PERCEPTION AND PRACTICES

REGARDING HAND HYGIENE AMONG

ADULTS IN LAHORE

SUPERVISORS
Professor Dr. Shahid Mahmood
(Head of Department of Community Medicine)
Dr. Mehwish Akhtar
(Assistant Professor Department of Community Medicine)

CO-SUPERVISOR
Dr. Javed
(Demonstrator Department of Community Medicine)

STUDY CONDUCTED BY:

Muhammad Arslan
Muhammad Aliq-u-Rehman
Faizan Safdar
Muhammad Asif Khan
Laila Shah
Kinza Khan
Changez Khan
Khizra Arshad
Muhammad Ahmer
Kiran Arif
 DECLERATION

The research proposal is an intellectual property of the Department of Community Medicine

Allama Iqbal Medical College, Lahore. It is hereby declared that this topic cannot be published
or submitted without prior permission from the department.

Principal Investigator:

Muhammad Arslan
Signatures: ___________
Co-Researchers:

Muhammad Aliq-u-Rehman
Signatures: ___________
Faizan Safdar
Signatures: ___________
Muhammad Asif Khan
Signatures: ___________
Laila Shah
Signatures: ___________
Kinza Khan
Signatures: ___________
Changez Khan
Signatures: ___________
Khizra Arshad
Signatures: ___________
Muhammad Ahmer
Signatures: ___________
Kiran Arif
Signatures: ___________
 Synopsis
TITLE:

Perception and Practices Regarding Hand Hygiene

among Adults in Lahore

INTRODUCTION:
Hand hygiene plays important role in preventing many of the feco-oral and
respiratory droplets borne diseases. Hand hygiene refers to the action of hand
cleansing by using water and detergent and/or the use of alcohol-based hand
sanitizers. The most fundamental personal hygiene practices for preventing
communicable diseases include hand washing, drinking boiled water, cooking food
thoroughly, taking precautions against bug bites such as mosquito bites, checking
areas with elevated risks for communicable diseases prior to traveling abroad, and
avoiding contact with wild animals. Generally, there is a progressive increase in
risks associated with a wide range of diseases directly correlated with
handwashing, for example, water- and foodborne diseases, contagious diseases,
severe acute respiratory syndrome (SARS), H1N1 influenza A, norovirus, cholera,
malaria, dysentery, meningitis, shigellosis, and multi-resistant Staphylococcus
aureus (1).
Hand washing is the most basic and simplest proven health-promoting practice
in preventing communicable diseases.
One study on children in the US reported that hand washing alone reduced the
incidence of common cold by 32% (2). Further, about 50% to 70% of waterborne
infections are preventable by washing hand alone, and particularly, hand washing
with soap effectively removes microorganisms and is effective in preventing
communicable diseases (3). Furthermore, hand hygiene also prevents zoonotic
diseases (4). Zoonotic are the diseases which are transmitted from vertebrate
animals to the humans. Washing the hands for at least 20 seconds or sterilizing
them with 60% alcohol-based hand sanitizer can help prevent respiratory viral
infections. Hand washing may serve as a strategy to prevent infection.
The risk of infections can be significantly reduced by creating proper
awareness about hand hygiene education and training Various studies all over the
world has proven that people have a low-level knowledge of infection control.
Other studies show that prevention and control of infections have been a low
priority due to various reasons It is estimated that three out of ten people, 2.3
billion globally, lack a facility with water and soap available to wash their hands
at home, including 670 million who have no handwashing facility at all (5).
Behavioral change theories such as the health belief model and theory of planned
behavior (TPB) are beneficial in examining the community’s behavior in
accepting the factors that promote hand hygiene practices as a public health
measure. However, studies examining the long-term impact of the perception of
hand washing on health status are rare, and it is difficult to evaluate whether poor
perception positively impacts disease prevention. While there are many guidelines
for hand hygiene practices (6), (7); there is a scarcity of research studies about the
attitudes and hand hygiene practices among public. The aim of this study is to
explore attitudes and behaviors of the people towards hand hygiene. This
descriptive study includes observations of hand hygiene practices using a
validated observation tool and face-to-face interviews with the people. Hand
hygiene is considered as one of the most important elements of the activities that
control communicable diseases (8), (5). Hand hygiene is highly cost effective in
prevention of diseases. It is estimated that half a million people die of diarrhea
and acute respiratory infections which can effectively be controlled with good
hand hygiene (5). Also, it is a great protection for oneself against obtaining some
infection and passing it on. We must continue to educate everyone on the
importants of good hand hygiene. Wash, Wash, Wash! Make this an everyday
habit to ensure that everyone’s safety is being upheld (9). A study shows that
during COVID19, hand hygiene compliance increased to 100% but then reduced
to previous 51% (10). THE SAVE LIVES: Clean your hands global campaign,
launched in 2009 and celebrated annually on May 5(World hygiene day) aims to
maintain hand hygiene globally (11).

OBJECTIVE:

To assess the perception and practices regarding hand hygiene among adults of
Lahore as per WHO guidelines.

OPERATIONAL DEFINITION:
Hand hygiene:
 It is a general term referring to any action of hand cleansing by using water and
detergent and/or the use of alcohol-based hand sanitizers for the removal of
transient microorganisms from hands.
Perception:
It refers to that the participant thinks that hand hygiene can prevent the diseases
and he considers it healthful to wash hands
• After using toilet
• When look visibly dirty
• Before eating food
• After coughing or sneezing
Practices:
It refers to that how much of the following WHO recommended steps of hand
hygiene the participant performs,
• Wet hands and apply enough soap to cover all hand surfaces
• Rub hands palm to palm
• Palm of one hand over the dorsum of other with the interlaced fingers
• Palm to palm with fingers interlaced
• Rotation of thumbs clasped in opposite palm
• Clean the under nails
• Rinse hands with water
• Dry hands

MATERIALS AND METHODOLOGY:

STUDY DESIGN:
It will be cross sectional study.
SETTING:
It will be conducted in premises of Jinnah Hospital Lahore which is a tertiary care
hospital with 1500 bedded capacity.
DURATION OF STUDY:
Its duration will be eight weeks (from August 2022 to September 2022).
SAMPLE SIZE:
Sample size of 264 is calculated at 95% confidence interval with 6% margin
of error and taking expected frequency of washing hands before eating as 55.7%
in Korean adults (12).

SAMPLE SELECTION:

INCLUSION CRITERIA:
Individuals of both genders greater than 18 years of all social classes visiting
Jinnah Hospital Lahore are included.
EXCLUSION CRITERIA:
Those patients who are handicapped or who are seriously ill and those
suffering from psychiatric illness will be excluded as they are unable to provide a
response.
SAMPLING TECHNIQUE:
Nonprobability convenience sampling
DATA COLLECTION PROCEDURE:
About 264 subjects visiting JHL will be included after verballay informed
consent. First, questions will be asked regarding perception and then practices
will be observed. We will provide them with water tank, soap, hand wash, and
towel placed on a table and will ask them to wash hands without any prior guide.
Our team will observe the hand washing technique of everyone. Our experienced
team will fil questionnaires by asking questions. We will make a grading system
based on WHO guidelines. We will rate the hand washing techniques of people
based on that grading system.
DATA ANALYSIS PROCEDURE:
Frequency distribution with percentages will be calculated for each categorical
variable. Responses on nominal data will be tabulated and 2x2 tables will be
generated for participant’s responses with sociodemographic characteristics.
Difference of proportions will be analyzed for statistical significance difference
using Chi-Squared test and value of p less than 0.05 will be considered as
statistically significant. Numerical data will be checked for normality assumption
and mean ± standard deviation will be calculated. Difference of means will be
analyzed using student t- test. Results will be presented as appropriate tables and
figures.

ETHICAL CONSIDERATION:
Verbal informed consent will be obtained from all the participants before the start
of interview. Confidentiality of all the participants will be maintained.
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