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Evaluating the effectiveness of the “Germ-Free Hands” intervention for improving the hand hygiene practices of public health students

Authors Kitsanapun A, Yamarat K

Received 2 February 2019

Accepted for publication 23 May 2019

Published 9 July 2019 Volume 2019:12 Pages 533—541

DOI https://doi.org/10.2147/JMDH.S203825

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Ms Justinn Cochran

Peer reviewer comments 3

Editor who approved publication: Dr Scott Fraser


Apaporn Kitsanapun, Khemika Yamarat

College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand

Purpose: This quasi-experimental study sought to assess the effectiveness of a multidisciplinary intervention called “Germ-Free Hands” to improve the hand hygiene practices of students attending Thailand’s Sirindhorn College of Public Health (SCPH).
Methods: The intervention was developed and implemented at SCPH and incorporated education, training, a workshop, and performance feedback. The intervention targeted behavioral antecedents specified by the Health Belief Model (HBM) and the Theory of Planned Behavior (TPB). Handwashing determinants (knowledge, beliefs, attitudes, subjective norms, perceived behavioral control, and intentions) and hand hygiene behaviors were assessed at baseline, immediately post-intervention, and 3 months post-intervention for the intervention group at (n=60) at the Suphanburi campus of SCPH and a matched control group (n=60) of students at the Ubonratchathani campus. Data analysis included descriptive statistics, independent samples t-tests, two-way measures of analysis of variance, and a generalized estimating equation to compare handwashing practices by self-reports between two groups.
Results: The “Germ-Free Hands” intervention produced significant improvements in the intervention group’s handwashing knowledge, behavioral and control beliefs, subjective norm scores, intentions, and behaviors, as compared to the control group. However, the intervention had no significant impact on normative beliefs, attitudes, or perceived behavioral control. Reported improvements also decreased 3 months post-intervention, and the number of bacterial colonies on students’ hands increased over the course of the study.
Conclusion: This study adds to the evidence that multidisciplinary interventions can be effective at improving handwashing rates. However, education and training must be continuous, rather than delivered as a one-time program, in order to have sustained results. Participants may also require more in-depth instruction in correct handwashing and drying techniques to remove bacteria effectively and prevent recolonization.

Keywords: handwashing, hand hygiene, public health student, Theory of Planned Behavior, Health Belief Model

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