A DESCRIPTIVE CROSS-SECTIONAL STUDY ON KNOWLEDGE OF HAND WASHING AMONG HEALTH PROFESSIONALS IN A MEDICAL COLLEGE

responses into four groups based on score more than 90% as excellent, 75-90% considered as good, 50-74% moderate, and less than 50% considered as low. All data was transferred to the excel sheet and transferred to a stascal package for the social sciences-17.The result was presented using frequency tables, graphs, and charts. Out of 370 parcipants, 318(85.9%) were females, and 52(14.1%) males. The mean age was 24.59±4.48 years. Of all the respondents, 24% had low, 30% moderate, 26% good, and 21% had excellent knowledge of hand hygiene. In terms of pracce, only 34% had a moderate level of pracce of hand hygiene. Regular training and re-training through simulaons of hand hygiene will lead to an improvement in the knowledge and pracce of hand washing.


Introduc on
Nosocomial infec on is common due to poor prac ce of hand hygiene. There is a varia on in the level of knowledge of hand washing among different health professionals.

Objec ves
The aim of the study was to assess the basic knowledge of hand washing among health professionals.

Methodology
This cross-sec onal study was done in 370 healthcare professionals like doctors, nurses, health assistants of a Na onal medical college. The ques onnaire used was adapted from the World Health Organiza on about hand hygiene knowledge for health professionals. There were 18 ques ons assessing the basic knowledge and prac ce of hand washing. The level of hand hygiene knowledge was calculated by dividing the responses into four groups based on score more than 90% as excellent, 75-90% considered as good, 50-74% moderate, and less than 50% considered as low. All data was transferred to the excel sheet and transferred to a sta s cal package for the social sciences-17.The result was presented using frequency tables, graphs, and charts.

INTRODUCTION
Hands are the major source of nosocomial infec ons due to poor hand hygiene and cause of increased morbidity, mortality, and health care costs among hospitalized pa ents 1 worldwide. A washing me of 10 to 15 seconds is recommended to remove transient flora from the hands. Hand washing by soap and water or an alcohol-based sani zer is considered the most important step in hand washing. The use of proper hand washing techniques can reduce the health care-associated infec on rates. Every person involved in pa ent care, healthcare worker or otherwise, should be able to accurately perform hand hygiene and at the appropriate me. Infec on The knowledge of hand washing is low in developing countries among the common people and health professionals due to 2,3 a lack of formal educa on training programs. There is a varia on in the knowledge among health professionals within the same country or between the countries about 4 hand washing. Preven on of infec on due to improper hand washing techniques is a challenge to the health care providers. Nosocomial infec ons can be prevented by the formal training and educa on program on hand washing.
This study was done to assess the basic knowledge of handwashing among health professionals in a ter ary care hospital.

METHODOLOGY
It was a descrip ve cross-sec onal study conducted in a Na onal Medical College, Birgunj Nepal between September 1 2021 to November 30, 2021. The ethical approval from the Ins tu onal Review Commi ee was obtained before enrolment of par cipants in this study. The ethical approval number was F-NMC/543/078-079. Wri en informed consent was obtained from each par cipants in the study. Health professionals like doctors, nurses, health assistants were included in this study. Heathcare professionals who did not give consent and were not interested to par cipate in the study were excluded from the study. The ques onnaire used was adapted from the World Health Organiza on (WHO) hand hygiene knowledge ques onnaire for health professionals. There were 18 ques ons assessing the basic knowledge and prac ce of hand washing. The ques onnaires contained closed and open-ended ques ons about three different parts which included socio-demographic, characteris cs, knowledge, and prac ce of hand washing among health professionals. The ques onnaires were distributed to wards, emergency department, opera on rooms. adult and pediatric intensive care unit. Then, they were filled by health professionals at their work place and collected by the data collectors. The ques ons could be answered as yes, no. For scoring, 1 mark was given for each correct response and 0 marks for each incorrect or not sure response indica ng a poor level of knowledge. The level of hand hygiene knowledge was calculated by dividing the responses into four groups based on score more than 90% as excellent, 75-90% considered as good, 50-74% moderate, and less than 50% considered as low. The conven onal formula for calcula on of sample size was not used. The whole sampling method was used in our study. Bias reduc on was done by collec ng data from all groups of pa ents, increasing the number of par cipants by making them understand the importance of this study by proper counseling by the inves gators. The collected data were checked for completeness and validity and analyzed by SPSS 17. The result was presented using frequency tables, graphs, and charts.

RESULTS
385 Healthcare professionals were in the hospital 8 did not gave consent 7 were not interested 370 healthcare professionals par cipated  One hundred and ten (30%) par cipants had a moderate level of knowledge of hand washing.  One hundred and twenty six (34%) showed a moderate level of prac ce among study par cipants.

DISCUSSION
Hand washing is a process to remove soil and transient microorganisms from the hands using soap and water. Hand an sepsis is a process of removing or destroying the resident and transient microorganisms on the hands using an an sep c agent, either by rubbing hands with an alcohol-based hand rub or hand washing with an an sep c soap. Hand an sepsis is also known as an sep c hand wash, an sep c hand-rubbing, hand decontamina on, and hand disinfec on. The poor accessibility of hand washing facili es, high workload, lack of adequate knowledge, and failure of administra ve leaders to make hand-hygiene an ins tu onal priority are the factors that contribute to poor 5 adherence to hand-hygiene. Hand washing techniques should be a part of pa ent care in each ins tu on. This study showed that females 318(85.9%) were common health professionals in our study which is similar to the 2-5 1 other studies. Study by Jemel has shown that male was common health professional in their study. Females are common than males because most of the studies on hand washing include nurses and most of the nurses in the developing countries are female. Nursing educa on is gained mostly by females in developing countries because people believe that females can provide good nursing care, sympathy to the pa ent and their family members than male.
Nurses were common in our study which is similar to the [1][2][3][4][5] other studies. All health care professionals play a very important role in the preven on of health-care-associated infec ons but nurses play a very significant role because they are health workers who spend more of their me with pa ents than doctors. In this study 111(30%) had a moderate knowledge of [1][2][3][5][6][7][8][9][10][11][12][13][14] handwashing which is similar to other studies, while other studies have shown a low level of knowledge for 4,15-18 19 handwashing. Study by Chakraborty et al has shown that healthcare professionals had an excellent level of knowledge. This difference may because the level of knowledge depends upon the type of training, prac ces in different health ins tu ons, level of health care facili es, awareness programs among the common people, healthcare professionals, type of hospitals, and study popula on. A moderate level of knowledge among healthcare professionals signifies the pathe c situa on among healthcare providers. There should be a good level of knowledge among health care providers as handwashing is directly related to pa ent outcome. This study has shown that out of 370 respondents, 319(86.1%) responded that steriliza on using alcoholbased hand rub is more effec ve than washing with soap 9 and water.while the study by a Ra'awji BAA et al and 19 Chakraborty has shown that soap and water was the most common method for disinfec on. This might be due to differences in the availability of an sep c agents. The use of alcohol-based hand rub has increased the last few years due easy availability, easy to avoid water during handwashing, can be done in every situa on and less cumbersome to use alcohol based than soap and water. This study has shown that 193(52.1%) has received training in handwashing in the last one year which is similar to the 12 study by a Kudavidnange et al while in a study by Ek were et 13 al it was 68.1%. This difference might be a failure to understand the importance of hand hygiene among health professionals. This also shows that lack of training programmes in ins tu ons, failure of health professionals to understand that one-me knowledge is not sufficient for pa ent care but up-grada on of skills and knowledge is required for effec ve pa ent care. In this study,126(34%) had a moderate prac ce of 5,6,9,10 handwashing which is similar to the other studies. while 1,3,8,12 other studies have shown that the prac ce of handwashing was poor. This difference may be because the prac cal applica on of theore cal knowledge is not always possible, lack of an infec on control commi ee in most of the hospitals in the developing countries, and a lack of poli cal commitment. This may be because it is human nature that what we learn we donot implement and we always choose the easy op ons that require less me and money. A moderate prac ce of handwashing signifies that health professionals are poor in pa ent care that requires a strictly vigilance policy for asep c handwashing techniques. This study showed that there was a similar level of knowledge and the prac ce of handwashing which is similar 5,6,9-11,13,14,19 1,3,8,12 to the other studies. while other studies have shown that there as a moderate level of knowledge but prac ce of handwashing was poor. This difference might be due to a lack of commitment and negligence of health care professionals. It also shows that prac ce cannot be improved unless we start upgrading the knowledge by regular training and re-training. In this study 368(99.4%) par cipants wash their hand a er exposure to body fluid. This shows that health professionals donot have knowledge that handwashing is important in each step of pa ent care. Nurses should be part of training, involved in training commi ee of handwashing. This is because implementa on of handwashing can become easier when a nurse can give message about handwashing than doctor himself.

CONCLUSION
There was a moderate level of knowledge and prac ce of hand washing among health professionals. Strict protocol for handwashing, regular training, and re-training through simula ons of hand hygiene will lead to an improvement in the knowledge and prac ce of handwashing.

RECOMMENDATIONS
Regular ins tu on based training programme should be done to increase the level of hand washing. Adherence to hand hygiene recommenda ons is the only single most important prac ce for preven ng the transmission of infec on in health care. An infec on control commi ee that includes doctors, nurses, and other professionals from all specialty and sub-specialty should be established in all ins tu ons to regularly check the progress and implementa on of handwashing programmes.

LIMITATIONS OF STUDY
It was a single-center, non-randomized study. The interven on was not done to assess the change in the knowledge and prac ce of handwashing.