Background: Compliance rate of hand hygiene practice by healthcare workers has been observed to be universally low despite its importance, simplicity and cost-effectiveness in preventing the spread of infectious diseases in the healthcare settings. This study aimed to improve healthcare workers’ knowledge, attitudes, and compliance with hand hygiene by using reminder cards displayed by patients.
Method: This before-after interventional study was carried out in 2019 among healthcare workers of a hospital in Tabriz, Iran. The intervention was a ‘Reminder Card’ showed by patients to remind healthcare workers to clean their hands. Participants' knowledge and attitude about hand hygiene and compliance to hand hygiene were assessed before and after the intervention. Descriptive statistics were presented and the inferential statistics were calculated using the paired t-test.
Results: Participants reported moderate knowledge (mean ± SD: 17.47± 3.03; n= 25) and attitude (mean ± SD: 68.65 ±10.99; n= 96) at baseline. We observed improvements following the intervention for knowledge and attitude, respectively (mean ± SD: 21.81 ±1.69; 79.23 ±7.83; P
Conclusion: The use of a ‘Reminder Card’ was shown to improve hand hygiene compliance in this study. Patient participation in prompting staff to clean their hands may assist in achieving hand hygiene compliance among healthcare workers ensuring quality, safe care, and infection prevention in the hospital.
Keywords: Knowledge, attitude, hand hygiene compliance, alcohol-based hand rub, handwashing, patient safety
Chegini Z, Kolawole I, Singh P, Alikhah F, Rasti Y, Motazedi Z.
Improving knowledge, attitude, and compliance of hand hygiene of Iranian healthcare workers: A pilot study using Reminder Card.
J Health Res.
 Palomar M, Alvarez-Lerma F, Riera A, Diaz MT, Torres F, Agra Y, et al. Impact of a national multimodal intervention to prevent catheter-related bloodstream infection in the ICU: the Spanish experience. Crit Care Med 2013;41(10):2364-72. https://doi.org/10.1097/CCM.0b013e3182923622.
 Le CD, Lehman EB, Nguyen TH, Craig TJ. Hand hygiene compliance study at a large central hospital in Vietnam. Int J Environ Res Publ Health 2019;16(4):607. https://doi.org/10.3390/ijerph16040607.
 Ho ML, Seto WH, Wong LC, Wong TY. Effectiveness of multifaceted hand hygiene interventions in long-term care facilities in Hong Kong: a cluster-randomized controlled trial. Infect Control Hosp Epidemiol 2012;33(8):761-7. https://doi.org/10.1086/666740.
 Derksen C, Keller FM, Lippke S. Obstetric Healthcare workers' adherence to hand hygiene recommendations during the COVID-19 Pandemic: observations and socialcognitive determinants. Appl Psychol Health Well Being 2020;12(4):1286-305. https://doi.org/10.1111/aphw.12240.
 World Health Organization [WHO]. Rational use of personal protective equipment for coronavirus disease (COVID-19): interim guidance. Geneva: WHO; 2020.
 Garba M, Uche L. Knowledge, attitude, and practice of hand washing among healthcare workers in a tertiary health facility in northwest Nigeria. J Med Tropics 2019;21(2):73-80. https://doi.org/10.4103/jomt.jomt_16_19.
 Amissah I, Salia S, Craymah J. A study to assess hand hygiene knowledge and practices among health care workers in a teaching hospital in Ghana. Int J Sci Res 2016;5:301-7. https://doi.org/10.21275/art2016631.
 Wetzker W, Bunte-Schonberger K, Walter J, Pilarski G, Gastmeier P, Reichardt C. Compliance with hand hygiene: reference data from the national hand hygiene campaign in Germany. J Hosp Infect 2016;92(4):328-31. https://doi.org/10.1016/j.jhin.2016.01.022.
 Gould DJ, Creedon S, Jeanes A, Drey NS, Chudleigh J, Moralejo D. Impact of observing hand hygiene in practice and research: a methodological reconsideration. J Hosp Infect 2017;95(2):169-74. https://doi.org/10.1016/j.jhin.2016. 08.008.
 Chegini Z, Janati A, Bababie J, Pouraghaei M. The role of patients in the delivery of safe care in hospital: study protocol. J Adv Nurs 2019;75(9):2015-23. https://doi.org/10.1111/jan.14045.
 Chegini Z, Arab-Zozani M, Janati A. Patient and health professional perspectives about engaging patients in addressing patient safety: a systematic review protocol. Open Access Maced J Med Sci 2019;7(9):1561-5. https:// doi.org/10.3889/oamjms.2019.280.
 Chegini Z, Janati A, Babaie J, Pouraghaei M. Exploring the barriers to patient engagement in the delivery of safe care in Iranian hospitals: a qualitative study. Nurs Open 2020;7(1): 457-65. https://doi.org/10.1002/nop2.411.
 World Health Organization [WHO]. WHO guidelines on hand hygiene in health care. Geneva: WHO; 2009.
 Jemal S. Knowledge and practices of hand washing among health professionals in Dubti Referral Hospital, Dubti, Afar, Northeast Ethiopia. Adv Prev Med 2018;2018:5290797. https://doi.org/10.1155/2018/5290797.
 Sharma R, Sharma M, Koushal V. Hand washing compliance among healthcare staff in intensive care unit (ICU) of a multispecialty hospital of North India. J Hosp Adm 2013;1(2): 27-33. https://doi.org/10.5430/jha.v1n2p27.
 Bouwer M, Labuschagne S, Spamer S, Vermaak C, Zietsman LM, Steyn D, et al. Knowledge of final-year medical students at theUniversity of the Free State of hand hygiene as a basic infection control measure. S Afr Fam Pract 2018;60(3): 74-8. https://doi.org/10.1080/20786190.2017.1396789.
 Bhagawati G. Get aware of hand hygiene: implement it in your attitude. J Educ Health Promot 2018;7:21. https://doi.org/10.4103/jehp.jehp_77_17.
 Santosaningsih D, Erikawati D, Santoso S, Noorhamdani N, Ratridewi I, Candradikusuma D, et al. Intervening with healthcare workers' hand hygiene compliance, knowledge, and perception in a limited-resource hospital in Indonesia: a randomized controlled trial study. Antimicrob Resist Infect Control 2017;6:23. https://doi.org/10.1186/s13756-017-0179-y.
 Ango UM, Awosan KJ, Adamu H, Salawu S, Sani MM, Ibrahim AH. Knowledge, attitude and practice of hand hygiene among healthcare providers in Semi-urban Communities of Sokoto State, Nigeria. Int J Trop Dis Health 2017; 26(2):1-9. https://doi.org/10.9734/IJTDH/2017/36599.
 Maheshwari V, Kaore NC, Ramnani VK, Gupta SK, Borle A, Kaushal R. 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):DC04-7. https://doi.org/10.7860/jcdr/2014/ 8510.4696.
 Malliarou M. Hand hygiene of nurses and patient safety. Int J Nurs Clin Pract 2017;4:217. https://doi.org/10.15344/2394-4978/2017/217.