HANDWASHING AND PERCEIVED FACTORS INFLUENCING THE PRACTICE AMONG NURSES IN STATE HOSPITALS IN IBADAN METROPOLIS, NIGERIA

Abstract

Hand Washing (HW) helps to prevent or control Nosocomial Infections (NI) among health workers. Compliance to HW guidelines among health workers is low. The perceived factors which influence its practice among nurses in Secondary Healthcare Facilities (SHF) are yet to be well investigated. This study was, therefore, designed to determine the practice of HW and the factors perceived to influence HW practice among nurses in public SHF in lbadan metropolis. The study was a cross-sectional survey. A cluster sampling technique was used to select 320 consenting nurses proportionately allocated to ward/clinics in all the five state-owned hospitals. A semi-structured questionnaire which included questions on 21-point knowledge. 17 point perception and 53-point HW practice scales, as well as perceived HW facilitating and barrier factors were used for data collection, Knowledge scores ≤7, >7-15 and >15 were categorised as poor, fair and good, respectively. Hand washing-related perception scores < 9 and ≥ 9, were respectively. Classified as unfavorable and favourable. Hand washing practice scores ≤26 and >26, were grouped as poor and good, respectively. Data were analysed using descriptive statistics, student’s t-test, chi-square test and logistic regression at p=0.05. Respondents' age was 36.8±9.0 years, 85.0% were females and 63.8% possessed nursing diploma. Knowledge score was 13.3±2.1 and respondents with poor, fair and good knowledge were 2.5%, 64.4% and 33.1%, respectively. The correctly mentioned HW practices for controlling NI included the following HW before and after touching a patient (95.9%); HW after dressing a bed (85.9%); and after contact with blood or body fluid (97.5%). Respondents' perception score was 13.7±2.1 and 98.8% had favourable perceptions. Respondents' practice score was 29.7±6.8 and 68.8% had good practice scores the good HW methods practiced included use of antiseptic soap and warm water (68.1%), and washing of both front and back of hands (80.0%). Poor HW methods practiced included use of running water alone (23.4%), HW in a basin (27.8%) and use of soap water in a basin (26.3%). The HW facilitating factors included availability of the following: a bucket of water with bowl (72.5%); a sink (59.1%); and soap racks (46.9%) while barriers to appropriate HW included irregular wider supply (64.7%); lack of water (47.5%) and lack of soap (46.3%). Respondents in wards were more likely to have good HW practices compared to respondents in the clinic (OR= 2.53, CI=1.45-4.46). Nurses in state hospitals in Ibadan favored hand washing but knowledge of the practices was low among them. In addition several of them practiced poor hand washing. Availability of sinks facilitates the adoption of hand washing among respondents in the wards compared to those in clinic. Continuing education and provision of hand washing-related resources in wards/ clinics are needed to address the situation.