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Evaluation of hand hygiene practices among patients visiting dental college of purvanchal region – A cross-sectional study


1 Unit of Public Health Dentistry, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, India
2 Pedodontics and Preventive Dentistry, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, India
3 Oral Medicine and Radiology, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, India
4 Oral Pathology and Microbiology, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, India

Date of Submission24-Nov-2021
Date of Decision11-Mar-2022
Date of Acceptance29-Mar-2022
Date of Web Publication17-Jun-2022

Correspondence Address:
PG Naveen Kumar,
Department of Public Health Dentistry, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jiaphd.jiaphd_217_21

  Abstract 


Background: Effective hand hygiene is one of the most cost-efficient means of preventing infectious diseases in the community. Studies conducted to assess the hand hygiene practices of the general population in India are relatively limited. The present study was conducted with the aim to assess hand hygiene practices among the participants visiting the outpatient department (OPD) of a dental institute in the Purvanchal region in India. Materials and Methods: This cross-sectional study was conducted on 880 participants visiting the OPD of a dental college in the Purvanchal region. The data were collected using a pretested questionnaire focusing on the hand hygiene practices of the participants. Statistical analysis was done using Chi-square test and the level of significance was set at 5%. Results: Results showed that 98.5% of the respondents used soap/antiseptic liquid soap or hand sanitizer. The frequency of handwashing increased with the improvement in socioeconomic status, with almost 70% of upper-class participants washing their hands daily 5–6 times or more (P = 0.001). A significant association was seen between education and extension of handwashing (P = 0.001). Conclusion: Majority of the population were using soap and water for handwashing which shows that people are aware that proper hand hygiene is necessary to prevent the spread of infectious diseases, especially COVID-19. However, more work is needed to educate people from lower socioeconomic status about good hand hygiene practices.

Keywords: Hand antiseptics, hand disinfectant, hand hygiene, handwashing, infection control



How to cite this URL:
Khairnar MR, Srivastava VK, Kusumakar A, Srivastava A, Agrawal R, Chandra A, Naveen Kumar P G, Akram Z. Evaluation of hand hygiene practices among patients visiting dental college of purvanchal region – A cross-sectional study. J Indian Assoc Public Health Dent [Epub ahead of print] [cited 2022 Aug 12]. Available from: https://www.jiaphd.org/preprintarticle.asp?id=347731




  Introduction Top


Effective hand hygiene is one of the most cost-efficient means of preventing infectious diseases in the community. Regular practice of handwashing at key times such as after using the toilet, before eating, coughing, sneezing, and touching other people's hands can substantially reduce the risk of transmitting infectious diseases such as diarrhea, pneumonia, and influenza which may cause serious illness or even death.[1] It is estimated that handwashing can reduce about 50% of diarrhea-related deaths and can reduce the risk of respiratory infections by around 16%.[1]

The recent novel COVID-19 pandemic has resulted in an improved hand cleansing awareness across the globe.[2],[3] Although people around the world use water for cleaning their hands, very few use soap with water to wash their hands. Washing hands with soap eliminates microorganisms much more efficiently.[4] When soap and water are not available, alcohol-based sanitizers may be used.[5] The COVID-19 pandemic anticipates an evident reminder that handwashing is one of the simplest ways to prevent the spread of any virus and ensure better health outcomes overall. Handwashing with soap can play a key role in preventing or slowing outbreaks.[6]

Studies conducted in India have mainly focused on hand hygiene practices of health-care workers, hospital staff, etc., However, studies conducted to assess the hand hygiene practices of the general population in India are relatively limited.[7],[8],[9] Hence, the present study was conducted with the aim to assess hand hygiene practices among the participants visiting the outpatient department (OPD) of a dental institute in the Purvanchal region in India.


  Materials and Methods Top


Study design

A cross-sectional questionnaire survey was conducted in February 2021 among patients visiting the OPD of a dental college in the Purvanchal region, India. Informed consent was obtained from all the participants before the study. Ethical clearance was obtained from the Institutional Ethical Committee (Ref. No.Dean/2021/EC/2672).

Sample size

Considering the population size of 5000 (number of patients visiting dental college OPD in 1 month), margin of error of 3%, 95% confidence level, and 50% response distribution, the sample size calculated was 880.

Data collection tool

A pretested questionnaire was administered through a print form to all the participants who were willing to take part in the study. The questionnaire was subjected to content validity testing in the form of content validity index: content validity: S-CVI/Ave (scale-level content validity index based on the average method): 0.98; S-CVI/Ave (scale-level content validity index based on proportion relevance): 0.99; and S-CVI/UA (scale-level content validity index based on the universal agreement method): 0.86.[10] The questionnaire was prepared in English and was designed to collect information regarding the sociodemographic characteristics of the participants, key times of washing hands, and their handwashing practices. Key handwashing practices were adapted from guidelines on handwashing given by the Center for Disease Control and Prevention.[3] Each participant was ensured sufficient time to fill the questionnaire and was assisted by interns to fill up the questionnaire. Sociodemographic characteristics included age, gender, education, monthly family income, and number of family members in the family. Socioeconomic status was determined according to the BG Prasad scale (modified for the year 2021).[11]

Statistical analysis

All the data were compiled using Microsoft Excel and analyzed using the SPSS version 23 (IBM Corp., Armonk, NY, USA). Demographic details and handwashing practices were presented using frequency and percentage. Association between hand hygiene practices and demographic variables was tested using Chi-square test. The level of significance was kept at 5%.


  Results Top


A total of 880 valid questionnaires were included in the study. The results showed that the mean age (± standard deviation) of the respondents of the questionnaire was 33.31 (12.37) years. Majority of the study participants were male (64.4%). The majority of the respondents received education of graduate level with 43.8% followed by high school with 35.5%. Most of the study participants belonged to upper-middle class (29.9%) followed by upper class (21%) and middle class (20.7%) [Table 1].
Table 1: Demographic characteristics of study participants

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The results showed that majority of the participants adhered to handwashing using soap and water after performing routine activities such as washing hands before and after meals, after using the washroom, after coming from outside and from work, before preparing meals, after cleaning their home, and touching garbage. Only half of the study participants reported washing their hands regularly after using public transportation and after touching animals and sick people. Around 8.9% of the people reported that they never wash their hands after meals. Even after shaking hands with others, 41.9% of the participants reported that they do not wash their hands. Around 33.9% of the participants never wash their hands after sneezing or coughing [Table 2].
Table 2: Handwashing practices (percentage) covering all routine activities of the household (n=880)

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Results showed that 98.5% of the respondents used soap/antiseptic liquid soap or hand sanitizer and only 1.5% used other handwashing aid such as detergents. Majority of the participants (63.6%) preferred drying their hands with towels. Around 60.5% of the participants reported washing their hands 5–6 times or more, whereas 39.5% washed their hands only 3–4 times/day. Results showed that 55% of the participants washed their hands for 20 s or more. About 11.8% of the participants were found to have nail-biting habits [Table 3].
Table 3: Distribution of handwashing practices followed in households

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No significant association was seen between the type of handwashing aid used and socioeconomic status (P = 0.711). Practice of drying hands with towels showed an increase with improvement in socioeconomic status with almost 75.7% of upper-class people using towels for drying hands after washing (P = 0.001) Lesser frequency of handwashing (3–4 times a day) was reported among 46.3% of lower class and 47.7% of lower upper-class participants. The frequency of handwashing increased with the improvement in socioeconomic status with almost 70% of upper-class participants washing their hands daily 5–6 times or more (P = 0.001) [Table 4].
Table 4: Assessment of association of handwashing practices with socioeconomic status

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There was no significant association seen between the education of the participant with the type of handwashing aid used, hand drying methods, frequency, and duration of handwashing. However, a significant association was seen between education and extension of handwashing (P = 0.001). Extension of washing to fingertips, palms, and in between fingers was reported by only 28.9% of the illiterate participants and the practice was increased till postgraduate participants (61.4%) [Table 5].
Table 5: Assessment of association of handwashing practices with education status

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  Discussion Top


The present study aimed to assess the hand hygiene practices among the participants visiting the OPD of a dental institute in the Purvanchal region in India. A total of 880 individuals participated in the study. Previously, no such kind of study was reported in this study area. Furthermore, studies about the assessment of handwashing practices in the general population are rare. In the present study, 98.5% of the participants were using soap water for hand hygiene. In a similar study conducted by Skolmowska et al., about 93.6% of individuals in the medium cities were using soap water.[12] In studies conducted in pre-COVID setting, by Ashwini et al., 62.5% were using soap and water.[7] In another study conducted by Mane et al. in 2019, 78% of individuals were using soap and water.[9] Another study conducted by Pandve et al. in 2016 showed that 80% of the individuals were using soap and water.[8]

In the present study, 91.6% of respondents always washed their hands with soap water before meal and 68.6% after meal, which is similar to the results (handwashing before and after having food by 92.9%) reported in a study conducted by Ashwini et al.[7] The study conducted by Mane et al. reported a higher percentage of people washing their hands before having food (98,08%) and after having food (98.92%).[9] In the study conducted by Skolmowska et al., 72.2% of respondents in the low COVID-19 morbidity region and 65% of the respondents in the high COVID-19 morbidity region always washed their hands with soap water before meals and 30% of respondents in low COVID-19 morbidity region and 27.1% of the respondents in high COVID-19 morbidity region always washed their hands with soap water after meals.[12] In the present study, 65.8% of the individuals reported regular washing of their hands after coming home from outside. Ashwini et al., in their study, showed that 15.6% of individuals were washing their hands after coming home from outside.[7] In the study by Mane et al., 61.75% of participants were washing their hands after coming home from outside.[9] In the study conducted by Skolmowska et al., 87% of respondents in the low COVID-19 morbidity region and 88.8% of the respondents in the high COVID-19 morbidity region always washed their hands with soap water after coming from outside.[12] Compliance to hand hygiene procedures after doing routine activities such as shaking hands with others, after using public transportation, after touching animals, and before and after touching sick people was poor. Similar results were reported in a study conducted by Mane et al.,[9] only 31.6% of the participants reported regularly washing their hands after sneezing or coughing which shows their negligence toward personal hygiene. Similar results were seen in the study conducted by Skolmowska et al., where participants were seen negligent toward handwashing after activities such as sneezing, coughing, or blowing nose.[12]

In the present study, less than half of the participants (47.8%) considered cleaning their fingertips, palm, and in between finger areas as appropriate and around 60.5% of participants reported washing their hands 5-6–times a day. A study conducted in Hong Kong reported that 76% of the participants stated that they would wash their hands more often during times of infectious disease outbreaks.[13] Around 55% of the participants in the present study reported washing their hands for 20 s or more which was higher than reported in the study conducted in Hong Kong (12.8%). Furthermore, 63.6% of the participants reported drying their hands with towels. In the study conducted in Hong Kong, participants preferred various other methods of hand drying such as rubbing hands on own clothing, air evaporation, use of a towel or disposable tissue, warm hand dryers, etc.[13]

Hand-drying methods and frequency of handwashing were showed significant improvement with improvement in socioeconomic status in the present study. This may be attributed to the fact that people with higher socioeconomic classes have more resources and purchasing capacity and they pursue quality products.[14] In a study conducted by Dobe et al., among adolescents of the rural Indian community, lower per capita income was significantly and negatively associated with adolescent handwashing practices.[15] Another study conducted by To et al. showed that handwashing with soap and water and handwashing behavior improved with improvement in household wealth (P < 0.05).[16] Assessment of handwashing practices showed a significant improvement in the extension of handwashing with education. Previous studies conducted also showed improvement in hand hygiene practice with improvement in educational status.[8],[16]

Strengths and limitations

The study was conducted in the only tertiary dental hospital present in the Purvanchal region and involved participants from every socioeconomic stratum. However, the study included only those participants who visited the OPD of the dental institute, and hence, it cannot be generalized to the whole population. This study was conducted during the COVID-19 times and hence may have resulted in overreporting of the hand hygiene practices by the participants because of the COVID-19 pandemic.


  Conclusion Top


The results of the study indicate that people were aware of the importance of proper hand hygiene to prevent the spread of infectious disease, especially COVID-19. The frequency of handwashing was seen more among the participants with higher education and belonging to higher socioeconomic strata. The study concludes that there is a need for awareness, encouragement, and reinforcement, especially for the people belonging to lower socioeconomic strata and educational backgrounds for the importance of proper hand hygiene in the prevention of any infectious disease.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Centre for Disease Control and Prevention. Hygiene Fast Facts. Information on Water-Related Hygiene. Availablefrom: https://www.cdc.gov/healthywater/hygiene/fast_facts.html#:~:text=Appropriate%20hand%20washing%20practices%20can,respiratory%20infections%20by%2016%25%204. [Last accessed on 2021 May 01].  Back to cited text no. 1
    
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Centre for Disease Control and Prevention. When and How to Wash your Hands. Available from: https://www.cdc.gov/handwashing/when-how-handwashing.html. [Last accessed on 2021 May 01].  Back to cited text no. 3
    
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Centre for Disease Control and Prevention. Show Me the Science – Why Wash Your Hands? Available fr/why-handwashing.html. [Last accessed on 2021 May 01].  Back to cited text no. 6
    
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Ashwini LH, Balu PS, Javalkar SR. Assessment of hand hygiene practices among rural population in Davangere. Int J Med Sci Public Health 2020;9:128-33.  Back to cited text no. 7
    
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Pandve HT, Chawla PS, Giri PA, Fernandez K, Singru SA. Study of hand washing practices in rural community of Pune, India. Int J Community Med Public Health 2016;3:190-3.  Back to cited text no. 8
    
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Mane D, Alate M, Kakde SV, Patel R. A survey report on hand hygiene practices in Gondi Villagers of Western Maharashtra, India: A statistical approach. J Pharm Sci Res 2019;11:2259-62.  Back to cited text no. 9
    
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Yusoff MS. ABC of content validation and content validity index calculation. Educ Med J 2019;11:49-54.  Back to cited text no. 10
    
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Khairnar M, Naveenkumar PG, Kusumakar A. Updated BG Prasad socioeconomic status classification for the year 2021. J Indian Assoc Public Health Dent 2021;19:154-5.  Back to cited text no. 11
  [Full text]  
12.
Skolmowska D, Głąbska D, Guzek D. Hand hygiene behaviors in a representative sample of polish adolescents in regions stratified by COVID-19 morbidity and by confounding variables (PLACE-19 Study): Is there any association? Pathogens 2020;9:1011.  Back to cited text no. 12
    
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Suen LK, So ZY, Yeung SK, Lo KY, Lam SC. Epidemiological investigation on hand hygiene knowledge and behaviour: A cross-sectional study on gender disparity. BMC Public Health 2019;19:401.  Back to cited text no. 13
    
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Iqbal S, Ismail Z. Buying behavior: Gender and socioeconomic class differences on interpersonal influence susceptibility. Int J Bus Soc Sci 2011;2:55-66.  Back to cited text no. 14
    
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Dobe M, Mandal RN, Jha A. Social determinants of good hand-washing practice (GHP) among adolescents in a rural Indian community. Fam Community Health 2013;36:172-7.  Back to cited text no. 15
    
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To KG, Lee JK, Nam YS, Trinh OT, Van Do D. Hand washing behavior and associated factors in Vietnam based on the Multiple Indicator Cluster Survey, 2010-2011. Glob Health Action 2016;9:29207.  Back to cited text no. 16
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

 
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