Evaluating the effectiveness of the “Germ-Free Hands” intervention for improving the hand hygiene practices of public health students

Abstract

Purpose

This quasi-experimental study sought to assess the effectiveness of a multidisciplinary intervention called “Germ-Free Hands” to improve the hand hygiene practices of students attending Thailand’s Sirindhorn College of Public Health (SCPH).

Methods

The intervention was developed and implemented at SCPH and incorporated education, training, a workshop, and performance feedback. The intervention targeted behavioral antecedents specified by the Health Belief Model (HBM) and the Theory of Planned Behavior (TPB). Handwashing determinants (knowledge, beliefs, attitudes, subjective norms, perceived behavioral control, and intentions) and hand hygiene behaviors were assessed at baseline, immediately post-intervention, and 3 months post-intervention for the intervention group at (n=60) at the Suphanburi campus of SCPH and a matched control group (n=60) of students at the Ubonratchathani campus. Data analysis included descriptive statistics, independent samples t-tests, two-way measures of analysis of variance, and a generalized estimating equation to compare handwashing practices by self-reports between two groups.

Results

The “Germ-Free Hands” intervention produced significant improvements in the intervention group’s handwashing knowledge, behavioral and control beliefs, subjective norm scores, intentions, and behaviors, as compared to the control group. However, the intervention had no significant impact on normative beliefs, attitudes, or perceived behavioral control. Reported improvements also decreased 3 months post-intervention, and the number of bacterial colonies on students’ hands increased over the course of the study.

Conclusion

This study adds to the evidence that multidisciplinary interventions can be effective at improving handwashing rates. However, education and training must be continuous, rather than delivered as a one-time program, in order to have sustained results. Participants may also require more in-depth instruction in correct handwashing and drying techniques to remove bacteria effectively and prevent recolonization.

Keywords:

• handwashing
• hand hygiene
• public health student
• Theory of Planned Behavior
• Health Belief Model

Acknowledgments

The authors thank all students at SCPH-SP and SCPH-UB who participated in this study.

Ethics approval and informed consent

This study’s protocol was approved by the Research Ethics Committee for Research Involving Human Research Participants, Health Sciences Group, Chulalongkorn University, Thailand. Committee approval is in accordance with the International Conference on Harmonization—Good Clinical Practice. Written informed consent were obtained from all participants. The research respected the confidentiality of all information collected from participants.

Disclosure

Miss Apaporn Kitsanapun reports that she is an instructor at Sirindhorn College of Public Health Suphanburi where the study was conducted. The authors report no further conflicts of interest in this work.