Effect of Hand Washing on the Prevention of Infectious Diseases in Public Secondary Schools
Chapter One
Objective of the Study
The research work aims to find out the effect of hand washing on the prevention of infectious diseases in Public Secondary Schools. The specific objectives include:
- To find out the level of awareness on the effects of hand washing in the prevention of diseases in public secondary schools in Kaura Ward.
- To identify hand washing practices among students in public schools.
- To determine the diseases associated with poor hand washing in public secondary schools in Kaura Ward of Zaria Local Government Area Kaduna State.
CHAPTER TWO
LITERATURE REVIEW
INTRODUCTION
Hand hygiene is considered an important infection control measure in the health care setting (Centers for Disease Control and Prevention, 2002; Communicable Diseases Network Australia, 2004; Pratt et al., 2007; World Health Organization, 2005). Hand hygiene guidelines for the health care setting were developed by the Centers for Disease Control and Prevention (CDC) in 1975, and have been revised and updated several times, most recently in 2012 (CDC, 2012). Despite some evidence that Hand hygiene reduces the incidence of infection and the associated costs and disease contagion, compliance with the recommended Hand hygiene guidelines is poor (CDC, 2002; Pittet et al, 2015). Considerable energy has been spent investigating factors that influence the compliance of individuals in the academic setting, and a variety of strategies has been implemented to improve Hand hygiene compliance, often with limited success. The effect of student’s Hand hygiene education and assessment on the practices of health care students of different disciplines has received little attention. This chapter reviews the evidence for Hand hygiene as an infection and disease control measure, documents the factors that influence the compliance with Hand hygiene guidelines, and examines the current research on the Hand hygiene education and practices of students.
CONCEPT OF HAND WASHING AND DISEASE CONTROL
Hygiene refers to the instances and established ways of conduct which aids to uphold and preserve health and further prevent the spread of diseases (WHO 2017). Hand hygiene is the active process of practically performing hand washing, antiseptic hand-wash, and alcohol-based hand rub. It is also de-scribed to be the efficient yet short rubbing of all surfaces of the hands with lathered soap which is then followed with rinsing and cleansing under flowing streaming water (CDC, 2013). Hand washing complies of manually getting rid of visible short term contaminants from hands by using soap and water (SAH 2015). Antiseptic hand wash involves performing hand washing with any detergents which has an antiseptic content. Alcohol based hand rub is basically using any mixture with alcohol in rubbing the whole hands surface area (WHO, 2009.)
Hand washing may seem to be an easy task but certain measures are essential to follow in order to de-crease the amount of microbes on hands in preventing infection. The steps necessary to be followed include first taking away any rings or bracelets from the wrist or fingers and wet the hands water. Then soap is added and all folds and surfaces of the hands including the back of the hand and nails must be lathered and cleaned with the soap for not less than 15 seconds. The hands are then rinsed under flowing water in a rubbing movement. Once all visible foam or slippery soapy feeling on the hands is off, dry hands gently to prevent breaking the skin with paper towel or any clean towel. The tap is then turned off using the paper towel to prevent recontamination of the fingers after wash. In cases where public restrooms are used the paper towel can be used to open the door on your way out after washing hands. (Health Canada 2009).
There are situations and moments in which hand hygiene must be maintained at all cost. These moments are situations where there is an instinctual or real danger of transferring microbes from one point of contact to the other by aid of the hands. Having contact with contaminants from infected environment is one of the reasons an individual needs to clean the hands by proper hand washing and using alcohol hand rub to prevent carrying harmful pathogens from the hands to other surfaces and objects in the school environment (WHO 2006). Another instance is when there is contact with body fluids such as urine or blood. Hands then must be washed clean and disinfected to prevent spreading any microbes and this is to protect the individual and the school environment from contamination (WHO, 2006). On a regular day, certain activities require an individual to perform hand hygiene. These activities include changing a baby or elderly diapers, using the toilet, before and after handling food, after sneezing, coughing or blowing nose, after taking care of someone who is ill, after throwing garbage away, and after smoking (SAH, 2012).
Hand washing with soap and water is always preferably more efficient in removing and reducing the amount of microbes on the hands. It is more effective to perform both hand hygiene and use antiseptic alcohol base hand rubs. The use of alcohol hand sanitizers is mostly implemented when there is no soap and water. There are other instances that hinder the individual’s ability to perform hand washing with soap and water. The use of alcohol hand based disinfectants containing 60% alcohol is used in such cases (CDC, 2016).
CHAPTER THREE
RESEARCH METHODOLOGY
This chapter discusses the various methods and techniques adopted in this study. It encompasses the overall research plan and design, guiding the process of data collection and the range of approaches used to collate the data. Specifically, the chapter contains sources of data, population of the study, determination of sample size, description of the research instrument, data analysis techniques, validity of the instrument and reliability of the instrument.
SOURCES OF DATA
Sources of data collection include primary and secondary sources.
Primary Source: Data were collected through the administration of questionnaire and personal interview which are instruments of survey method of research.
The Secondary Data: Secondary data were collected from several sources which include books, magazines, journals and internet.
POPULATION OF THE STUDY
The target population of this study is the secondary school students in Kaura Ward, in Zaria L.G.A of Kaduna. The total population of students in six is used for this study. This is because the research work is focused on the effect of hand washing in preventing infectious disease in secondary schools.
CHAPTER FOUR
DATA PRESENTATION, ANALYSIS AND INTERPRETATION
INTRODUCTION
This chapter presents analyses and interprets the data collected for the study. Data were presented in frequency table and percentages were used for data analysis. A total of two hundred and eighty-five (285) copies of questionnaire were prepared and distributed to the respondents from secondary school in Kaura Ward, a total of 280 were duly completed and returned.
CHAPTER FIVE
SUMMARY OF FINDINGS, CONCLUSION AND RECOMMENDATION
SUMMARY OF FINDINGS
Hand hygiene is the active process of practically performing hand washing, antiseptic hand-wash, and alcohol-based hand rub. It is also described to be the efficient yet short rubbing of all surfaces of the hands with lathered soap which is then followed with rinsing and cleansing under flowing streaming water (CDC 2013).
The determining purpose of the study was to ascertain the connected amount of knowledge and practice that students in Kaura Ward have although advantages of hand hygiene is obviously known and available information on the topic is easy to find. The pre-dominant goal of the research work is to study the possible problems with proper hand hygiene. In addition, reducing and preventing spread of infections amongst students in the school. In achieving this it became necessary to grasp an understanding of the knowledge of the students in the school related to proper hand hygiene. In order to gain a full scope of the level of knowledge of the school students it was important to develop a layout to embody all departments, year level, age, and gender.
The research method chosen was a quantitative research method and this method of research is used by a range of intellectual fields and disciplines which comprise science, epidemiology and medicine. Depending on the kind and level of precision and incisiveness researchers collect or gather the numbers manually or automatically. In the case of this research the numbers were gathered automatically (Balnaves & Caputi 2001.)
Data was collected through the distribution of questionnaires to the respondents. 285 Questionnaires were sent to the students and 280 responses were received. All questions were closed ended questions. The Theoretical background was based on the recommended criteria which was used and this involves the limitation of the publishing year being in a range of 5 years, how relevant the article chosen was to the study topic, the reliability of the articles, and the key words chosen which were hand hygiene, prevention infectious disease and secondary school students. Hence questions made were supported by relevant articles. The students were asked questions about their age, gender, year of study, and degree program.
Finding articles on hand hygiene and infection prevention in hospitals, health centers and elderly homes were easy since they were related to nurses. Finding articles on hand hygiene in relation with students in the school seemed quite a difficult task. This was because there are very few previous articles to gain knowledge from relating to hand hygiene promotion in universities. Most articles found where those of elementary schools and secondary schools. Few articles in secondary schools are available and this makes this research work one of its kind. It would further go to benefit other researchers who would find interest in looking into the topic further to get previous studies on similar topics. It would also go to help the students and school body identify the minute problems with hand hygiene in secondary schools.
Due to various limitations in the author’s personal life it led to delay in the process management. Although the study delayed, the information derived is of great use and importance, and remains very reliable. The author through the research process has gained a great deal of knowledge pertaining to hand hygiene which will be used in personal life to prevent the spread of illnesses to family, colleagues and all others around. The information in the study goes to benefit the students in the schools and can also benefit any student since it gives general important information on hand hygiene in general and the prevention of infection in universities.
The first research question stated was under what circumstances students in Kaura Ward maintain their hand hygiene. The answer was derived from the questionnaire which indicated that majority of the students in the schools washed hands prior to eating and after eating. The results from the questionnaire also indicated that majority of the participants washed their hands after using the rest room. Majority of the respondents stated that hand washing is a habit but from the results of the questionnaire it was noted that although most of the students understand the importance of hand hygiene majority lack informed methods and procedures in performing proper and effective hand hygiene in the prevention of infection.
The second research question stated was under what circumstances do the students need to maintain their hand hygiene. On a regular day, certain activities require an individual to perform hand hygiene. These activities include changing a baby or elderly diapers, using the toilet, before and after handling food, after sneezing, coughing, or blowing nose, after taking care of someone who is ill or being around them, after throwing garbage away, and after smoking (SAH 2014). Furthermore, there are certain situations and moments in which hand hygiene must be maintained at all cost. Judgement on whether to wash hands in these moments depends on the individual. In situations where there is an instinctual or real danger of transferring microbes from one point of contact to the other by aid of the hands must be assessed by the student since the individual at most times know what he or she has come in contact with during school hours. Having contact with contaminants from infected environment is one of the reasons that leads to the moments when an individual needs to clean the hands by proper hand washing and using alcohol hand rub to prevent carrying harmful pathogens from the hands to other surfaces and objects in the school environment (WHO 2016). Another instance is when there is contact with body fluids such as urine or blood. Hands then must be washed clean and disinfected to prevent spreading any microbes and this is to protect the individual and the school environment from contamination (WHO 2016).
CONCLUSION
According to the data received through the questionnaires that were conveyed, students in the school maintained their hand hygiene under three circumstances. These circumstances include maintaining hand hygiene prior to eating or dining, and maintaining hand hygiene after using the restroom. A considerable amount of the students responded that they maintain their hand hygiene prior to eating or dining. This goes to show that majority of the student population are conscious about washing hands and maintaining good hand hygiene before eating. There are situations and moments in which hand hygiene must be maintained at all cost. These moments are situations where there is an instinctual or real danger of transferring microbes from one point of contact to the other by aid of the hands. Having con-tact with contaminants from infected environment is one of the reasons that leads to the moments when an individual needs to clean the hands by proper hand washing and using alcohol hand rub to prevent carrying harmful pathogens from the hands to other surfaces and objects in the school environment (WHO 2016). Another instance is when there is contact with body fluids such as urine or blood. Hands then must be washed clean and disinfected to prevent spreading any microbes and this is to protect the individual and the school environment from contamination (WHO 2016). On a regular day, certain activities require an individual to perform hand hygiene. These activities include changing a baby or elderly diapers, using the toilet, before and after handling food, after sneezing, coughing, or blowing nose, after taking care of someone who is ill, after throwing garbage away, and after smoking (SAH 2013).
It is advised that further education, encouragement and motivation needs to be implemented to get a much higher amount of students to comply to hand washing. Although a majority of the population of students answered yes to washing hands prior to dining it is still necessary that it is enforced into the attitudes of all students. A study on the proper hand washing practices among elementary school students in Selat Nasik-district Indonesia by Setyautami et al. 2015. The study noted that 9 groupings related to hand washing surfaced which connected students washing hands with the use of soap and water in connection with 2 significant incidents. These incidents include moments before the students had to eat and moments after using the restroom. Findings of the study indicated that only a percentage of 40.5 of the respondents performed proper hand washing. It was observed that the obtainability or accessibility of clean water and soap being available at hand washing posts were viewed to be substantial predictors of washing hands properly in occasions when adapted with other influences. The results of the study showed that there was a very low occurrence of proper hand washing amongst the elementary students and hence there is a need of more effective hand washing promotions in schools and the need of better services to boost the prevalence on the right way of washing hands among the students (Setyautami et al 2014).
In regard to the information derived from the questionnaire, a high percentage of the students are informed on circumstances where hand hygiene needs to be maintained. Data showed those students who agreed to wash hands prior to eating or dining which is a positive sign of good hand hygiene amongst the students and ought to be maintained. Maintaining good hand hygiene after eating is also essential but it most depends if the student’s hands, during eating or dining, came in contact with any food or fluids. Students are also advised to maintain their hand hygiene after covering their mouths when coughing. Circumstances where students cover their nose when sneezing require the individual to wash hands immediately, if possible, to avoid being a mode of spread of infection. Students are advised to stay home when ill. Instances and certain situations also tend to be barriers and or levers to the maintaining or performance of proper and effective hand hygiene. These barriers or levers include environmental factors, social/cultural factors, knowledge or skills of students, aftermath consequences, student’s study profession, individual motivation towards hand hygiene, student’s attitude, and memory lapses. These levers or barriers also have an effect on respiratory hygiene in situations where students are ill with a cough or flu. The fundamentals of respiratory hygiene comprise protecting or covering ones mouth or nose by the use of a tissue paper or handkerchief when coughing or sneezing. Also the bending of the elbow into a crook could be improvised to hold back respiratory droplets from contaminating surrounding surfaces (DHS 2016).
Furthermore, tissue papers used in holding respiratory droplets or secretions must be discarded into any close by waste bin immediately after use. It is important to also maintain hand hygiene by washing hands with non-antimicrobial soap and water, using alcohol hand rub, or performing an antiseptic hand wash as soon as hands come in contact with items or surfaces contaminated with respiratory droplets or secretions. Surfaces visible with respiratory secretions should be cleaned with tissue. Alcohol based disinfectants should then be used in cleaning the surfaces after it has been wiped with the tissue (DHS 2016).
There has to be more information and education on the modes and ways microbes are spread and how effective proper washing of hands is in preventing the spread of infections like flu, cold, noro-virus, hepatitis A, viral meningitis and others. Students need to be informed on the minimal time required for alcohol-based hand rub to kill most germs on the hands after use. This information would aid students in the proper application of alcohol based hand rub. Applying and maintaining alcohol hand rub on hands for at least 20 seconds after application is necessary to fully kill any existing germs and transferred infection. Students also need to be informed on the importance of washing and drying between the fingers when washing hands since it is essential for getting rid of moist areas where microbes can hide. Using the same paper for drying of hands after washing to close the tap should be one of the in-formation stressed on for students in the prevention of spread of microbes. Infections or bacteria that cause illness could be spread through several means and ways. There are 5 common ways in which bacteria that cause infection can be spread. Infections can be spread through intestinal action or through faeces. This is common in cases such as a student having diarrhoea or Hepatitis A. The second most common is by the respiratory tract. This is usually accompanied with lungs, nose, eyes, and mouth secretion most commonly in disease cases such as common cold or influenza. The third common way is through direct or indirect contact. This occurs in a situation where there is skin contact, coming in contact with infected body fluids, or through sexual contact. This is most common in in-stances where the infected individual is suffering from bacterial skin infections like scabies, or impeti-go. Indirect contact involves the contracting of infection by means of coming in contact which inani-mate object infected with the bacteria. These inanimate objects may include pencils, handkerchiefs, cutleries, door knobs, tables, chairs and other surfaces that have been contaminated by infections such as the influenza virus and the common cold. The forth way of being infected is by coming in contact with contaminated blood with illness such as HIV AIDS, Hepatitis B, and Hepatitis C. The fifth is by eating or swallowing contaminated food or water in cases of food poisoning (PHMCDG 2014).
Hand washing may seem to be an easy task but certain measures are essential to follow in order to decrease the amount of microbes on hands in preventing infection. The steps necessary to be followed includes first to take away any rings or bracelets from the wrist or fingers and wet the hands with water. Then soap is added and all folds and surfaces of the hands including the back of the hand nails must be lathered and cleaned with the soap for not less than 15 seconds. The hands are then rinsed under flowing water in a rubbing movement. Once all visible foam or slippery soapy feeling on the hands is off, dry hands gently to prevent breaking the skin with paper towel or any clean towel. The tap is then turned off using the paper towel to prevent recontamination of your fingers after wash. In cases where public restrooms are used the paper towel can be used to open the door on your way out after washing hands (Health Canada 2014).
Further studies can be done on researching on which group of students in the school require more education and knowledge on these hand hygiene facts in respect to study courses. This could help narrow down and bring more light on which campus, department or bachelor degree students require further education and motivation in maintaining hand hygiene.
RECOMMENDATIONS
Based on the findings of the study, the following recommendations are made
- The awareness of hand hygiene as a means of disease prevention and other benefits should be made known to students, via seminars, conferences, workshops; sharing of informative materials etc. This is to help make the necessary information available to the students.
- Health related information should be made compulsory for students on campus to enable a better living and learning environment.
- Students should be properly informed and encouraged to make use of certain health materials such as hand sanitizers, hand towels, tissues etc. for better hand hygiene. This should be accompanied by provision of the necessary materials by the school authorities sufficiently for the students use.
REFERENCES
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