Knowledge of final-year medical students at the University of the Free State of hand hygiene as a basic infection control measure

Figures & data

Table 1: Knowledge of final-year medical students at the University of the Free State of hand hygiene as a basic infection control measure; only correct options are indicated (n = 105)

Factor	n (%) *
1. The antimicrobial activity of alcohol results from the ability to:
Denature proteins	53 (50.5)
2. Which part of a patient’s room is most densely and diversely colonised by microorganisms?
Doorknob	49 (46.7)
3. When using an alcohol-based hand sanitiser, what is the minimal time needed to kill most germs on your hands before rinsing with water?
None of the listed options (i.e. NOT 2; 8; 10; 20 seconds)	11 (10.5)
4. Which of the following methods of hand drying after a wash prevents contamination to the greatest degree in a hospital environment?
Paper towels	51 (48.6)
5. According to the World Health Organization (WHO), what should one do after using an alcohol-based hand sanitiser to prevent the formation of a biofilm?
None of the listed options (i.e. NOT rinse hands with clean water; dry hands with sterile cloths; wash hands with soap and water; apply 1% chlorhexidine and rinse with clean water)	41 (39.1)
6. Apart from the issue of skin tolerance and level of comfort, water temperature …
Does not appear to be a critical factor for microbial removal from hands being washed	21 (20.0)
7. Clostridium difficile contaminated hand can easily be decontaminated with …
Washing hands with water and soap	52 (49.5)
8. Which one of the following statements regarding hand hygiene is incorrect?
It is not necessary to wash your hands between patients during screening	89 (84.8)
9. Which statement is true about glove use?
It is necessary to discard gloves after each task	83 (79.1)
10. The efficiency of alcohol-based hand hygiene products is not affected by the following factor(s):
All of the above affects efficiency (percentage of alcohol in solution used; volume of alcohol used; whether hands are wet or dry when alcohol is applied)	56 (53.3)
11. Examination gloves are correctly used in which of the following statements:
During direct and indirect patient exposure (e.g. contact with blood/emptying emesis basins)	73 (69.5)
12. How are antibiotic-resistant pathogens most commonly spread from one patient to another in healthcare settings?
From one patient to another via hands of contaminated healthcare workers	34 (32.4)
13. What is the most frequent source of germs responsible for healthcare-associated infections with regard to cross-contamination?
Germs already present on or within the patient	8 (7.6)
14. According to the WHO, what is the single most important way to prevent the spread of disease in the hospital environment?
Handwashing	56 (53.3)
15. What should the temperature of water be when washing your hands?
Medium hot	48 (46.2)
16. What is a necessity when washing your hands?
Need to remove rings	43 (41.0)
17. The following hand condition can acquire and spread microorganisms the most readily:
Wet hands	31 (29.5)
18. Which of the following should be avoided, as recommended by the WHO, as it is associated with increased likelihood of colonisation of hands with harmful germs?
Both B and C (wearing of jewellery; wearing of long-sleeved white coats)	45 (42.9)
19. When a microbiologist swabs a patient’s hand, the microorganism they would be able to find the most in terms of numbers is:
Staphylococcus epidermidis	89 (84.8)

* The results indicate n (%) students who chose the correct answer.

Table 2: Correct and most frequently chosen incorrect answer to questions where less than 40% of the students chose the correct option

Item	n (%)*
3. When using an alcohol-based hand sanitiser, what is the minimal time needed to kill most germs on your hands before rinsing with water?
 None of the listed options (i.e. NOT 2; 8; 10; 20 seconds)	11 (10.5)
 10 seconds	42 (40.0)
5. According to the World Health Organization (WHO), what should one do after using an alcohol-based hand sanitiser to prevent the formation of a biofilm?
 None of the listed options (i.e. NOT rinse hands with clean water; dry hands with sterile cloths; wash hands with soap and water; apply 1% chlorhexidine and rinse with clean water)	41 (39.1)
 rinse hands with clean water	23 (21.9)
6. Apart from the issue of skin tolerance and level of comfort, water temperature …
 does not appear to be a critical factor for microbial removal from hands being washed	21 (20.0)
 A and C is correct (does appear to be a critical factor for microbial removal from hands being washed AND does appear to influence the efficiency of the antimicrobial activity of the antimicrobial agents used for hand washing purposes)	53 (50.5)
12. How are antibiotic-resistant pathogens most commonly spread from one patient to another in healthcare settings?
 From one patient to another via hands of contaminated healthcare workers	34 (32.4)
 Both A and D (airborne spread from patients coughing or sneezing AND from one patient to another via hands of contaminated healthcare workers.	61 (58.1)
13. What is the most frequent source of germs responsible for healthcare-associated infections with regard to cross-contamination?
 Germs already present on or within the patient	8 (7.6)
 All the above mentioned (the hospital’s water system AND germs already present on or within the patient AND the hospital air (air conditioners included) AND the hospital environment (surfaces))	46 (43.8)
17. The following hand condition can acquire and spread microorganisms the most readily:
 Wet hands	31 (29.5)
 All of the above (hands with undamaged skin AND dry hands AND hands with gloves AND wet hands)	58 (55.2)

 = correct answer;  = most frequently chosen incorrect answer.

* Clinical significance:

20-30 seconds of alcohol-based hand rub (ABHR) recommended by the WHO constitute just a single step in hand hygiene but the optimal time is being challenged.

Rinsing hands with water or wiping them with a towel immediately after using ABHR might counteract the effect of the product. The benefit of AHBR is also lost since frequent hand washing with soap and water promote skin dryness and irritation.

Hot water promotes skin irritation and might not be readily available. It is reassuring and important to know that water temperature is of less importance.

The transmission of bacteria is more likely to occur from wet hands than from dry hands and proper drying of hands should therefore form an integral part of the hand hygiene process.

Knowing that HCW's hands is the most important source of the spreading of germs and the fact that most germs occur from patient's own colonization is critical important to understand to ensure that ABHR should be used before touching and after touching each patient.