1.1 Introduction
Hand hygiene is defined as the practice of cleaning the hands with soap and water or an alcohol-based hand rub to remove dirt, microorganisms, and other contaminants in order to prevent the transmission of infectious agents and promote patient safety. It is recognized as one of the most effective and cost-efficient infection prevention and control measures in healthcare settings World Health Organization; Centers for Disease Control and Prevention (World Health Organization [WHO], 2009; CDC, 2024). Personal hand hygiene practices among healthcare workers involve washing hands with soap and clean water, using alcohol-based hand sanitizers, maintaining clean and short fingernails, avoiding artificial nails and hand jewelry during patient care, and observing the recommended moments for hand hygiene. The World Health Organization introduced the "Five Moments for Hand Hygiene" to guide healthcare workers on the appropriate times to clean their hands, including before touching a patient, before clean or aseptic procedures, after body fluid exposure, after touching a patient, and after touching the patient's surroundings (WHO, 2009).
As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the aim and objectives of the study. Others are significance of the study, scope of work, research hypothesis and questions, limitation of the study and definition of terms.
1.2 Background of Study
Historically, personal hand hygiene among healthcare workers dates back to the nineteenth century when hospital-acquired infections were common causes of illness and death among patients. During this period, little attention was given to the importance of handwashing before attending to patients because the relationship between contaminated hands and the spread of disease had not yet been fully understood. As a result, infections frequently spread from one patient to another through the hands of healthcare personnel (Pittet, 2001).
According to World Health Organization (2009), hand hygiene is the act of cleaning the hands with soap and water or an alcohol-based hand rub to remove microorganisms and prevent the transmission of infectious agents. It is widely regarded as the single most effective measure for preventing healthcare-associated infections and ensuring patient safety in healthcare settings. Personal hand hygiene among healthcare workers extends beyond routine handwashing to include compliance with recommended hand hygiene moments, maintaining clean and short fingernails, avoiding artificial nails and hand jewelry during clinical practice, and consistently observing infection prevention guidelines. These practices are essential because healthcare workers interact continuously with patients, medical equipment, and hospital environments where disease-causing microorganisms may be present.
Centers for Disease Control and Prevention (2024) reported that, effective hand hygiene interrupts the chain of infection by preventing microorganisms from spreading from one patient to another, from contaminated surfaces to patients, and from patients to healthcare personnel. Furthermore, World Health Organization (2009) reported that healthcare-associated infections remain among the most common adverse events affecting patient safety worldwide, with millions of patients acquiring infections during the course of healthcare delivery each year. These infections contribute to prolonged hospitalization, increased treatment costs, antimicrobial resistance, long-term disability, and avoidable deaths, making hand hygiene an indispensable component of quality healthcare. Similarly, Didier Pittet (2001) asserted that proper hand hygiene significantly reduces the transmission of pathogenic microorganisms in healthcare facilities and serves as the foundation of infection prevention and control programmes. The study emphasized that contaminated hands remain one of the principal routes through which healthcare-associated pathogens spread within hospitals.
Consistent with this view, Barry Farr (2000) contended that improvements in hand hygiene compliance are directly associated with reductions in hospital-acquired infections and improved patient outcomes. These findings underscore the importance of maintaining high standards of personal hygiene among healthcare workers regardless of their professional category. Moreover, Benedetta Allegranzi and Didier Pittet (2009) stated that despite global recognition of hand hygiene as the cornerstone of infection prevention, compliance among healthcare workers remains below recommended standards in many healthcare institutions. The authors identified several barriers, including inadequate availability of hand hygiene materials, insufficient training, heavy workload, time pressure, forgetfulness, skin irritation resulting from repeated handwashing, and weak institutional support.
Building on this perspective, John M. Boyce and Didier Pittet (2002) affirmed that healthcare workers frequently encounter microorganisms through direct patient contact and contaminated environmental surfaces. According to their report, failure to perform hand hygiene at the appropriate moments substantially increases the likelihood of transmitting infectious agents between patients. They further maintained that consistent hand hygiene before and after patient care remains one of the simplest, safest, and most cost-effective approaches to reducing healthcare-associated infections.
Supporting this position, World Health Organization (2009) introduced the "Five Moments for Hand Hygiene" as an internationally accepted framework for healthcare workers. The guideline recommends cleaning hands before touching a patient, before clean or aseptic procedures, after exposure to body fluids, after touching a patient, and after touching the patient's surroundings. According to the organization, strict adherence to these five critical moments significantly minimizes opportunities for microbial transmission and enhances patient safety across different healthcare settings.
Likewise, Centers for Disease Control and Prevention (2024) reported that hand hygiene compliance should be supported by the continuous availability of clean water, soap, alcohol-based hand rubs, functional handwashing stations, regular staff education, and effective monitoring systems. The agency further stated that healthcare institutions with strong infection prevention programmes consistently record lower rates of healthcare-associated infections compared with facilities where compliance is poor.
This study is set against the backdrop of persistent healthcare-associated infections, varying levels of compliance with recommended hand hygiene practices among healthcare workers, and the continuing need to strengthen infection prevention and control measures through effective personal hand hygiene practices.
1.3 Statement of Problems
Investigation revealed that healthcare-associated infections remain a major challenge to healthcare systems globally despite advances in infection prevention and control. A substantial proportion of these infections are transmitted through the contaminated hands of healthcare workers, making personal hand hygiene a critical component of patient safety. Poor adherence to recommended hand hygiene practices increases the risk of cross infection, prolongs hospital admission, raises healthcare costs, and contributes to increased morbidity and mortality (World Health Organization, 2009).
Although evidence consistently demonstrates that proper hand hygiene significantly reduces the spread of infectious diseases, compliance among healthcare workers remains below recommended standards in many healthcare facilities. Factors such as inadequate knowledge, lack of hand hygiene resources, excessive workload, time constraints, and poor institutional support continue to affect consistent practice, thereby limiting the effectiveness of infection prevention programmes (Allegranzi & Pittet, 2009).
In many developing countries, including Nigeria, challenges such as inadequate water supply, limited availability of alcohol-based hand rubs, overcrowded health facilities, and inconsistent monitoring of infection prevention practices further weaken compliance with recommended hand hygiene guidelines. These conditions increase the vulnerability of both patients and healthcare workers to preventable infections and compromise the quality of healthcare services (World Health Organization, 2009). It is against this backdrop that this study seeks to assess the effect of personal hand hygiene practices among healthcare workers.
1.4 Aim and Objectives of Study
The aim of this study is to assess the effect of personal hand hygiene practices among healthcare workers. The specific objectives of this study are to:
- Determine the level of personal hand hygiene practices among healthcare workers.
- Examine the level of compliance with recommended hand hygiene guidelines among healthcare workers.
- Identify the factors influencing personal hand hygiene practices among healthcare workers.
- Determine the effect of personal hand hygiene practices on infection prevention among healthcare workers.
- Identify measures for improving personal hand hygiene practices among healthcare workers.
1.5 Research Questions
The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:
- What is the level of personal hand hygiene practices among healthcare workers?
- What is the level of compliance with recommended hand hygiene guidelines among healthcare workers?
- What factors influence personal hand hygiene practices among healthcare workers?
- What is the effect of personal hand hygiene practices on infection prevention among healthcare workers?
- What measures can improve personal hand hygiene practices among healthcare workers?
1.6 Research Hypotheses
In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.
Hypothesis One
- H0: There is no significant level of personal hand hygiene practice among healthcare workers.
- H1: There is a significant level of personal hand hygiene practice among healthcare workers.
Hypothesis Two
- H0: There is no significant level of compliance with recommended hand hygiene guidelines among healthcare workers.
- H1: There is a significant level of compliance with recommended hand hygiene guidelines among healthcare workers.
Hypothesis Three
- H0: There is no significant relationship between influencing factors and personal hand hygiene practices among healthcare workers.
- H1: There is a significant relationship between influencing factors and personal hand hygiene practices among healthcare workers.
Hypothesis Four
- H0: Personal hand hygiene practices have no significant effect on infection prevention among healthcare workers.
- H1: Personal hand hygiene practices have a significant effect on infection prevention among healthcare workers.
Hypothesis Five
- H0: The identified improvement measures have no significant effect on personal hand hygiene practices among healthcare workers.
- H1: The identified improvement measures have a significant effect on personal hand hygiene practices among healthcare workers.
1.7 Significance of Study
It is believed that at the completion of the study the findings will provide dependable information on personal hand hygiene practices among healthcare workers. The study will also support better infection prevention activities in healthcare facilities.
Furthermore, this research will contribute to existing academic knowledge on hand hygiene among healthcare workers. It will also encourage improved compliance with recommended hand hygiene guidelines.
Lastly, the findings will serve as reference material for future studies on infection prevention and control.
1.8 Scope of Study
The scope of this research is focused on the effect of personal hand hygiene practices among healthcare workers in University of Benin Teaching Hospital. The study covers doctors, nurses, laboratory scientists, pharmacists, and other healthcare workers involved in patient care.
1.9 Limitations of the Study
The study was limited to healthcare workers in the selected hospital, making it difficult to generalize the findings to all healthcare facilities in Nigeria. Furthermore, information obtained during the research was based on the responses provided by participants, which was assumed to be accurate and truthful.
1.10 Definition of Terms
Healthcare Worker:
A healthcare worker is any trained professional involved in providing preventive, curative, rehabilitative, or supportive healthcare services to patients. This includes doctors, nurses, pharmacists, laboratory scientists, and other clinical personnel (World Health Organization, 2006).
Hand Hygiene:
Hand hygiene refers to the process of cleaning the hands with soap and water or an alcohol-based hand rub to remove microorganisms and reduce the spread of infections in healthcare settings (World Health Organization, 2009).
Personal Hand Hygiene Practices:
Personal hand hygiene practices refer to the routine behaviours performed by healthcare workers to maintain clean hands, including handwashing, use of alcohol-based hand rubs, keeping fingernails clean and short, and observing recommended hand hygiene procedures (Boyce & Pittet, 2002).
Healthcare-Associated Infection:
A healthcare-associated infection is an infection acquired by a patient during the process of receiving treatment in a healthcare facility that was neither present nor incubating at the time of admission (World Health Organization, 2009).
Infection Prevention and Control:
Infection prevention and control refers to evidence-based measures and procedures designed to prevent the spread of infectious diseases within healthcare settings and protect patients, healthcare workers, and visitors (World Health Organization, 2021).
Compliance:
Compliance refers to the extent to which healthcare workers consistently follow established hand hygiene guidelines and infection prevention protocols during patient care (Centers for Disease Control and Prevention, 2024).
Alcohol-Based Hand Rub:
Alcohol-based hand rub is a preparation containing alcohol that is applied to the hands to eliminate harmful microorganisms when soap and water are unavailable or unnecessary (Boyce & Pittet, 2002).
Patient Safety: Patient safety refers to the prevention of avoidable harm to patients during healthcare delivery through safe clinical practices and effective infection prevention measures (World Health Organization, 2021).
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