Hand hygiene knowledge, attitudes, and self-reported practices among medical and nursing staff of a tertiary-care military hospital: a cross-sectional study

Keywords: Hand hygiene, COVID-19, healthcare workers, knowledge, attitudes, survey, Pakistan


Hand hygiene (HH) serves as a primary public health measure against healthcare-associated infections. During the coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome (SARS) coronavirus 2 (SARS-CoV-2), HH has been fundamentally reinforced for preventing infection transmission globally. This cross-sectional study provides data as a baseline evaluation of knowledge, attitude, and self-reported practice, along with the differences of each between medical and nursing staff. A self-administered questionnaire comprising a standardized World Health Organization Hand Hygiene Knowledge Questionnaire (WHO, revised August 2009) and Likert scales for attitude and practice was employed, using convenience sampling to collect data from 383 healthcare workers (HCWs), 92 nurses (24.9%), and 277 doctors (75.1%) in a tertiary-care military hospital. Both nurses and doctors had moderate knowledge with no significant difference (P = 0.54). Moreover, attitude and practice were reported as moderate for both groups. However, the self-reported HH practice of doctors was significantly (P < 0.05) better than that of nurses, while nurses had significantly better (P < 0.01) attitudes in comparison with doctors. Participants who had received formal training in the previous 3 years were 70.65% among nurses and 44.76% among doctors. In total, 78.36% acknowledged routine use of alcohol-based hand rub. It suggested a relationship of HH to demographic variables, professional role, and departmental service. It should be noted that this study shows no relationship between knowledge and practice, and a negative correlation between knowledge and attitude. Concurrently, while further investigation is required to pinpoint the obstacles to achieving proper HH, it can be concluded that infrastructure promoting its practice among HCWs needs to be established.


Download data is not yet available.


Pittet D, Allegranzi B, Sax H, Dharan S, Pessoa-Silva CL, Donaldson L, et al. Evidence-based model for hand transmission during patient care and the role of improved practices. Lancet Infect Dis 2006; 6: 641–52. doi: 10.1016/S1473-3099(06)70600-4

World Health Organization. WHO guidelines on hand hygiene in health care: a summary first global patient safety challenge clean care is safer care. World Health Organ 2009; 30(1): 270. Available from: http://whqlibdoc.who.int/publications/2009/9789241597906_eng.pdf [cited July 2009].

World Health Organization. The burden of health care-associated infection worldwide. 2010. Available from: https://www.who.int/gpsc/country_work/burden_hcai/en/ [cited 10 February 2021].

Prüss A, Giroult E, Rushbrook P. Hospital hygiene and infection control. Safe management of wastes from healthcare activities. Hong Kong: World Health Organization; 1999, pp. 148–58.

Anwar MA, Rabbi S, Masroor M, Majeed F, Andrades M, Baqi S. Self-reported practices of hand hygiene among the trainees of a teaching hospital in a resource limited country. J Pak Med Assoc 2009; 59: 631–4.

Kotwal A, Anargh V, Singh H, Kulkarni A, Mahen A. Hand hygiene practices among health care workers (HCWs) in a tertiary care facility in Pune. Med J Armed Forces India 2013; 69: 54–56. doi: 10.1016/j.mjafi.2012.08.011

Siddarth Sai MS, Srinivas Rao MS, Sandeepthi M, Pavani K, Vinayaraj EV. Hand Hygiene practices among health providers working in tertiary care hospitals in and around Hyderabad, Telangana state (South India). Int J Res Med Sci 2015; 1: 250–5. doi: 10.5455/2320-6012.ijrms20150145

Whitby M, McLaws M-L, Ross MW. Why healthcare workers don’t wash their hands: a behavioral explanation. Infect Control Hosp Epidemiol 2006; 27: 484–492. doi: 10.1086/503335

Maheshwari V, Kaore NCM, Ramnani VK, Gupta SK, Borle A, Rituja K. A study to assess knowledge and attitude regarding hand hygiene amongst residents and nursing staff in a tertiary health care setting of Bhopal city. J Clin Diagn Res 2014; 8(8): 4–7. doi: 10.7860/JCDR/2014/8510.4696

Ather H, Khan A, Shabnum S. Knowledge and compliance toward standard precaution among health care workers at Bahria International Hospital Lahore, Pakistan. Int J Soc Sci Manag 2020; 7(1): 17–20. doi: 10.3126/ijssm.v7i1.27406

Ahmed J, Malik F, Memon ZA, Bin Arif T, Ali A, Nasim S, et al. Compliance and knowledge of healthcare workers regarding hand hygiene and use of disinfectants: a study based in Karachi. Cureus 2020; 12: 7036. doi: 10.7759/cureus.7036

Iqbal M, Zaman M, Azam N. Knowledge and perception of hand hygiene among health care workers of a tertiary care military hospital: a descriptive study. Pak Armed Forces Med J 2018; 68(5): 1372–7. Available from: https://www.pafmj.org/index.php/PAFMJ/article/view/2325 [cited 10 February 2021].

Diwan V, Gustafsson C, Klintz SR, Joshi SC, Joshi R, Sharma M, et al. Understanding healthcare workers self-reported practices, knowledge and attitude about hand hygiene in a medical setting in rural India. PLoS One 2016; 11(10): e0163347. doi: 10.1371/journal.pone.0163347

Suchitra J, Lakshmi Devi N. Impact of education on knowledge, attitudes and practices among various categories of health care workers on nosocomial infections. Indian J Med Microbiol 2007 Jul 1; 25(3): 181–7. doi: 10.1016/S0255-0857(21)02104-6

Riasat R, Malik M, Yousaf I, Imam K. Knowledge and practices of infection control among healthcare workers in a tertiary care hospital. Pak J Physiol 2019; 15(4): 46–8. Available from: http://www.pjp.pps.org.pk/index.php/PJP/article/view/1190 [cited 10 February 2021].

World Health Organization. Hand hygiene knowledge questionnaire for health-care workers. 2009. World Health Organization, Geneva.

Cruz J, Cruz C, Al-Otaibi ASD. Gender differences in hand hygiene among Saudi nursing students. IJIC 2015; 11(4). doi: 10.3396/ijic.v11i4.029.15

Goyal A, Narula H, Gupta P, Sharma A, Bhadoria A, Gupta P. Evaluation of existing knowledge, attitude, perception and compliance of hand hygiene among health care workers in a Tertiary care centre in Uttarakhand. J Fam Med Prim Care 2020; 9(3): 1620. doi: 10.4103/jfmpc.jfmpc_1183_19

Squires JE, Linklater S, Grimshaw JM, Graham ID, Sullivan K, Bruce N, et al. Understanding practice: factors that influence physician hand hygiene compliance. Infect Control Hosp Epidemiol 2014 Dec; 35(12): 1511–20. doi: 10.1086/678597

Barroso V, Caceres W, Loftus P, Evans KH, Shieh L. Hand hygiene of medical students and resident physicians: predictors of attitudes and behaviour. Postgrad Med J 2016; 92(1091): 497–500. doi: 10.1136/postgradmedj-2015-133509

Vaillant L, Birgand G, Esposito-Farese M, Astagneau P, Pulcini C, Robert J, et al. Awareness among French healthcare workers of the transmission of multidrug resistant organisms: a large cross-sectional survey. Antimicrob Resist Infect Control 2019; 8(1): e173. doi: 10.1186/s13756-019-0625-0

Alfahan A, Alhabib S, Abdulmajeed I, Rahman S, Bamuhair S. In the era of corona virus: health care professionals’ knowledge, attitudes, and practice of hand hygiene in Saudi primary care centers: a cross-sectional study. J Community Hosp Intern Med Perspect 2016 Jan; 6(4): 32151. doi: 10.3402/jchimp.v6.32151

Yehouenou CL, Dohou AM, Fiogbe AD, Esse M, Degbey C, Simon A, et al. Hand hygiene in surgery in benin: opportunities and challenges. Antimicrob Resist Infect Control 2020; 9(1): 85. doi: 10.1186/s13756-020-00748-z

Jang T-H, Wu S, Kirzner D, Moore C, Youssef G, Tong A, et al. Focus group study of hand hygiene practice among healthcare workers in a teaching hospital in Toronto, Canada. Infect Control Hosp Epidemiol 2010; 31(2): 144–50. doi: 10.1086/649792

Sili U, Ay P, Bilgin H, Hidiroglu S, Korten V. Hand hygiene knowledge, perception and practice of healthcare workers in a Turkish university hospital intensive care unit. J Infect Dev Ctries 2019 Aug 31; 13(8): 744–7. doi: 10.3855/jidc.10916

Phan HT, Tran HTT, Tran HTM, Dinh APP, Ngo HT, Theorell-Haglow J, et al. An educational intervention to improve hand hygiene compliance in Vietnam. BMC Infect Dis 2018; 18(1): e116. doi: 10.1186/s12879-018-3029-5

Sopjani I, Jahn P, Behrens J. Training as an effective tool to increase the knowledge about hand hygiene actions. An evaluation study of training effectiveness in Kosovo. Med Arch 2017; 71(1): 16–19. doi: 10.5455/medarh.2017.71.16-19

Akingbola OA, Singh D, Srivastav S, Plunkett DS, Combs MM. The Impact of Hand Hygiene Posters on Hand Hygiene Compliance Rate among Resident Physicians: A Brief Report. Clinical Pediatrics 2016; 1(4): 1–2. doi: 10.4172/2572-0775.1000113.

Fuller C, Savage J, Besser S, Hayward A, Cookson B, Cooper B, et al. ‘The dirty hand in the latex glove’: a study of hand hygiene compliance when gloves are worn. Infect Control Hosp Epidemiol 2011; 32(12): 1194–9. doi: 10.1086/662619

Kirk J, Kendall A, Marx JF, Pincock T, Young E, Hughes JM, et al. Point of care hand hygiene – where’s the rub? A survey of US and Canadian health care workers’ knowledge, attitudes, and practices. Am J Infect Control 2016; 44: 1095–110. doi: 10.1016/j.ajic.2016.03.005

Elsafi S, Al-Howti S. Factors influencing hand hygiene compliance of healthcare students. IJIC 2019; 15(4): e19118. doi: 10.3396/ijic.v15i4.015.19

ALSofiani AM, AlOmari F, AlQarny M. Knowledge and practice of hand hygiene among healthcare workers at Armed Forces Military Hospitals, Taif, Saudi Arabia. Int J Med Sci Public Health 2016; 5(6): 1282. doi: 10.5455/ijmsph.2016.15042016439

How to Cite
Zia, I., Cheema, S., Sheikh, N., & Ashraf, H. (2022). Hand hygiene knowledge, attitudes, and self-reported practices among medical and nursing staff of a tertiary-care military hospital: a cross-sectional study. International Journal of Infection Control, 18. https://doi.org/10.3396/ijic.v18.21469
Original Articles