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van de Mortel, TF 2010, 'A cross-cultural comparison of health care students' hand hygiene knowledge, beliefs and practices', PhD thesis, Southern Cross University, Lismore, NSW.

Copyright T van de Mortel 2010


Registered nurses’ hand hygiene (HH) compliance is generally higher than that of physicians. This may partially be explained by differences in undergraduate HH education. A HH Questionnaire (HHQ) containing a HH knowledge quiz, Practices Inventory, Beliefs Scale, Importance Scale, and a social desirability scale, was used to examine healthcare students’ HH knowledge, beliefs, practices, and education in Australia, Sweden, Greece and Italy.

The HHQ was completed by 899 nursing and 505 medical students from 18 universities. The scales demonstrated adequate reliability (α = 0.71-0.81). The mean score on the HH quiz was 64.4%. On 5-point Likert scales, students reported positive HH beliefs (3.94/5), and practices (4.58/5), and perceived that HH was considered important in the clinical setting (3.99/5). A third of students did not know the indications for alcohol-based hand gels. Interactive teaching strategies were considered more effective by students than those that were not.

Nursing students’ HH knowledge scores, and scores on the Beliefs and Importance scales were significantly higher (p < .001) than those of medical students. Nursing students were significantly more likely to perceive that HH was considered important in the curriculum, were assessed on HH knowledge and skills more frequently during their degree (x¯ = 7.64 vs 3.69 times), and were more likely to report positive HH practices (p < .001). There were small (r = 0.12–0.15) statistically significant correlations between social desirability scores and scores on the scales. The very high social desirability scores of some students indicated a limited capacity for accurate self-assessment, indicating that students need training in self-assessment.

There was a significant relationship between HH knowledge, the number of teaching strategies used and the number of times HH was assessed during the degree (p = .015). The number of teaching strategies, HH beliefs, frequency of HH assessment, perceptions of the importance of HH in the curriculum and as an infection control measure had a significant influence on students’ HH practices (p < .001). Perceptions of the importance given to HH in the curriculum, by supervisors and facilities, and as an infection control measure influenced students’ scores on the Beliefs scale.

The higher knowledge scores of nursing students, underpinned by the greater emphasis on HH education and assessment in nursing curricula suggests that HH knowledge could be improved through repeated HH education and assessment in undergraduate curricula. Teaching in tutorials and clinical settings may be more effective than methods that don’t involve interaction between students and teachers. The influence of students’ perceptions of the importance placed on HH in their curriculum, and the clinical setting, indicates the importance of good role models in the socialisation of students.

While the HHQ examined students’ HH knowledge, beliefs and practices, it did not determine the quality of the education that students received. As students’ knowledge acquisition can also be influenced by aptitude and education quality, further research is needed to examine these factors.