STS-2024 RESEARCH CONCEPT NOTE/PROPOSAL

Title: Assessment of the impact of practical training on awareness of hand hygiene practices
amongst health care workers and food handlers in a tertiary care hospital.

Introduction :
Healthcare-associated infections (HAIs) are a major global health challenge, affecting
millions annually and causing severe illnesses, prolonged hospital stays, and increased
financial burdens on healthcare systems. In underdeveloped nations, HAIs can reach alarming
incidences, with rates up to 19%(1).Hand hygiene is a fundamental practice in healthcare
settings and food handling environments to reduce healthcare-associated infections (HAIs),
combat antimicrobial resistance, and improve patient safety (2). Healthcare workers (HCWs)
and food handlers play pivotal roles in maintaining hygiene standards, Unfortunately, with
hand hygiene protocols among healthcare workers (HCWs) remains inadequate, with as many
as 40% not adhering to proper hand hygiene practices(3-5). The World Health Organization
(WHO) has endorsed hand-washing techniques to mitigate healthcare-associated infections
(HAIs), yet low compliance is frequently linked to insufficient knowledge among healthcare
workers (HCWs)(6-8). In response, the WHO introduced the "My five moments for hand
hygiene" concept, offering a scientifically grounded approach to enhance hand hygiene
practices(9).Interactive training programs and the availability of hand sanitizers have
demonstrated significant effectiveness in improving compliance with hand hygiene standards
among healthcare workers (HCWs)(10).A single session on basic hand hygiene techniques
can result in significant improvements (11).

Yet adherence to hand hygiene protocols can vary due to knowledge gaps or improper
training. Effective practical training programs are essential for improving awareness and
compliance with hand hygiene practices among these groups. The World Health Organization
(WHO) emphasizes the importance of hand hygiene as a cost-effective measure to reduce
healthcare-associated infections and improve patient safety.

This proposal aims to assess the impact of practical training on the awareness of hand
hygiene practices among healthcare workers and food handlers in a tertiary care hospital. By
evaluating the effectiveness of training interventions, this study seeks to identify gaps in
knowledge and practices, and recommend targeted strategies for enhancing hand hygiene
compliance.
STS-2024 RESEARCH CONCEPT NOTE/PROPOSAL

Objectives:

This study aims to:

1. Evaluate the baseline knowledge and current practices of hand hygiene among
healthcare workers and food handlers.
2. Implement practical training sessions tailored to improve awareness and compliance
with hand hygiene protocols.
3. Assess the immediate and sustained impact of the training on hand hygiene practices.
4. Identify factors influencing the adoption of hand hygiene practices among healthcare
workers and food handlers.

Methodology:

Study Design:
This study will utilize a quasi-experimental design with pre- and post-training assessments to
measure the impact of practical training on hand hygiene awareness and practices.
Study Setting:
The study will be conducted in a tertiary care hospital with participation from healthcare
workers across different departments and food handlers involved in food preparation and
service.
Study Population:
Participants will include healthcare workers
(Doctor’s, nurses, technicians) and food handlers who voluntarily agree to participate and
meet the eligibility criteria.
Sample size:
The Study will include 200 health care workers and 100 food handlers employed in the
tertiary care hospital

Inclusion criteria Exclusion Criteria

Participants will include healthcare workers Healthcare workers and food handlers who
STS-2024 RESEARCH CONCEPT NOTE/PROPOSAL

and food handlers who voluntarily agree to do not provide voluntary consent to
participate and meet the eligibility criteria participate.
Participants who do not meet the eligibility
criteria, such as individuals not directly
involved in patient care or food preparation
within the hospital setting.

Sample Selection Criteria:

A convenient sampling technique will be used to select the sample for the study.

Intervention:
Practical training sessions on hand hygiene practices will be developed based on guidelines
from the World Health Organization (WHO) and local infection control protocols. The
training curriculum will cover:

 Importance of hand hygiene in infection prevention.

 Proper handwashing techniques using soap and water.
 Use of alcohol-based hand rubs when soap and water are not readily available.
 Steps for hand hygiene before and after patient contact, handling food, or performing
procedures.
 Techniques for glove use and disposal, emphasizing that gloves do not replace proper
hand hygiene.
 Importance of maintaining clean nails and skin integrity.

The training sessions will be interactive and include demonstrations, hands-on practice, and
feedback sessions to reinforce learning. Sessions will be conducted multiple times to
accommodate different shifts and ensure maximum participation.

Data Collection Procedures:

Data will be collected using structured questionnaires before and after the training sessions.
Observational checklists will be used to document adherence to hand hygiene protocols in
real-time.
STS-2024 RESEARCH CONCEPT NOTE/PROPOSAL

1. Baseline Assessment:
Prior to the training sessions, a baseline assessment will be conducted using structured
questionnaires to collect demographic information and assess participants' knowledge,
attitudes, and current practices regarding hand hygiene. Observational checklists will also be
used to document compliance with hand hygiene practices during routine activities.

2. Practical Training:
Practical training sessions will be delivered to participants over a specified period, tailored to
address identified gaps in knowledge and practice. The sessions will include one lecture and
six hands-on workshops, with each workshop accommodating 20 students. The training will
span over one month and will be organized in the general lecture theatre and Microbiology
practical room. Each session will emphasize correct hand hygiene techniques and provide
opportunities for participants to practice and receive feedback.

3. Post-Training Assessment:
Immediately following the training sessions, a post-training assessment will be conducted
using the same questionnaires and observational checklists to evaluate changes in knowledge,
attitudes, and practices related to hand hygiene among participants. This assessment will
measure the immediate impact of the training intervention.

4. Follow-up Assessment:
A follow-up assessment will be conducted at a later time (e.g., 3 months post-training) to
assess the sustainability of improved hand hygiene practices among participants. This
assessment will help determine the long-term impact of the training intervention and identify
any areas requiring reinforcement or additional support.

Quality Control:
To ensure data quality and reliability, data collectors will be trained on administering the
questionnaire uniformly. Supervision during data collection will be maintained to address any
issues promptly and ensure consistency in data gathering procedures. Double-checking of
collected data will be conducted for accuracy and completeness before finalizing the dataset
for analysis.
STS-2024 RESEARCH CONCEPT NOTE/PROPOSAL

Confidentiality:
Participants' anonymity and confidentiality will be strictly maintained throughout the study.
No personally identifiable information will be collected, and all data will be coded and stored
securely in compliance with institutional guidelines on data protection.

Plan of Analysis/Statistical Tools:

Descriptive statistics, including frequencies, percentages, means, and standard deviations,
will be used to summarize demographic data and baseline characteristics of participants.
Paired t-tests or Wilcoxon signed-rank tests will be employed to compare pre- and post-
training scores for knowledge and practices related to hand hygiene. Factors influencing hand
hygiene practices will be analyzed using logistic regression or ordinal regression models.
Statistical significance will be set at p < 0.05.

Ethical Considerations:
Ethical approval will be obtained from the Institutional Ethics Committee (IEC) prior to
commencing data collection. Informed consent will be obtained from all participants after
explaining the study's purpose, procedures, potential risks, and benefits. Participation will be
voluntary, and participants will have the right to withdraw at any time without consequence.
Confidentiality of participants' responses will be maintained throughout and after the study.

Implications/Outcome:

The findings of this study will provide valuable insights into the effectiveness of practical
training in improving awareness and compliance with hand hygiene practices among
healthcare workers and food handlers. Enhanced adherence to hand hygiene protocols is
expected to reduce the transmission of infections in the hospital and food handling
environments, thereby improving patient and consumer safety. The study outcomes will
guide the development of evidence-based interventions and policies aimed at sustaining
improved hand hygiene practices in similar healthcare and food service settings.
STS-2024 RESEARCH CONCEPT NOTE/PROPOSAL

Reference:

1. Challenge FG. WHO Guidelines on Hand Hygiene in Health Care. Retrieved from: whqlibdoc
who int/publications/009 pdf. 2009.
2. Mertz D, Johnstone J, Krueger P, Brazil K, Walter SD, Loeb M. Adherence to hand hygiene
and risk factors for poor adherence in 13 Ontario acute care hospitals. American journal of
infection control. 2011 Oct 1;39(8):693-6.
3. Longtin Y, Sax H, Allegranzi B, Schneider F, Pittet D. Hand hygiene. N Engl J Med. 2011 Mar
31;364(13):e24.
4. Tibballs J. Teaching hospital medical staff to handwash. Medical Journal of Australia. 1996
Apr;164(7):395-8.
5. Boyce JM, Pittet D. Guideline for hand hygiene in health-care settings: recommendations of
the Healthcare Infection Control Practices Advisory Committee and the
HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Infection Control & Hospital
Epidemiology. 2002 Dec;23(S12):S3-40.
6. Chou DT, Achan P, Ramachandran M. The World Health Organization ‘5 moments of hand
hygiene’: the scientific foundation. The Journal of Bone & Joint Surgery British Volume. 2012
Apr 1;94(4):441-5.
7. Hussen FM. A Point-in-Time Observational Study of Hand Washing Practices of Healthcare
Workers in the North of West Bank (Doctoral dissertation).
8. Creedon SA. Hand hygiene compliance: exploring variations in practice between hospitals.
Nursing times. 2008 Dec 1;104(49):32-5.
9. Sax H, Allegranzi B, Uckay I, Larson E, Boyce J, Pittet D. ‘My five moments for hand
hygiene’: a user-centred design approach to understand, train, monitor and report hand
hygiene. Journal of Hospital infection. 2007 Sep 1;67(1):9-21.
10. Sjöberg M, Eriksson M. Hand disinfectant practice: the impact of an education intervention.
The open nursing journal. 2010;4:20.
11. Trampuz A, Widmer AF. Hand hygiene: a frequently missed lifesaving opportunity during
patient care. InMayo clinic proceedings 2004 Jan 1 (Vol. 79, No. 1, pp. 109-116). Elsevier.