Original Investigation
Public Health
June 13, 2024
Hand Hygiene Education Components Among First-Year Nursing Students: A Cluster Randomized Clinical Trial
Jing Chen, Lin Yang, Yim-Wah Mak, et al
JAMA Netw Open. 2024;7(6):e2413835.
doi:10.1001/jamanetworkopen.2024.13835
Question Which components of an educational program featuring a handwashing instructional video and hand scan images are effective at increasing the level of decontamination after handwashing among nursing students?
Findings This cluster randomized clinical trial involved 270 first-year nursing students and found that all groups, including the control group, had significantly less fluorescence residue on hands after the intervention. The groups that had access to the instructional video showed a significant improvement in handwashing performance in terms of the percentage of correctly performed handwashing steps compared with the control group.
Meaning In this study, a program that included an instructional video did not improve the amount of contaminants removed.
Abstract
Importance Few studies have directly and objectively measured the individual and combined effects of multifaceted hand hygiene education programs.
Objective To evaluate the individual and combined immediate effects of an instructional video and hand scan images on handwashing quality, decontamination, and knowledge improvement.
Design, Setting, and Participants This cluster randomized clinical trial was conducted in June to July 2023 among first-year nursing students at a university in Hong Kong. The study used an intention-to-treat analysis.
Intervention Hand hygiene education sessions featuring an instructional video, hand scan images, or both.
Main Outcomes and Measures The primary outcome was the change in residue from fluorescent lotion remaining on participants’ hands after handwashing before and after the intervention. The secondary outcomes included handwashing quality and knowledge of hand hygiene.
Results A total of 270 of 280 students (mean [SD] age, 19 [1] years; 182 [67.4%] female) participated in the trial (96.4% participation rate). Participants were randomized to a control group (66 participants), hand scan image group (68 participants), instructional video group (67 participants), and hand scan image with instructional video group (69 participants). All intervention groups had greater reductions in residue after the intervention compared with the control group, although none reached statistical significance (hand scan image group: 3.9 [95% CI, 2.0-5.8] percentage points; instructional video group: 4.8 [95% CI, 2.9-6.7] percentage points; hand scan image with instructional video: 3.5 [95% CI, 1.6-5.4] percentage points; control group: 3.2 [95% CI, 1.3-5.2] percentage points). The instructional video group showed a significant improvement in their handwashing performance, with a higher percentage of participants correctly performing all 7 steps compared with the control group (22.4% [95% CI, 13.1% to 31.6%] vs 1.5% [−7.9% to 10.9%]; P < .001). Hand scan images revealed that wrists, fingertips, and finger webs were the most commonly ignored areas in handwashing.
Conclusions and Relevance In this cluster randomized clinical trial of an education program for hand hygiene, a handwashing instructional video and hand scan images did not enhance the level of decontamination. The intervention group had improved handwashing techniques compared with the control group, a secondary outcome.
Trial Registration ClinicalTrials.gov Identifier: NCT05872581
