{"id":35473,"date":"2020-12-30T11:24:04","date_gmt":"2020-12-30T11:24:04","guid":{"rendered":"https:\/\/biomedpharmajournal.org\/?p=35473"},"modified":"2021-01-11T06:41:58","modified_gmt":"2021-01-11T06:41:58","slug":"awareness-of-hand-hygiene-in-hospital-set-up-for-infection-control-knowledge-based-questionnaire-for-health-care-workers-in-a-teaching-hospital","status":"publish","type":"post","link":"https:\/\/biomedpharmajournal.org\/staging\/vol13no4\/awareness-of-hand-hygiene-in-hospital-set-up-for-infection-control-knowledge-based-questionnaire-for-health-care-workers-in-a-teaching-hospital\/","title":{"rendered":"Awareness of Hand Hygiene in Hospital Set-up for Infection Control: Knowledge-based Questionnaire for Health Care Workers in a Teaching Hospital"},"content":{"rendered":"

Introduction<\/strong><\/p>\n

The word hygiene is derived from the word Hygeia, which refers to the Greek Goddess of health and hygiene. Hand hygiene is defined by the World Health Organization (WHO) \u00a0as \u201ca general term referring to any action of hand cleansing\u201d, i.e., it is the mode of cleaning one\u2019s hands either with the help of soap and water or with the use of alcohol-based sanitizer in order to get rid of microorganisms, dirt, etc. Hand hygiene is recognized as the leading measure to prevent cross transmission of microorganisms and to reduce the incidence of health care-associated infections.<\/p>\n

Hand hygiene, using either alcohol-based hand rub or with soap and water is the most effective method of preventing infections. The use of alcohol-based hand rub is a better way to get rid of transient microorganisms especially in developing countries where there is scarcity of water. If practiced properly, especially between each bed of the patient in a hospital, it can reduce the rate of infection with methicillin-resistant Staphylococcus aureus.[1] <\/sup><\/p>\n

Holmes and Semmelweis \u00a0proved that\u00a0 the contamination of the hands of Health Care Workers (HCWs) played a major role in puerperal sepsis.[2]<\/sup> Transmission of microorganisms through contaminated HCWs\u2019 hands is the most common source of infection in most places and consists of five sequential steps<\/p>\n

Organisms are present on the patient\u2019s skin, or on inanimate objects in the patient\u2019s environment<\/p>\n

Organisms transfer to the hands of HCWs<\/p>\n

Organisms survive for few minutes on HCWs\u2019 hands<\/p>\n

Handwashing done by soap or sanitizer is inadequate or not done at all, which leads to persistence of the microorganisms in HCW\u2019s hands<\/p>\n

The contaminated hands come in direct contact with another patient or with inanimate objects which in turn will come in contact with the patient.[3]<\/sup><\/p>\n

Though the Centre for Disease Control (CDC) gradually increased the regulation of hand hygiene practices, particularly in healthcare settings, it was not until 2009 that an international standard for hand hygiene practices was established by the WHO, in the comprehensive Guidelines on Hand Hygiene. In order to reduce the problems related to hand washing, WHO introduced \u201cMy five moments for hand washing.\u201d The five moments which have been instructed to health care workers during patient care are: (1) use of hand wash before you touch the patient (2) before you perform any aseptic and clean procedure (3) after exposure to body fluids (4) after you touch a patient (5) after you leave the surroundings of the patient.[<\/sup>4]<\/sup><\/p>\n

The guidelines concerning hand hygiene focus on the aspects of hygiene as the act of cleaning, focusing on the reduction in bulk microbial load, rather than the reduction in transmission of infection.<\/strong>[5]<\/sup> Moreover, hand hygiene not only reduces the incidence of nosocomial infections but also the burden associated with these infections (prolonged hospital stay, long-term disability, increased antimicrobial resistance, massive additional financial burden on patients and their family, and excess deaths).[6] <\/sup><\/p>\n

If we analyze the circumstances of hand wash, we need to\u00a0 perform hand wash before we arrive at work, after arrival at work, before leaving from the work place, after reaching home, in between client contacts, when the hands are soiled, after the removal of gloves, before eating, after handling excretion of body fluids (urine and feces), after handling blood samples, before and after performing invasive procedures and after handling contaminated instruments.<\/p>\n

The duration of time required for handwash depends on the circumstances. While using an alcohol-based hand rub, we require 10 to 15 seconds to remove transient flora from the hands. When we are using soap and water to wash soiled hands, 40 to 60 seconds are required. High risk areas, such as contact with infected patients or surgical hands may require even 2 minutes. [7] <\/sup><\/p>\n

Handwashing is the easiest and most effective method to prevent infection which the entire world is also stressing on now, to protect everyone from the COVID-19 pandemic. However, about 50% of HCAIs occur mainly due to the hands of health care providers (HCPs).<\/strong>[4]<\/sup> Though hand hygiene procedures are relatively simple, studies have shown that the compliance among healthcare workers is not very encouraging. HAIs due to poor hand hygiene are the prime reasons for increasing morbidity, mortality and healthcare costs which the current pandemic, COVID-19 is also facing.<\/p>\n

Objectiv<\/strong>e<\/p>\n

To find out the lacunae in hand hygiene and aim to formulate and take preventive measures that can prevent HAI and multidrug resistant pathogens.<\/p>\n

Methods<\/strong><\/p>\n

The study was done in a tertiary care teaching hospital for a period of three months (February 2020 – April 2020). The study was done using a self-administered questionnaire. The questionnaire was given to all health care professionals working in the hospital, which included doctors, nurses, and lab technicians. Ethical clearance was obtained from the institution to carry out the study.<\/p>\n

Study Design<\/strong><\/p>\n

A descriptive-based cross-sectional study to analyze the knowledge and practice of hand washing among health care workers at ACS Medical College and Hospital, Chennai, Tamil Nadu, India.<\/p>\n

Study Population<\/strong><\/p>\n

The population selected for this study consisted of all the health care workers at ACS Medical College and Hospital comprising nurses, doctors and laboratory technicians.<\/p>\n

Inclusion Criteria<\/strong><\/p>\n

All health care workers who were interested and willing to participate in the study were included.<\/p>\n

Exclusion Criteria<\/strong><\/p>\n

All health care workers who were not willing to participate in the study were excluded.<\/p>\n

Statistical Methods<\/strong><\/p>\n

Statistical analysis was done with the response from the questions answered by the population. Descriptive and inferential statistical analysis was carried out in the study. Chi-square \/ Fisher Exact test was used to find the significance of the study parameters on a categorical scale between two or more groups. Non-parametric setting was done for Qualitative data analysis. Fisher Exact test was used when cell samples were small.<\/p>\n

Statistical Software<\/strong><\/p>\n

Statistical software SPSS 22.0 and R environment ver.3.2.2 were used for the analysis of the data and Microsoft word and Excel was used to generate tables etc.<\/strong><\/p>\n

Results<\/strong><\/p>\n

The analysis was done through a knowledge-based questionnaire. A total of 134 people participated, comprising 75 doctors (56%), 38 nurses (28.4%), 11 lab technicians (8.2%) and 10 others (7.4%). (Table 1)<\/p>\n

Table 1: No. of participants<\/strong><\/p>\n\n\n\n\n\n\n\n\n
Profession<\/strong><\/td>\nNo. of subjects<\/strong><\/td>\n%<\/strong><\/td>\n<\/tr>\n
Doctor<\/td>\n75<\/td>\n56.0<\/td>\n<\/tr>\n
Lab Technician<\/td>\n11<\/td>\n8.2<\/td>\n<\/tr>\n
Nurse<\/td>\n38<\/td>\n28.4<\/td>\n<\/tr>\n
Others<\/td>\n10<\/td>\n7.5<\/td>\n<\/tr>\n
Total<\/td>\n134<\/td>\n100.0<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

This study was carried out to evaluate the awareness about hand washing techniques among health care workers. Most of them had adequate knowledge. However, there were variations in the steps of hand wash while washing their hands and the time required to wash hands using soap and water.<\/p>\n

According to WHO guidelines, there are 6 steps in hand washing technique, and it takes 40-60 seconds for hand wash when you are using soap and water. While using alcohol-based hand rub, you require 20-30 seconds for hand wash to remove transient flora from hands. In our observation, the nurses were better in knowledge about hand washing steps (78.9%) than doctors (41.3%) and lab technicians (45.5%). This may be because hand hygiene training is imparted more among nurses than the doctors. (Table 2)<\/p>\n

Table 2: Assessment of hand wash steps in health care workers<\/strong><\/p>\n\n\n\n\n\n\n\n
How many steps are there in the hand washing procedure as per WHO guidelines?<\/td>\nDoctor (n=75)<\/strong><\/td>\nNurse (n=38)<\/strong><\/td>\nLab Technician (n=11)<\/strong><\/td>\nOthers (n=10)<\/strong><\/td>\nTotal (n=134)<\/strong><\/td>\n<\/td>\n<\/tr>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 5 steps<\/td>\n10(13.3%)<\/td>\n2(5.3%)<\/td>\n0(0%)<\/td>\n4(40%)<\/td>\n16(11.9%)<\/td>\n <\/p>\n

 <\/p>\n

<0.001**<\/td>\n<\/tr>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 6 steps<\/td>\n31(41.3%)<\/td>\n30(78.9%)<\/td>\n5(45.5%)<\/td>\n3(30%)<\/td>\n69(51.5%)<\/td>\n<\/tr>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 9 steps<\/td>\n14(18.7%)<\/td>\n6(15.8%)<\/td>\n2(18.2%)<\/td>\n3(30%)<\/td>\n25(18.7%)<\/td>\n<\/tr>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 10 steps<\/td>\n20(26.7%)<\/td>\n0(0%)<\/td>\n4(36.4%)<\/td>\n0(0%)<\/td>\n24(17.9%)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

It is widely known that effective hand wash plays a role in preventing HAIs. As many as 80 per cent of individuals retain disease-causing bacteria even after effective hand wash. So, it is important to know the time taken to wash hands to prevent infection.<\/p>\n

For the question regarding the time taken for handwash, doctors had a better knowledge than nurses and lab technicians. This might be because they are used to routine hand wash before surgery and before any procedures. Around 35 (46.7%) doctors suggested that it would take 40 to 60 seconds for hand wash when you are using soap and water whereas 15 (39.5%) nurses and none of the lab technicians knew the answer. (Table 3)<\/p>\n

Table 3 : Assessment of hand wash among health care workers<\/strong><\/p>\n\n\n\n\n\n\n\n
How long should you wash your hands while washing with soap?<\/td>\nDoctor (n=75)<\/strong><\/td>\nNurse (n=38)<\/strong><\/td>\nLab Technician (n=11)<\/strong><\/td>\nOthers (n=10)<\/strong><\/td>\nTotal (n=134<\/strong><\/td>\n<\/td>\n<\/tr>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 4-6 sec<\/td>\n0(0%)<\/td>\n4(10.5%)<\/td>\n0(0%)<\/td>\n2(20%)<\/td>\n6(4.5%)<\/td>\n <\/p>\n

 <\/p>\n

<0.001**<\/td>\n<\/tr>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 8-10 sec<\/td>\n4(5.3%)<\/td>\n2(5.3%)<\/td>\n4(36.4%)<\/td>\n2(20%)<\/td>\n12(9%)<\/td>\n<\/tr>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 10-15 sec<\/td>\n36(48%)<\/td>\n17(44.7%)<\/td>\n7(63.6%)<\/td>\n6(60%)<\/td>\n66(49.3%)<\/td>\n<\/tr>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 40 – 60 sec<\/td>\n35(46.7%)<\/td>\n15(39.5%)<\/td>\n0(0%)<\/td>\n0(0%)<\/td>\n50(37.3%)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

When asked about the disposal of used gloves, only 31 (41.3%) out of 75 doctors mentioned that the gloves should be discarded in a red bin. Meanwhile, 36 (94.7%) out of 38 nurses answered that it should discarded in a red bin, whereas all 11 (100%) lab technicians were clear in discarding gloves in red bin as they wear gloves regularly in the lab. (Table 4)<\/p>\n

Table 4: Assessment of biomedical waste management in health care workers.<\/strong><\/p>\n\n\n\n\n\n\n
 <\/p>\n

What should be done after using gloves?<\/td>\n

Doctor (n=75)<\/strong><\/td>\nNurse (n=38)<\/strong><\/td>\nLab Technician (n=11)<\/strong><\/td>\nOthers (n=10)<\/strong><\/td>\nTotal (n=134)<\/strong><\/td>\n<\/td>\n<\/tr>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Discard gloves in blue bin and then wash your hands<\/td>\n3(4%)<\/td>\n0(0%)<\/td>\n0(0%)<\/td>\n0(0%)<\/td>\n3(2.2%)<\/td>\n <\/p>\n

 <\/p>\n

<0.001**<\/td>\n<\/tr>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Discard gloves in red bin and then wash your hands<\/td>\n31(41.3%)<\/td>\n36(94.7%)<\/td>\n11(100%)<\/td>\n5(50%)<\/td>\n83(61.9%)<\/td>\n<\/tr>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Discard gloves in yellow bin and then wash wash your hands<\/td>\n41(54.7%)<\/td>\n2(5.3%)<\/td>\n0(0%)<\/td>\n5(50%)<\/td>\n48(35.8%)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

When ungloved hands come in contact with fluids from a wound, it is mandatory to wash hands with soap and water instead of cleaning with an alcohol-based sanitizer. The lab technicians did not have any knowledge about this and there was no response from them (0%). Around 40 doctors (53.3%) and 19 nurses (50%) answered correctly.<\/p>\n

It is necessary to wear gowns while working with a patient since blood or body fluids may get on your clothing from a procedure that you plan on performing. For this, 68 (90.7%) doctors, 68 (90.7%) nurses and 11 (100%) lab technicians answered correctly. Around seven (9.3%) doctors and seven technicians (9.3%) answered that they need to wear gowns only if the patient has AIDS or Hepatitis. Only three (7.9%) nurses mentioned that a gown is required only if the patient has HIV.<\/p>\n

Table 5: Knowledge assessment of PPE (personal protective equipment)<\/strong><\/p>\n\n\n\n\n\n\n\n
It is absolutely necessary to wear a gown when working with a patient if<\/td>\nDoctor (n=75)<\/strong><\/td>\nNurse (n=38)<\/strong><\/td>\nLab Technician (n=11)<\/strong><\/td>\nOthers (n=10)<\/strong><\/td>\nTotal (n=134)<\/strong><\/td>\n<\/td>\n<\/tr>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Blood or body fluids may get on your clothing from a task you plan to perform<\/td>\n <\/p>\n

68(90.7%)<\/td>\n

 <\/p>\n

32(84.2%)<\/td>\n

 <\/p>\n

11(100%)<\/td>\n

 <\/p>\n

5(50%)<\/td>\n

 <\/p>\n

116(86.6%)<\/td>\n

 <\/p>\n

 <\/p>\n

 <\/p>\n

0.002**<\/td>\n<\/tr>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 The patient has AIDS or hepatitis<\/td>\n7(9.3%)<\/td>\n3(7.9%)<\/td>\n0(0%)<\/td>\n3(30%)<\/td>\n13(9.7%)<\/td>\n<\/tr>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 The patient’s hygiene is poor<\/td>\n0(0%)<\/td>\n3(7.9%)<\/td>\n0(0%)<\/td>\n0(0%)<\/td>\n3(2.2%)<\/td>\n<\/tr>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 You are assisting with medicine administration<\/td>\n0(0%)<\/td>\n0(0%)<\/td>\n0(0%)<\/td>\n2(20%)<\/td>\n2(1.5%)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

While coughing, we should cover our mouth inside the elbow sleeve. The answer was given by 62 (82.7%) doctors, 22 (57.9%) nurses and two (18.2%) lab technicians. Around 63.6% of lab technicians mentioned that they need to cover only the mouth while coughing. (Table 6) The current guidelines mention that its always better to cough inside your elbow sleeves. [<\/sup>8] <\/sup><\/p>\n

Table 6: Knowledge about cough etiquette<\/strong><\/p>\n\n\n\n\n\n\n
What should you do while coughing?<\/td>\nDoctor (n=75)<\/strong><\/td>\nNurse (n=38)<\/strong><\/td>\nLab Technician (n=11)<\/strong><\/td>\nOthers (n=10)<\/strong><\/td>\nTotal (n=134)<\/strong><\/td>\n<\/td>\n<\/tr>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Cover your mouth<\/td>\n11(14.7%)<\/td>\n11(28.9%)<\/td>\n7(63.6%)<\/td>\n2(20%)<\/td>\n31(23.1%)<\/td>\n <\/p>\n

 <\/p>\n

 <\/p>\n

 <\/p>\n

<0.001**<\/td>\n<\/tr>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Cover your mouth inside your elbow sleeves<\/td>\n <\/p>\n

62(82.7%)<\/td>\n

 <\/p>\n

22(57.9%)<\/td>\n

 <\/p>\n

2(18.2%)<\/td>\n

 <\/p>\n

8(80%)<\/td>\n

 <\/p>\n

94(70.1%)<\/td>\n<\/tr>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Turn your<\/p>\n

head and cough<\/td>\n

 <\/p>\n

2(2.7%)<\/td>\n

 <\/p>\n

5(13.2%)<\/td>\n

 <\/p>\n

2(18.2%)<\/td>\n

 <\/p>\n

0(0%)<\/td>\n

 <\/p>\n

9(6.7%)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Chi-Square\/Fisher Exact Test<\/p>\n

Regarding the practice of hand wash in a day, it was practiced always by 36% of doctors, 65.8% of nurses and 81.8% of lab technicians. It was practiced most of the time by 53.3% of doctors, 34.2% of nurses and 18.2% of lab technicians. Around 10.7% of doctors agreed that they practice sometimes while there was no response (0%) from both nurses and lab technicians. (Table 7) The excuses given by people for not giving importance about hand hygiene are laziness, forgetfulness, too many patients etc. Some of them emphasized that they will start practicing regularly.<\/p>\n

Table 7: Opinions about hand hygiene<\/strong><\/p>\n\n\n\n\n\n\n
How often do you practice hand-hygiene in a day?<\/td>\nDoctor (n=75)<\/strong><\/td>\nNurse (n=38)<\/strong><\/td>\nLab Technician (n=11)<\/strong><\/td>\nOthers (n=10)<\/strong><\/td>\nTotal (n=134)<\/strong><\/td>\n<\/td>\n<\/tr>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Always<\/td>\n27(36%)<\/td>\n25(65.8%)<\/td>\n9(81.8%)<\/td>\n5(50%)<\/td>\n66(49.3%)<\/td>\n <\/p>\n

0.009**<\/td>\n<\/tr>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Most of the time<\/td>\n40(53.3%)<\/td>\n13(34.2%)<\/td>\n2(18.2%)<\/td>\n5(50%)<\/td>\n60(44.8%)<\/td>\n<\/tr>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Sometimes<\/td>\n8(10.7%)<\/td>\n0(0%)<\/td>\n0(0%)<\/td>\n0(0%)<\/td>\n8(6%)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Discussions<\/strong><\/p>\n

The current study was done to analyse knowledge of hand hygiene and practice among health care professionals in a tertiary care teaching institution. The overall knowledge about hand hygiene was good at ACS Medical College and Hospital. Hand washing was complied with by (46.7%) doctors and 15 (39.5%) nurses.<\/p>\n

In an observational study conducted among health care providers in a Tertiary Hospital in Ghana, the compliance rate for hand washing was observed ranging from 9.2% to 57% among doctors and 9.6% to 54% among nurses. [9] <\/sup>In a cross-sectional study by Maheshwari et al. in India, the level of knowledge on hand hygiene was observed among both residents and nurses. They found that the nurses were most positive toward hand hygiene than the residents.[<\/sup>10]<\/sup><\/p>\n

The results of the current study indicated that most of the respondents followed hand hygiene that was not sufficient to prevent infection. The participants who were involved in the study also mentioned that the main reasons for skipping handwashing in hospital is laziness, too many patients and forgetfulness among others. A similar observation had been made in a study by Pittet et al. [11].<\/sup> They pointed out similar attitudes such as \u201cnot thinking about it at the moment\u201d, \u201cforgetting\u201d, and \u201cbeing busy\u201d. In a study by Salmam et al,.[12] <\/sup>the majority (97.4%) of HCWs agreed that hand hygiene is an essential part of their role whereas 71.4% stated that they forget to follow hand hygiene most of the time. Moreover, 50.6% reported that the frequency of hand hygiene made it difficult for them to carry it out as often as necessary and 70.3% found it difficult to follow hand hygiene due to time-pressure.<\/p>\n

Provisions to arrange for regular training of health workers when they join work is essential to emphasize the awareness of microbial transmission by hands, stressing the importance of hand hygiene and its indications and to demonstrate the correct procedures for hand rubbing and hand washing. All these can be achieved using regular presentations, e-learning modules, posters, group activities, videos, self-learning modules, practical demonstrations, feedback forms during assessment, pre and post assessment, arranging training sessions and other methods. The health care providers may improve through placing reminders and prompts (posters, stickers, voice prompts, leaflets, gadgets, etc.) related to the importance of hand hygiene and the appropriate indications and procedures for its performance. <\/strong>[13], [14]<\/sup><\/p>\n

Regarding biomedical waste management, the nurses and the lab technicians had better knowledge than doctors. The knowledge about the disposal of gloves in red bin was answered by 94.7% of nurses and all the lab technicians (100%) whereas the doctors were not clear about the disposal of gloves (41.3%).<\/p>\n

It was similar to a study by Rao et al where nurses had better knowledge than doctors regarding the disposal of biomedical waste management.[<\/sup><\/strong>15] <\/strong><\/sup>The nurses had a better knowledge as they have been given responsibility to handle this on a day to day basis.<\/strong> A study which was done in Shenen Gibe Hospital in Southwest Ethiopia showed that 68.8% doctors had adequate practice and 82.97% of nurses had more knowledge about hand washing. [1<\/sup>6]<\/sup><\/p>\n

Conclusion<\/strong><\/p>\n

The conclusion of this study indicates that most of the study participants, though they had adequate knowledge about hand hygiene they did not have sufficient practice of hand washing techniques. The nosocomial infections can be controlled by improving hand hygiene which can be implemented with effective training like role models or practical demonstrations.<\/p>\n

Acknowledgement<\/strong><\/p>\n

I would like to acknowledge my HOD and my colleagues from the pathology and pharmacology departments who helped me with the study. I would like to acknowledge my daughter who helped me with the editing process.<\/p>\n

Conflict of Interest<\/strong><\/p>\n

There was no conflict of interest.<\/p>\n

Funding Source<\/strong><\/p>\n

There was no funding for this study.<\/p>\n

References<\/strong><\/p>\n

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