Nurses' Hand Hygiene Beliefs and Practices: A Cross-Sectional Study

Year 2025, Volume: 12 Issue: 2, 141 - 147, 17.07.2025

Oluwasegun Ganiyu Bakare , Nurhan Bayraktar

https://doi.org/10.31125/globnursinsights.1744010

Abstract

Aim: Healthcare-associated infections (HAIs) are related to significant morbidity, mortality, and increased hospital costs. Hand hygiene has been demonstrated to be an effective measure in preventing HAIs. This study aimed to evaluate nurses’ beliefs and practices concerning hand hygiene.
Material and Methods: This cross-sectional study was conducted in two university hospitals in North Cyprus between November and December 2020, involving a total of 80 nurses. Data were collected using the Turkish revised version of the Hand Hygiene Belief Scale and the Hand Hygiene Practices Inventory. Descriptive statistics, Mann-Whitney U test and Kruskall Wallis test were used to compare the groups.
Results: The findings revealed that the overall hand hygiene belief score among nurses was 3.99±1.74, while the overall hand hygiene practice score was 4.85±0.84. Comparisons between hand hygiene belief and practice scores and nurses' demographic data indicated no statistically significant difference.
Conclusions: Nurses had positive hand hygiene beliefs and a high level of practice score of hand hygiene. Notably, the practice scores exceeded the belief scores.
Implication for nursing practice/management or policy: Educational strategies to improve the hand hygiene beliefs of the nurses are recommended. Future studies could expand the participation rate, extending the research across multiple healthcare institutions.

Keywords

Hand hygiene , Hand hygiene beliefs , Hand hygiene practices , Healthcare associated infections , Nurses , Precautions

References

• Al-Khawaldeh, O., Al-Hussami, M. and Darawad, M. (2015). Influence of nursing students handwashing knowledge, beliefs, and attitudes on their handwashing compliance. Health, 7, 572-579. doi: 10.4236/health.2015.75068.
• Blomgren, P. O., Leo Swenne, C., Lytsy, B., & Hjelm, K. (2024). Hand hygiene knowledge among nurses and nursing students-a descriptive cross-sectional comparative survey using the WHO's "Hand Hygiene Knowledge Questionnaire". Infection Prevention in Practice, 6(2), 100358. https://doi.org/10.1016/j.infpip.2024.100358
• Centers for Disease Control and Prevention. (2020). Clean hands count for safe healthcare. Retrieved April 5, 2020, from https://www.cdc.gov/patientsafety/features/clean-hands-count.html
• Centers for Disease Control and Prevention. (2024). Clinical safety: Hand hygiene for healthcare workers: Health care associated infections. Retrieved January 07, 2024, from https://www.cdc.gov/clean-hands/hcp/clinical-safety/
• Center for Disease Control and Prevention. (2025). Healthcare associated infections. Retrieved January 09, 2025, from https://www.cdc.gov/healthcare-associated-infections/php/data/?CDC_AAref_Val=https://www.cdc.gov/hai/data/index.html
• Ceylan, B., Gunes, U., Baran, L., Ozturk, H., & Sahbudak, G. (2020). Examining the hand hygiene beliefs and practices of nursing students and the effectiveness of their handwashing behaviour. Journal of Clinical Nursing, 29(21-22), 4057–4065. https://doi.org/10.1111/jocn.15430.
• Chau, J. P., Thompson, D. R., Twinn, S., Lee, D. T., & Pang, S. W. (2011). An evaluation of hospital hand hygiene practice and glove use in Hong Kong. Journal of Clinical Nursing, 20(9-10), 1319–1328. https://doi.org/10.1111/j.1365-2702.2010.03586.x
• Corbo, M. I., Wachocka, M., Pozzi, M., Cioce, M., Di Donato, M., Raponi, M.,…Laurenti, P. (2024). Hand hygiene, knowledge and training motivational drives: findings from a survey in a university hospital. Frontiers in Public Health, 12, 1421324. https://doi.org/10.3389/fpubh.2024.1421324
• Cruz, J. P., & Bashtawi, M. A. (2016). Predictors of hand hygiene practice among Saudi nursing students: A cross-sectional self-reported study. Journal of infection and public health, 9(4), 485–493. https://doi.org/10.1016/j.jiph.2015.11.010
• Darawad, M. W., & Al-Hussami, M. (2013). Jordanian nursing students' knowledge of, attitudes towards, and compliance with infection control precautions. Nurse Education Today, 33(6), 580–583. https://doi.org/10.1016/j.nedt.2012.06.009
• de Kraker, M.E.A., Tartari, E., Tomczyk, S., Twyman, A., Francioli, L. C., Cassini, A.,…Pittet, D. (2022). Implementation of hand hygiene in health-care facilities: results from the WHO Hand Hygiene Self-Assessment Framework global survey 2019. The Lancet. Infectious Diseases, 22(6), 835–844. https://doi.org/10.1016/S1473-3099(21)00618-6
• From-Hansen, M., Hansen, M. B., Hansen, R., Sinnerup, K. M., & Emme, C. (2024). Empowering health care workers with personalized data-driven feedback to boost hand hygiene compliance. American Journal of Infection Control, 52(1), 21–28. https://doi.org/10.1016/j.ajic.2023.09.014
• Haenen, A., Huis, A., Teerenstra, S., Liefers, J., Bos, N., Voss, A., de Greeff, S., & Hulscher, M. (2024). Effect and process evaluation of an ıntervention to ımprove hand hygiene compliance in long-term care facilities. Journal of the American Medical Directors Association, 25(4), 591–598. https://doi.org/10.1016/j.jamda.2023.06.020
• Hinkin, J., & Cutter, J. (2014). How do university education and clinical experience influence pre-registration nursing students' infection control practice? A descriptive, cross sectional survey. Nurse Education Today, 34(2), 196–201. https://doi.org/10.1016/j.nedt.2013.09.005
• Huang, P. C., Chien, L. Y., & Huang, H. P. (2023). Assessing hand hygiene knowledge, attitude, behavior and adherence among nursing assistants: A cross-sectional study. Geriatric Nursing (New York, N.Y.), 51, 232–237. https://doi.org/10.1016/j.gerinurse.2023.03.020
• Hung, M. S. Y., Yam, S. W. S., Ngai, C. C. Y., Wong, I. Y. Y., & Li, A. Y. K. (2018). Knowledge, practices, compliance and beliefs of university nursing students’ toward hand hygiene: A cross-sectional survey. GSTF J Nurs Health Care, 5(1), 1-7.
• Jeong, S. Y., & Kim, O. (2013). Knowledge and Beliefs about Hand Hygiene among Hospital Nurses. Korean Journal of Occupational Health Nursing, 22(3), 198–207. ttps://doi.org/10.5807/kjohn.2013.22.3.198.
• Karabey, S., Ay, P., Derbentli, S., Nakipoglu, Y., & Esen, F. (2002). Handwashing frequencies in an intensive care unit. The Journal of Hospital İnfection, 50(1), 36–41. https://doi.org/10.1053/jhin.2001.1132
• Karadağ, M., Yıldırım, N., & İşeri, Ö. P. (2016). El hijyeni inanç ölçeği ve el hijyeni uygulamaları envanterinin geçerlilik ve güvenirliliği. Cukurova Medical Journal, 41(2), 271-284. http://dx.doi.org/10.17826/cutf.206317
• Karadag, M., Pekin Iseri, O., Yildirim, N. & Etikan, I. (2016). Knowledge, beliefs and practices of nurses and nursing students for hand hygiene. Jundishapur Journal of Health Sciences, 8(4), e36469. https://doi.org/10.17795/jjhs-36469.
• Lotfinejad, N., Peters, A., Tartari, E., Fankhauser-Rodriguez, C., Pires, D., & Pittet, D. (2021). Hand hygiene in health care: 20 years of ongoing advances and perspectives. The Lancet. Infectious Diseases, 21(8), e209–e221. https://doi.org/10.1016/S1473-3099(21)00383-2
• Mehta, Y., Gupta, A., Todi, S., Myatra, S., Samaddar, D. P., Patil,…Ramasubban, S. (2014). Guidelines for prevention of hospital acquired infections. Indian Journal of Critical Care Medicine, 18(3), 149–163. https://doi.org/10.4103/0972-5229.128705
• Pittet, D., Simon, A., Hugonnet, S., Pessoa-Silva, C. L., Sauvan, V., & Perneger, T. V. (2004). Hand hygiene among physicians: performance, beliefs, and perceptions. Annals of Internal Medicine, 141(1), 1–8. https://doi.org/10.7326/0003-4819-141-1-200407060-00008
• Prescott, K., Mahida, N., Wilkinson, M., & Gray, J. (2021). Hand hygiene: a COVID beneficiary?. The Journal of Hospital Infection, 111, 4–5. https://doi.org/10.1016/j.jhin.2021.03.017
• Sensoy, E. (2021). Determination of nursing students' hand hygiene and glove use habits. Lokman Hekim Dergisi, 11 (2), 353-363. https://orcid.org/0000-0003-2989-459X
• Sharif, A., Arbabisarjou, A., Balouchi, A., Ahmadidarrehsima, S., & Kashani, H. H. (2016). Knowledge, attitude, and performance of nurses toward hand hygiene in hospitals. Global Journal of Health Science, 8(8), 53081. https://doi.org/10.5539/gjhs.v8n8p57
• Shobowale, E. O., Adegunle, B., & Onyedibe, K. (2016). An assessment of hand hygiene practices of healthcare workers of a semi-urban teaching hospital using the five moments of hand hygiene. Nigerian Medical Journal, 57(3), 150–154. https://doi.org/10.4103/0300-1652.184058
• Ssekamatte, T., Mugambe, R. K., Isunju, J. B., Wanyenze, R. K., Nalugya, A., Adyedo, C.,…Moe, C. L. (2024). Application of the behaviour-centred design to understand facilitators and deterrents of hand hygiene among healthcare providers: findings from a formative phase of a cluster randomised trial in the Kampala Metropolitan area. BMC Health Services Research, 24(1), 1031. https://doi.org/10.1186/s12913-024-11512-z
• Tartari, E., Storr, J., Bellare, N., Kilpatrick, C., McGuckin, M., Schwaber, … Allegranzi, B. (2024). WHO research agenda on the role of the institutional safety climate for hand hygiene improvement: a Delphi consensus-building study. BMJ Quality & Safety, bmjqs-2024-017162. Advance online publication. https://doi.org/10.1136/bmjqs-2024-017162
• van de Mortel T. (2009) Development of an instrument to assesshealth care students’ hand hygiene knowledge, beliefs and prac-tices. Australian Journal of Advanced Nursing 26(3), 9–16.
• van De Mortel, T. F., Kermode, S., Progano, T., & Sansoni, J. (2011). A comparison of the hand hygiene knowledge, beliefs and practices of Italian nursing and medical students. Journal of Advanced Nursing, 68(3), 569–579. https://doi.org/10.1111/j.1365-2648.2011.05758.x
• World Health Organization. (2009). WHO guidelines on hand hygiene in health care. Retrieved June 21, 2020, from https://www.ncbi.nlm.nih.gov/books/NBK144046/.
• World Health Organization. (2011). Report on the burden of endemic health care-associated infection worldwide; Clean care is safer care. Retrived June 17, 2021, from https://apps.who.int/iris/bitstream/handle/10665/80135/9789241501507_eng.pdf.
• World Health Organization. (2023). Key facts and figures: World hand hygiene day. Retrieved January 09, 2025, from https://www.who.int/campaigns/world-hand-hygiene-day/2023/key-facts-and-figures
• World Health Organization. (2024). Global report on infection prevention and control. Retrieved January 09, 2025, from https://www.who.int/publications/i/item/9789240103986