الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Healthcare-associated infections (HCAIs) affect millions of patients worldwide annually. Hand hygiene (HH) has been identified as the single most important factor preventing HCAIs.
This study was conducted to assess knowledge; attitude and practices of proper hand hygiene among nurses in Alexandria Police Hospital as well as inspecting the availability of facilities required for hand hygiene in different wards in Alexandria Police Hospital.
A descriptive cross-sectional survey was conducted to assess hand hygiene knowledge and attitude of nurses, their practice regarding hand hygiene procedures, compliance to the five moments of hand hygiene and to assess the availability of hand hygiene facilities.
This study was conducted in the surgery, internal medicine, obstetrics-gynecology departments, intensive care unit (ICU), neonatal intensive care unit (NICU), and renal dialysis unit of Alexandria Police Hospital.
A total of 110 nurses who attended at least one training session on hand hygiene and agreed to participate were included.
Three forms of data collection tools were prepared for collection of data:
1. Observational check-list for assessment of availability of hand hygiene facilities. (Facility assessment Checklist).
2. Observation check-list for nurses: Anonymous and confidential observation checklist using standardized WHO method for hand hygiene steps. It is used for assessment of technique of H.H in each moment of observation. The nurse performance in each moment was assessed as compliant or non-compliant (according to WHO criteria.
3. Self- administered questionnaire to measure knowledge and attitude of nurses.
• Knowledge section includes 13 questions and scored out of 13. The percent score was then calculated by dividing the number of correct answers over 13 multiplied by 100.
- The percent score was categorized into:
Poor knowledge (<50%)
Fair knowledge (50- 75%)
Good knowledge (>75%)
• Attitudes on hand hygiene was assessed using eleven statements and scaled into agree, disagree and uncertain and they are scored out of 33. The questionnaire included six negative attitude statements and five positive ones.
- The percent score was calculated and categorized into:
Negative attitude (<50%)
Neutral attitude (50-75%)
Positive attitude (>75%)
The following results were obtained:
Part I: Hand hygiene facilities in different wards.
The only deficit was observed concerning sink: bed ratio. Score was five which is less than the best score a facility can get ( ten).This was due to unavailability of a sink: bed ratio of 1:1 in intensive care unit and due to lack of sink in isolation room The remaining items as clean running water , soap, alcohol base hand rub and single-use towels got the maximum score. The assessment checklist for Alexandria Police Hospitals score was 100 out of 105 so it is classified as (Advanced) according to WHO facility assessment checklist.
Part II: Hand hygiene knowledge, attitudes of studied nurses and their socio-demographic characteristics
1. A total of 110 nurses were included in the study. Female consisted more than half of them (53.6%). Their age varied between 20 up to 50 years with a mean of 25.46 ± 5.62 years. Three quarters of them (75.5%) were nurses who studied two years diploma while only one fourth (24.5%) studied five years bachelor degree in nursing. The mean working years was 5.92 ± 5.45 years.
2. Knowledge of studied nurses regarding hand hygiene
The mean knowledge percent score is 59.9% ±16.3%. Slightly more than half of nurses 56.4% had fair knowledge percent score percent (50-75%) while the rest of them were poor (25.5%) or good (18.1%) respectively.
• Knowledge percent score was insignificantly related to nurses’ sex, age, and qualification.
The mean working years of nurses was significantly related to their knowledge percent score (p=0.028).
Attitude of studied nurses towards hand hygiene
No one in the studied sample had negative attitude toward hand hygiene. The majority of them (85.5%) had a positive attitude and the remaining (14.5%) had neutral attitude.
Insignificant relation was found between attitude percent score and nurse’s age, sex, mean working years and qualification.
There were insignificant relation between knowledge and attitude scores percent (p=0.932).
Part III: Compliance with hand hygiene practices in 711 moments of hand hygiene
a- Compliance of 110 moments of HH observed on the 110 nurses who responded to the self-administered questionnaire and associations.
There were 110 opportunities of HH observed on the nurses that responded to the self-administered questioner .About half of these moments (46.30%) were before touching a patient, (19.60%) were compliant to HH. About quarter of these moments (21.8%) were before clean/aseptic procedure and almost four fifths of them (79.2%) were compliant. After body fluids exposure moments contributed to 15.50% of the observed moments and the majority of them were compliant (94.1%). Three quarters of observed nurses after touching patients surrounding were compliant (75%) and the moments observed contributed to 11% of observed units. After contact with the patients observations were only 5.50% of the observed units and half of nurses who were observed were compliant (50%).The highest percentage of compliance among moments of observations was 94.1% which was after body fluid exposure while the lowest percentage of compliance was 19.60% which was before touching a patient. These findings were statistically insignificant (p=0.393).
Insignificant relation was observed between nurses HH compliance and their sex, age, qualification, and working experience. Overall compliance of the 110 nurses’ HH observation was 51.8%.
Nurse’s compliance was insignificantly related to their knowledge and attitude percent score.
b- Compliance of 601 moments of hand hygiene (different five moments of HH), 550 done and 51 missed opportunities.
There were 601 moments of HH observed, 51 of them missed which meant that the nurse should have performed HH but did not.
There were 550 observation moments seen in the study period. The observed moments of HH were 40.7% before clean aseptic procedure while 27.8% were after body fluid exposure. There were 16% moments of HH observed after contact with the patient. Before touching patients and after touching patients surrounding moments contributed to 12.4% and 3.1% of the moments observed respectively.
Observation of compliance to techniques of hand hygiene showed that four fifths (79.3%) of hand hygiene action were alcohol hand rubbing while the rest were hand washing with soap/ antiseptic and water.
Slightly less than one quarter of the studied nurses (24.5%) who performed hand washing passed enough running water on all hands parts. The majority of studied nurses (99.3%) used enough soap or antiseptic suitable for HH.