Healthcare-associated infections pose a continuing threat for mortality and morbidity among hospitalized patients [
Assessment and raising awareness of hygiene standards during undergraduate education may affect the behavior of graduate students upon entering professional life and contribute to the reduction of nosocomial infection rates. Thus, the present study was performed to examine the knowledge on and the adherence to hygiene guidelines among medical students after completion of the third year of medical studies, with special emphasis on gender differences.
An open paper-based questionnaire was distributed among 200 randomly selected medical students at the Medical University of Graz, Austria. This public university runs a six-year medical program. All surveyed students had finished the third year of medical studies including education in the subject of Hygiene and Microbiology. All of them had already had patient contact. Confidentiality was protected by using only anonymized data, and the questionnaire had a cover to mask the questions. The questionnaire consisted of 20 single-choice questions (Table Knowledge of hygiene guidelines regarding the daily clinical routine. Adherence to hygiene guidelines [ Satisfaction with current hygiene education, equipment, and quality standards in the framework of medical education.
Distributed questionnaire. The survey was paper based and only single choice was accepted.
Question | Answer possibilities |
---|---|
How often do you disinfect your hands during a day in the clinical setting? | After every patient contact |
Before and after every patient contact | |
Two-three times/day | |
Never | |
| |
How often do you disinfect the membrane of your stethoscope? | After every patient contact |
Before and after every patient contact | |
Two-three times/day | |
Never | |
| |
How often do you disinfect your hands before or after blood sample collection? | After every patient contact |
Before and after every patient contact | |
I wear gloves | |
Never | |
| |
How often do you wear gloves for blood sample collection? | Always |
Most of the time | |
Never | |
| |
How often do you perform “recapping” of needles? | Always |
Most of the time | |
Never | |
| |
How often do you change your white coat? | Regularly, at least every 1-2 weeks |
Sometimes, about every 1-2 months | |
Only if the white coat is dirty | |
I do not remember | |
| |
How often do you wear your white coat during lunch break in the canteen? | Always |
Most of the time | |
Never | |
| |
Do you leave the operation wing with operation theater clothing? | Yes, always |
Sometimes | |
Only if I go back in foreseeable time | |
No, never | |
| |
Assess your knowledge regarding hygiene guidelines in the OT (school marks) | Excellent |
Good | |
Satisfactory | |
Sufficient | |
Not sufficient | |
| |
How well do you know the hygiene guidelines at your university hospital? | Excellent |
Good | |
Satisfactory | |
Sufficient | |
Not sufficient | |
| |
Have you ever read and understood the hygiene guidelines? | Yes |
No | |
I would like but I do not know where to find them | |
| |
If you know the hygiene guidelines, would you have difficulties to state at least three guidelines? | Yes |
No | |
| |
Would you favor the implementation of an obligatory operation theater license? | Yes |
No | |
This would not solve the fundamental problem since adherence to hygiene guidelines decreases over time | |
| |
Have you ever had a professional introduction to hygiene guidelines? | Yes, in the framework of a lecture or seminar |
Yes, by a doctor in the clinical setting | |
Yes, in the framework of a clinical internship | |
No | |
| |
Do you think that the amount of disinfectant dispensers provided in the hospital is sufficient? | Yes |
No | |
I always have a pocket dispenser with me | |
| |
Do you wear bracelets, rings, or wristwatches in the hospital? | Yes, always |
Most of the time | |
No, never | |
| |
Do you sit on the hospital bed during patient contact? | Yes, always |
Rather often | |
Sometimes | |
Rather seldom | |
No, never | |
| |
Do you shake hands with the patient when greeting each other? | Yes, always |
Rather often | |
Sometimes | |
Rather seldom | |
No, never | |
| |
Do you think that there are sufficient numbers of white coats provided (one at a time) for students at your hospital? | Yes |
2-3 would be better | |
At own disposal would be better | |
| |
Have you ever had patient contact even if you were seriously ill, since you otherwise would not have fulfilled the requirements to take part in an exam? | Yes, repeatedly |
1-2 times during my medical studies so far | |
No, never |
All completed questionnaires without any contradiction (e.g., giving several answers to the same question or failure to complete the questionnaire) were included for evaluation. Completed questionnaires were coded. Descriptive measures were used to assess students' self-rated knowledge on and adherence to hygiene standards and if they were in favor of introducing mandatory quality standards, such as an operation theater license. Using chi-squared test, the above-mentioned variables were examined according to gender differences. The data were analyzed using SPSS 19.0 (SPSS Inc., Chicago, IL).
In the present study, 192 (96%) of 200 medical students returned questionnaires according to the inclusion criteria; 58% of the respondents were females and 42% were males. The mean age of the students was 23.5 years.
Of the respondents, 70% judged their knowledge on hygiene guidelines as “excellent” or “good” and 49% of them reported adherence to hygiene guidelines (Figure
Self-assessment of knowledge and call for improved education. The
Regarding adherence to hygiene guidelines, 57% of the respondents reported that they did not always follow hand disinfection recommendations and 39% did not wear gloves at all when collecting blood samples, while 90% of the students refrained from “recapping” of needles (Figure
Compliance with WHO guidelines. The
Asked about practices with direct patient contact, only 6% of the students did not shake hands when greeting their patients and 42% performed stethoscope disinfection after each patient contact. In contrast, 92% of the respondents judged the disinfectants provided on the wards as sufficient and 73% changed their white coats regularly. However, only 19% judged the number of white coats provided per student as sufficient. According to Wright et al. [
Among all respondents, 74% reported that they had received a professional introduction to hygiene guidelines beyond their subject of Hygiene and Microbiology. This took place either in the framework of a teaching unit or a voluntary internship. Nevertheless, the majority of students (79%) favored the introduction of mandatory quality standards such as an operating theater license. This is in accordance with previous studies [
All variables examined showed no statistical significance between female and male students (
Limitations of our study are as follows. The sample size ( Only 1 higher-education institution was sampled. Self-reported hand hygiene adherence might be higher than adherence observed. The individual number of clinical traineeships completed may affect the level of knowledge positively. The degree of experience in the clinical setting, for example, weeks of internships, was not recorded.
At medical universities, students are usually educated on hygiene-related guidelines only once during their medical education. This may result in serious deficiencies regarding the practical application of those guidelines. The current study showed the following. The majority of the medical students surveyed reported adherence to hygiene-related guidelines in the clinical setting. Most of them judged their hygiene behavior as adequate. Female students showed a better self-assessment regarding the knowledge of and adherence to hygiene guidelines in comparison to their male counterparts. The majority of students demanded for further training and in-depth education on hygiene-related guidelines.
An increased emphasis on hygiene education, behavior, and assessment is needed for future physicians to gain optimal competence and to improve in-hospital patient safety. Ultimately, optimal medical education results in optimal patient care.