Knowledge, attitude and barriers to hands hygiene practice: a study of Kampala International University undergraduate medical students

Hannah W. Muiru


Background: Hand hygiene is the simplest method that is effective in terms of cost with its importance in preventing transmission of microorganisms and infections. Though this being the case, it has been found to be clumsy and faulty in most healthcare settings. What has been done on assessing the medical students’ knowledge, attitude and practice and comparisons of these factors between the medical disciplines is not exhaustive.

Methods: A descriptive cross sectional study was conducted among the undergraduate medical students to assess the knowledge in medical students, their attitude and barriers to hand hygiene practice where simple random sampling technique was applied to obtain a sample size. A questionnaire on alcohol-based hand rubs and WHO recommendations on hand hygiene was used for data collection.

Results: A total of 392 respondents were interviewed. The respondents comprised of 232 males and 160 females. The overall mean score for individual knowledge was 49.4%. The study revealed that more than half of the respondents 203 had poor knowledge on hand hygiene while 43.1% had average and 5.1% were consider to have good knowledge. Most of the respondents had good attitude on hand hygiene on most of the aspects that were assessed. Several barriers to effective hand hygiene practice were highlighted by the respondent.

Conclusions: The study concluded that more sensitization was needed to increase awareness and knowledge of the practice in medical students which could be achieved by adding a course on hand hygiene practice to the undergraduate medical students’ curriculum amongst others.


Cross infection, Simple hand wash, Alcohol-based hand rubs, Hand hygiene, Barriers

Full Text:



World Health Organization (WHO), Practical guidelines for infection control in health care facilities. Geneva, WHO 2004;1:76-80.

World Health Organization. WHO guidelines for hand hygiene in healthcare. First global patient safety challenge: clean care is safer care; 2009.

Mohesh G, Dandapani A. Knowledge, attitude and practice of hand hygiene among medical students-a questionnaire based survey. Unique J Med Dental Sci. 2014;2(3):127-31.

Mathur P. ‘‘Hand hygiene: back to the basics of infection control. Indian J Med Res. 2011;134(11):126-31.

Pittet D. Infection control and quality health care in the new millenium, American J Infection Control. 2005;33(5):258–67.

Snow M, White GL, Alder SC, Stanford JB. Mentor's hand hygiene practices influence student's hand hygiene rates. American J Infection Control. 2006;34(1):18‐24.

Pittet D, Hugonnet S, Harbarth S, et al, Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Infection control Programme. Lancet. 2000;356:1307-12.

Chen Y, Chou YP. Impact of nosocomial infection on the cost of illness and lengths of stay in intensive care unit. Infection Control Hospital Epidemiol. 2005;26(3):281‐97.

Centers for Disease Control and Prevention. Guideline for hand hygiene in health care settings: Recommendations of the Healthcare Infection Control Practices Advisory Committee and HICPA/SHEA/APIC/IDSA. Hands Hygiene Taskforce. Morbidity mortality weekly report 2002;51(16):1-45.

Backman C, Zoutman, D. E & Marck, P.B, Integrative review on current evidence on the relationship between Hand hygiene interventions and the incidence of health care associated infections. Am J Infection Control. 2008;36(5):333-48.

Johnson PD, Martin R, Burrell LJ, Garbs EA, Kirsa SW, O’Keeffe J, et al, Efficacy of an alcohol/chlorhexidine hand hygiene program in a hospital with high rate of nosocomial Methicillin resistant Staphylococcus aureus (MRSA) infection. Med J Australia. 2005;183(10):9-14.

Grayson ML, Jarvie LJ, Martin R, Johnson PDR, Jodoin ME, McMullan C, et al, Significant reduction in methicillin‐resistant Staphylococcus aureus bacteraemia and clinical isolates associated with a multi‐site, hand hygiene culture‐change program and subsequent state-wide rollout. Med J Australia. 2008;188(11):633‐40.

Rosenthal VD, Guzman S, Safdar N. Reduction in nosocomial infection with improved hand hygiene in intensive care units of a tertiary care hospital in Argentina. Am J Infection Control. 2005;33:392–7.

Kothari CR. Research methodology, methods and techniques. 2nd ed. New international publishers; 2004.

Mann CM, Wood A. How much do medical students know about infection control? J Hospital Infection. 2006;64(4):366‐70.

Nair SS, Hanumantappa R, Hiremath SG, Siraj MA, Raghunath P. Knowledge, Attitude, and Practice of Hand Hygiene among Medical and Nursing Students at a Tertiary Health Care Centre in Raichur, India. ISRN Prev Med. 2014; 2014: 608927.

Bandura A. Health promotion from the perspective of Social Cognitive theory. Psychol Health. 1998;13(4):623‐49.

Al-Naggar RA, Al-Jashamy K. Perceptions and Barriers of Hands Hygiene Practice among Medical Science Students in a Medical School in Malaysia. Int Med J Malaysia. 2013;12(2):11-4.

Barret R, Raddle J. Hand hygiene practices; nursing students’ perceptions. J Clin Nursing. 2008;17(14):1851-7.