENE
Table 4.2: proportion of health care workers that practice hand hygiene
Items
Variable
1.
Does
that
Frequency
practice
percentage
proper
hand 67
100%
2.
Before attending to each patient
59
91.0%
3.
When hands are visibly soiled
2
2.9%
4.
Before and after gloving
3
4.9%
5.
After touching inanimate objects
3
4.5%
hygiene
Table 4.2,shows that 67(100% )of the respondents practice proper hand hygiene in the course of
clinical practice ,59( 91.0%) of respondents wash their hand before attending to each patient,
2(2.9% )wash their hands when they are visible soiled, 3(4.9%) of respondents wash their hands
before and after gloving,3( 4.5%) wash their hands after touching inanimate objects.
30
4.3
FORMS OF HAND HYGIENE PRACTICED AMONG HEALTH CARE WORKERS
Table 4.3: forms of hand hygiene practiced among health care workers
ITEMS VARIABLE
FREQUENCY
PERCENTAGE
1.
Plain water and soap
18
26.9%
2.
Alcohol hand rub
37
55.20%
3.
Antiseptic hand wash
6
5.90%
4.
Non
alcoholic
hand 8
11.90%
sanitizer
67
100%
there is running tap in my 65
97.0%
TOTAL
5.
unit
6.
There is no running tap in 2
2.9%
my unit
TOTAL
67
100%
7.
I have personal hand rub
65
97.0%
8.
I don’t have personal hand 2
2.9
rub
TOTAL
67
100%
31
Table 4.3 above,shows that 18( 26.90%) of respondents practice Plain water and soap as hand
hygiene practice,37(55.20%) practice the use of alcohol hand rub, 6(5.90%) use Non alcoholic
hand sanitizer, while 8(11.90%) practice the use of Antibacterial soap as hand hygiene practice.
While 65( 97.0%) of the respondents have personal hand rubs while 2( 2.9%) of respondents do
not have hand rubs.
4.4
IMPACT OF HAND HYGIENE PRACTICES IN THE PREVENTION OF
HOSPITAL ACQUIRED INFECTIONS
Figure 4.4: Distribution of respondents showing their views on impact of hand hygiene
practices in the prevention of hospital Acquired infections
60
strongly
Agree
50.7
50
47.7
47.7
46.2
46.3
Agree
43.4
40
Undecided
30
25.4
Disagree
25.4
20.8
20
14.9
10
5.9
5.9
2.9 2.9
0
0
0
Hand washing helps limit
spread of infection
Hand hygiene helps prevent Hand hygiene in a way limits hand hygiene helps protect
hospital acquired infection patients long stay in hospital the health of the health
worker
32
Figure 4.4 above shows that 50(47.7%) of respondents strongly agree that Hand hygiene
prevents hospital acquired infection,48(46.2%) agree that Hand hygiene prevents hospital
acquired infection,8(5.9%) are undecided that Hand hygiene prevents hospital acquired
infection,0( 0%) disagree and 0( 0%) strongly disagree that Hand hygiene prevents hospital
acquired infection.
The figure above also shows that, 50.7% of respondents strongly agree that hand washing helps
limit spread of infections generally, 43.4% agree that hand washing helps limit spread of
infections generally, 2.9% are undecided that hand washing helps limit spread of infections
generally, 0% disagree and 2.9% strongly disagree that hand washing helps limit spread of
infections generally.
The above also shows that, 25.4% of respondents strongly agree that hand hygiene in a way
limits patients long stay in hospital, 14.9% agree that hand hygiene in a way limits patients long
stay in hospital, 25.4% are undecided that hand hygiene in a way limits patients long stay in
hospital, 13.4% disagree and 20.8% strongly disagree that hand hygiene in a way limits patients
long stay in hospital.
The above also shows that, 47.7% of respondents strongly agree that hand hygiene helps protect
the health of the health workers, 46.3% agree that hand hygiene helps protect the health of the
health workers, 5.9% are undecided that hand hygiene helps protect the health of the health
workers, 0% disagree and 0% strongly disagree that hand hygiene helps protect the health of the
health workers.
33
4.5
FACTORS MILITATING AGAINST HAND HYGIENE PRACTICE.
Table 4.5: Distribution of respondents showing factors militating against hand hygiene
Practice.
ITEMS
VARIABLES
SA
n
1.
There are no running taps 17
A
UD
%
n
%
25.4
10
14.9
23.9
9
13.4
N
SD
D
%
n
%
n
%
0
0
3
4.5
2
2.9
10
14.9
17
25.
17
25.3
around my units
2.
There are no soaps at my 14
units for hand washing
3.
There is no time to carry- 21
3
31.3
38
56.7
2
2.9
4
5.9
2
2.9
31.3
38
56.7
2
2.9
2
2.9
4
5.9
8.9
2
2.9
2
2.9
29
43.
28
41.7
out the procedure
4.
Sinks and washing basins 21
arenot available
5.
There are no provision for 6
personal hand sanitizers
3
From table 4.5 above, 25.4% of respondents strongly agree that lack of running taps around their
units is a factor that militates against hand hygiene, 14.9% agree that lack of running taps around
34
their units militates against hand hygiene, 0% are undecided, 4.5% strongly disagree that lack of
running taps around their units is a factor that militates against hand hygiene, and 2.9% of
respondents disagree that lack of running taps around their units is a factor that militates against
hand hygiene
The Items 2 above ,also shows that 23.9% of respondents strongly agree that lack of soaps in
their units for hand washing is a factor that militates against hand hygiene, 13.4% agree that lack
of soaps in their units for hand washing militates against hand hygiene, 14.9% are undecided,
25.3% strongly disagree that lack of soaps in their units for hand washing is a factor that
militates against hand hygiene, and 25.3% of respondents disagree that lack of soaps in their
units for hand washing is a factor that militates against hand hygiene
Items 3 above also shows that, 31.3% of respondents strongly agree that lack of time to carry-out
the procedure is a factor that militates against hand hygiene, 56.7% agree that lack of time to
carry-out the procedure militates against hand hygiene, 2.9% are undecided, 5.9% strongly
disagree that lack of time to carry-out the procedure is a factor that militates against hand
hygiene, and 2.9% of respondents disagree that lack of time to carry-out the procedure is a factor
that militates against hand hygiene
Also items 4 from the table above shows that 31.3% of respondents strongly agree that lack of
Sinks and washing basins are factors that militates against hand hygiene practice, 56.7% agree
that
lack of Sinks and washing basins militates against hand hygiene practice, 2.9% are
undecided, 2.9% strongly disagree that
lack of Sinks and washing basins are factors that
militates against hand hygiene practices, and 5.9% of respondents disagree that lack of Sinks
and washing basins are factors that militates against hand hygiene practices.
35
Items 5 from the table above also shows that, 8.9% of respondents strongly agree that lack of
provisions for personal hand sanitizers is a factor that militates against hand hygiene practice,
2.9% agree that lack of Sinks and washing basins militates against hand hygiene practice, 2.9%
are undecided, 43.3% strongly disagree that lack of provisions for personal hand sanitizers is a
factor that militates against hand hygiene practices, and 41.7% of respondents disagree that lack
of provisions for personal hand sanitizers is a factor that militates against hand hygiene practices
4.6
ANSWERING OF RESEARCH QUESTIONS
Question 1: What is the proportion of health care workers that practice hand hygiene?
This will be answered with items 1and 2, of table 4.2
The proportion of health care workers that practice hand hygiene from table 2,shows that 100%
of the respondents practice proper hand hygiene in the course of clinical practice and 91.0% of
respondents wash their hands before attending to each patient. This shows that majority of the
respondents are enlightened about hand hygiene practices.
Question 2: What are the various forms of hand hygiene practices carried out by health
personnel’s?
This will be answered with items 1,2,3,4 of table4.3
According to table 3, 26.90% of respondents practice Plain water and soap as hand hygiene
practice, 55.20% practice the use of alcohol hand rub, 5.90% use Non alcoholic hand sanitizer,
while 11.90% practice the use of Antibacterial soap as hand hygiene practice.
36
Question 3: What are the various barriers limiting hand hygiene practice among health
personnel’s?
This will be answered with items 1,2,3,4 and 5 from table 4.5
From table 4.5, 25.4% of respondents strongly agree that lack of running taps around their units
is a factor that militates against hand hygiene, and 14.9% agree that lack of running taps around
their units militates against hand hygiene. Also, 23.9% of respondents strongly agree that lack of
soaps in their units for hand washing is a factor that militates against hand hygiene and 13.4%
agree that lack of soaps in their units for hand washing militates against hand hygiene.
Also from table 4.5,items 3,shows that 31.3% of respondents strongly agree that lack of time to
carry-out the procedure is a factor that militates against hand hygiene ,and 56.7% agree that lack
of time to carry-out the procedure militates against hand hygiene. The table also shows that,
31.3% of respondents strongly agree that lack of Sinks and washing basins are factors that
militates against hand hygiene practice, 56.7% agree that lack of Sinks and washing basins
militates against hand hygiene practice. This shows that, lack of running taps around their units,
lack of soaps in their units for hand washing and lack of time to carry-out the hand washing
procedure are all factors militating respondents from carrying out proper hand washing practice.
Question 4: What is the impact of hand hygiene practice in the prevention of health care
acquired infection among health personnel’s?
This will be answered with the bar chart of figure 4.4 above.
According to figure 4.4, 47.7% of respondents strongly agree that Hand hygiene prevents
hospital acquired infection, 46.2% agree that Hand hygiene prevents hospital acquired infection.
37
Also, 50.7% of respondents strongly agree that hand washing helps limit spread of infections
generally and 43.4% agree that hand washing helps limit spread of infections generally. The
table also shows that 25.4% of respondents strongly agree that hand hygiene in a way limits
patients long stay in hospital, 14.9% agree that hand hygiene in a way limits patients long stay in
hospital and 47.7% of respondents strongly agree that hand hygiene helps protect the health of
the health workers as well as 46.3% agree that hand hygiene helps protect the health of the health
workers. This shows that hand washing helps in the prevention of health care acquired infection
among health personnel.
38
CHAPTER FIVE
This chapter consists of the relevant findings in chapter four and related literature review in
chapter two.
This chapter was discussed under the following sub headings:
-DISCUSSION OF FINDINGS
-LIMITATIONS OF THE STUDY
-SUMMARY OF THE STUDY
-CONCLUSION
-RECOMMENDATIONS
-SUGGESTIONS FOR FURTHER STUDIES
5.0
DISCUSSION OF FINDINGS TO NURSING
It was carried out on 67 health care workers in General hospital, Ekpan, Delta state.
From the data analysis, Majority of the respondents (55.2%) are within the age of 31-40 years,
65.7% of respondents are female, 92.5% are married. Also, 58.2% of respondents are Nurses,
31.3% are physicians and 10.4% are health assistants. Majority of respondents (92.5%) have
spent 1-10 years in service. Majority of respondents (40.3%) work in the Outpatient department
(OPD), 26.9% work in the women’s ward, 5.9% work in the Obstetrics unit, 5.9% work in the
pediatric ward, and 5% of the respondents work in the male ward.Also 85.0% of the respondents
are Christians and 14.9% are muslims. From that data analysis, 100% of the respondents practice
proper hand hygiene in the course of clinical practice, and majority of the respondents (91.0%)
wash their hands before attending to each patient, 2.9% wash their hands when they are visible
39
soiled, 4.9% of respondents wash their hands before and after gloving, 4.5% wash their hands
after touching inanimate objects. And 91.0% of respondents wash their hands before attending to
each patient. From the findings of the study, it shows that majority of the respondents are
knowledgeable about hand hygiene practices
In a study by Glad Mohesh, Abinaya Dandapani (2014) on the knowledge, attitude and practice
of hand hygiene among Medical students-a questionnaire based survey. Ninety six students
reported that they are aware of hand hygiene practices, but. 50% of them accepted that, hand
hygiene practices before and after handling a patient will prevent health care associated
infections. Although 94% agreed, 6% disagreed hand hygiene as an important preventive
measure for cross infections. 95%of them washed their hands before and after their food
intake.70% of them used soap and water whereas only 6.36% used alcohol based agents.1/4th of
the students didn’t have a habit of washing their hands after handling a patient
Also from the findings, ,majority of the respondents agree that lack of running taps around their
units, lack of soaps in their units for hand washing and lack of time to carry-out the hand
washing procedure are all factors militating respondents from carrying out proper hand washing
practice.
5.1
IMPLICATIONS OF FINDINGS TO NURSING
The findings of this study contribute to the body of knowledge underlying hand hygiene
practices and its impact in the control of Health care acquired infection. Nurses represent a large
working group that performs the greatest amount of direct patient care in Health Services. Hand
hygiene is one of the most effective measures to prevent hospital acquired infections Nurses’
hands come into close contact with patients and are frequently contaminated during routine
40
patient care: e.g. auscultation and palpation or while touching contaminated surfaces, devices or
materials such as changing of dressing. Therefore, hand hygiene is considered an essential, cheap
and most effective means of preventing cross infection. The aim of hand hygiene is to remove
dirt and limit the microbial counts on the skin, to prevent cross transmission of pathogens
between patients. Since nurses are present 24 hours a day, 7 days a week in the healthcare
setting, it is essential for nurses to comply with hand hygiene policy and maintain patient safety
5.2
LIMITATION OF THE STUDY
During the course of the study ,the following limitations were noticed and experienced
5.3

Getting the respondents to fill the necessary questionnaire was hard

The pandemic made it difficult to access the research setting
SUMMARY OF THE STUDY
Hands are the most effective mode of transfer of microorganism in healthcare and can result in
healthcare associated infections which are major causes of morbidity and mortality worldwide.
Reduction of infection by this mode of transfer can be achieved by a simple but very effective
measure of performing hand hygiene at the appropriate time which is one of the most
fundamental principles in infection prevention and control. Good hand hygiene practices have
been shown to reduce healthcare associated infections. Hand washing with soap and water has
been considered a measure of personal hygiene for health workers around the hospital facility.
Proper hand hygiene practices should be reiterated to health workers all over health facilities and
should be carried out with strict adherence. The use of alcohol based hand sanitizers has proven
41
to be the most effective against pathogens because of its ability to eliminate the microbial
existence on surfaces. Furthermore, hand hygiene practices will help reduce the stress of hospital
acquired infections as well as in a reduces the length of stay of patients in the hospital that is
related to acquiring hospital related infections/diseases.
5.4
CONCLUSION
Hand-to-hand contact can spread mild conditions, such as the common cold, but also more
severe or life-threatening diseases. Infectious diseases are a particular risk to the very young, the
elderly, those with a preexisting disease, and people with a compromised immune system.
Nurses washing their hands not only prevent them from getting sick, but it also reduces the risk
of infecting others. If they don't wash their hands properly before coming into contact with
others, they can infect their patients but also their family members (Pittet, Allegranzi and Joyce
2012).
The Centers for Disease Control and Prevention clearly mandates that all healthcare personnel
decontaminate their hands as they enter a patient’s room and as they leave the room (CDC, 2012;
CDC 2013). The perceived barriers to hand washing that are consistently being targeted in
research studies are inaccessible or inconveniently located sinks and dispensers, forgetfulness,
heavy workload, ignorance of guidelines and lack of scientific knowledge. Placing dispensers
immediately next to each bed is a solution to the problem or using the visual display of large
posters emphasizing the importance of hand washing reminds staff to wash their hands
(Magiorakos et al 2009; Aiello et al, 2008; Aiello et al,2010 Allegranzi and Pittet 2009).
To comply with routine hand hygiene recommendations, health care workers should ideally
perform hand hygiene where and when care is provided, which means at the point of care and at
the moments indicated, and following the recommended technique and time.
42
5.5
RECOMMENDATIONS
While hand washing is a natural act, it is also a learned behavior and since handwashing is an
important health behavior, nurses, doctors and health care assistants needs to practice proper
hand washing to prevent the spread of health care acquired infection to patients. Many of the
findings expressed in this research have implications for practice and policy development.
Research indicates that certain barriers limit the practice of hand hygiene. Mani (2010), In the
light of this the following recommendations are made:

To the Nurses:
Nurses and other health care workers should ideally perform hand hygiene where and when care
is provided, which means at the point of care and at the moments indicated, and following the
recommended technique and time

To the government:
The government should provide adequate materials for hand washing such as clean running tap,
soap and detergents so as to enable the health care workers to perform proper hand hygiene.
There is also the need for regular training and seminar in other to keep health care workers
updated in knowledge about the importance of hand hygiene.
5.6
SUGGESTIONS FOR FURTHER STUDIES:
Further studies should be conducted on the knowledge attitude and practice of hand hygiene
among health care workers in selected hospitals in Delta state.
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REFERENCES
1. Didier Pittet, (2015) Effectiveness of a hospital-wide programme to improve compliance with hand
hygiene. Infection Control Programme 356: 1307-1312.
2. Hossain k, Saw M, Alam T, Ohtsuki V, Kamaru I (2013) Effectiveness of hand washing and
disinfection methods in removing transient bacteria after patient nursing. Research Journal of Hygiene 85: 13203.
3.
Hugonnet S, Perneger T, Pittet D (2012) Alcohol-based hand rub improves compliance with hand hygiene in
intensive care units Archive, of Internal Medicine
4. Jarves P, (2015) Effect of hand washing on child health: A randomized controlled trial. Lancet 366: 225-233.
5. Karabay (2015) Recovery of coliforms from the hands of nurses and patients: activities leading to
contamination. Journal of Hospital Infection 21: 85-93.
6.
Pittet D, Allegranzi B, Sax H, Dharan S, Pessoa-Silva (2016) Evidence-based model for hand transmission
during patient care and the role of improved practices. Lancet Infectious Diseases
7. Rabbi C (2013) International Nosocomial Infection Control Consortium report, data summary for 2010-2012,
issued January 2008. American Journal of Infection Control 36: 627-637.
8. Silva (2014) Marketing hand hygiene in hospitals--a case study. Journal of Hospital Infection pg56
9.
Smith and Coichorst, (2012) Effectiveness of hand washing and disinfection methods in removing
transient bacteria after patient nursing. Journal of Hygiene 85: 193-203.
10.
Storr G, (2015) Systematic review of economic analyses of health care-associated infections. American
Journal of Infection Control
11.
Tao, (2013) Effective hand washing- a tool in nosocomial infection reduction. Journal of
Hospital Infection 31: 75-63.
12. Vincent L (2013) hospital acquired infections in adult intensive-care units. Lancet 361: 2068-2077.
13. World Alliance for Patient Safety (2015) The Global Patient Safety Challenge 2005-2006 “Clean Care is Safer
Care”. Geneva, World Health Organization.
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