The impact of hand hygiene knowledge on self-efficacy among Spanish nursing students: a cross-sectional study

Abstract

Background: Hand hygiene (HH) is a good ally to prevent healthcare-associated infections (HAIs). Nevertheless, its incidence continues to concern global bodies such as the World Health Organization (WHO). Nursing student (NS) education will be crucial to reducing HAIs. Objective: The aim of this current study was to establish the level of HH knowledge among Spanish NS in order to identify gaps in their understanding. We also evaluated self-efficacy among NS as a key strategy for infection control (IC). Methods: We conducted a cross-sectional study of 483 NS in their second, third, or fourth years in the Faculty of Nursing at University of Valencia (Spain). Participants were recruited by convenience sampling; we collected their sociodemographic data, information on their level of knowledge regarding HH using a WHO questionnaire, and their self-efficacy in IC using a questionnaire based on the Health Belief Model, previously validated and showing moderate to high reliability (ICC = 0.63). Results: The mean knowledge score was 63.2%, with fourth-year NS achieving significantly higher scores than second-year NS (p < 0.001). The poorest results were those for the WHO “5 Moments for Hand Hygiene” item: only 10.6% identified the need for HH before injections, 19.2% recognized alcohol-based hand rub as more effective than handwashing, and just 21.4% responded correctly regarding HH after patient environment contact. Only 18% correctly identified the main source of pathogens causing HAIs. Self-efficacy scores increased significantly with academic experience (p < 0.001) and correlated positively with HH knowledge. Conclusion: In this single-site study, we found that NS had a moderate knowledge of HH, with those in their third or fourth year scoring better than those in their second year. Self-efficacy in IC might play an important role in preventing HAIs and so it is crucial to enhance the effectiveness of HH among NS to improve clinical competence, student self-confidence, and quality of patient care. These data contribute to a body of knowledge that can help improve the NS training curricula endorsed by international organizations with a view to help prevent HAIs.