Protocol

1. Title of the project: Exploring the Hand hygiene practice among care givers in outpatient pediatric department of a tertiary care teaching hospital.

2. Type of Study: Cross-sectional study.

3. Aims & objectives:

AIM: To explore hand hygiene practices and to assess health literacy among caregivers of the pediatric population.

OBJECTIVE:

1.     To explore the knowledge of hand hygiene practice among caregivers of the pediatric population visiting healthcare facilities for vaccination.

2.     To study the attitude and practice towards hand hygiene practice among caregivers of the pediatric population.

3.     To study the effect of health literacy level on hand hygiene practice in caregivers of the pediatric population.

4. Justification for study (whether of national significance with rationale):

Hand hygiene refers to any action of cleansing hands. Hand hygiene is critical among caregivers, as contaminated hands are the most common source of illness or disease transmission. Proper hand hygiene limits germ proliferation, lowers infection risk, and reduces healthcare expenses, hospital stays, and reimbursement. According to the CDC, hand hygiene is the most important technique for preventing disease transmission in hospitals. The WHO emphasizes hand washing as the most effective step in stopping the disease cycle. It removes visible soiling and reduces microbial colonization of the skin. Hand hygiene practices are especially important among pediatric caregivers for various reasons. India’s diverse population makes it susceptible to various infectious diseases, especially among children with undeveloped immune systems. Regular hand hygiene, including soap and water handwashing or alcohol-based sanitizers, can reduce disease transmission and prevent disease. This reduces child mortality, helps in the control of disease outbreaks, protects vulnerable children, and enhances medical resources. Handwashing is the most effective and simple method for preventing infection spread in hospitals, minimizing pathogen transmission, and preventing hospital-acquired infections (HAIs). Research aims to identify factors that support or hinder effective hand hygiene practice among caregivers of pediatric populations visiting healthcare facilities for vaccination. Understanding the opportunities and barriers to practice hand hygiene during vaccination visits can help identify potential transmission routes and improve overall infection control strategies.

The study highlights attitudes and practice towards that impact hand hygiene practices among pediatric caregivers. This knowledge can influence compliance and help develop educational programs, resources, and campaigns that address specific cultural practices. Understanding these variations and implementing necessary interventions can promote and sustain proper hand hygiene practices, leading to reduced infection rates and improved healthcare outcomes for pediatric patients. Health literacy is crucial in providing healthcare to children, as it influences caregivers’ understanding and implementation of healthcare advice, particularly hand hygiene standards.

Low health literacy levels in caregivers may hinder their understanding of hand hygiene’s impact on pediatric patients’ health. Accessible, simple education programs are needed to improve hand hygiene practices. Digital health literacy, an extension of health literacy, uses technology to enhance health literacy, behavior change, and improve caregivers’ hand hygiene practices. COVID-19 has prompted the demand for evidence-based digital health interventions for families with children with health issues, enhancing health knowledge and behavior.

5. Departments involved:

Department of Pediatrics, Kasturba Hospital, Manipal.

6. Study period: 6 Months (September 2023 to February 2024).

7. Sample size:

Time-bound

8. Materials and methods:   

a) Inclusion and exclusion criteria:

Inclusion criteria:

1.     All the caregivers of the pediatric population visit a healthcare facility for vaccination.

2.     Caregivers of the pediatric population under the age of 5.

3.     Study will be conducted on the outpatient caregivers visiting the healthcare facility.

4.     Participants willing to participate in the study who have signed the consent form.

Exclusion criteria:

1.     Unwilling participants who have not signed the consent form.

2. Individuals who don’t provide direct care to patients.

b) Biological materials required (type - blood, tissue, etc.,. and quantity): Nil

            c) Statistical methods: Descriptive Statistics like mean and ±SD will be used for continuous variables. For categorical variables, frequency and proportion will be used. Graphical and pictorial tools like Pie charts and bar graphs will be used to project hand hygiene practice levels among caregivers. Inferential Statistical tools like confidence intervals are used for analysis.

            d) Tools used: Predesigned questionnaire, which was previously used for a similar kind of study will be used. We have email permission from the author to reuse the same questionnaire and use it by translating it into the Indian local language.

9. Detailed description of procedure/processes:

It will be a cross-sectional study design that includes a questionnaire. Permission to use the questionnaire has been obtained, one author is the guide of the current study, and the second author’s permission is attached. The questionnaire is translated into Kannada language through the forward-backward-forward translation method. The English questionnaire will be translated back into English by another bilingual expert. The modified version of the English questionnaire will be sent to the original author for comments and suggestions. The Kannada version will be validated by experts. The modified and validated versions of the English and Kannada questionnaires will be used in the study. The participants’ information sheets outlining the objectives and methodology of the study will be given to the participants. Written informed consent will be obtained for the participants in the study. The participants will be requested to fill out the self-administered tool, which will take 10-12mins. The contents of the questionnaire will be explained to the participants in case of need. The data will be analyzed, evaluated, and managed in the Excel sheet. Each participant will be given a separate code, and the confidentiality of the participants will be strictly maintained. Based on the study’s findings, recommendations based on evidence and guidelines for increasing hand hygiene practices among caregivers in pediatric wards will be suggested.

10. Outcome measures: Data will be obtained through the questionnaire and interview related to hand hygiene practice, and the effect of health literacy level on hand hygiene practice among the caregivers of the pediatric population can be assessed.

11. Potential risks and benefits:

Risk: Minor increase over minimal risk.

Benefit: The study will offer facts concerning hand hygiene practices, attitudes, and the influence of health literacy level on hand hygiene practice among pediatric caregivers.

12. Ethical considerations and methods to address issues:

The study protocol will be submitted for approval to the Institutional Ethics Committee (IEC).

The study’s participants’ confidentiality will be rigorously respected.

13. Budget (give details) and proposed funding source: Self-funded.

14. Review of the literature (within 1000 words):

Hand hygiene refers to the action of cleansing hands. Hand hygiene in health care facilities refers to both hand washing and the use of hand sanitizers such as alcohol-based hand rub. Hand hygiene is one of the most important measures to prevent the spread of many infectious diseases. The COVID-19 pandemic has bought great attention to hand hygiene in controlling diseases and has created a unique opportunity to position it as an important public policy issue. Hand hygiene is a highly cost-effective investment, providing outsized health benefits for relatively little cost. Likewise, hand hygiene practice among the carers in the pediatric population is also very important. When a child is hospitalized, parents play a great role in providing care for them through proper hand hygiene practices (1).

A cross-sectional study on hand hygiene practice and training gaps in a neonatal intensive care unit in coastal Karnataka was conducted(2). Observations of 2000 opportunities for hand washing and a written interview of 40 healthcare workers were carried out for six months, from July 2017 to January 2018. The study identified gaps in training adherence to the steps needed to be followed, opportunities missed for hand hygiene practice, and the maintenance of the stipulated time for each step by healthcare providers. The questionnaire on five moments of hand hygiene was prepared, and content and face validation were done. The study finds that hand hygiene practices are as low as 0% observed while performing an invasive activity. There is a gap in the duration of hand-washing practices and hand hygiene before and after any care activity is performed on the neonate. This gap resulted in the spread of healthcare-associated infections. Thus, the study concludes that during infection control training, emphasis should also be given to the opportunities and hands-on practices of hand hygiene.

A composite scale study on measuring maternal health literacy in adolescents attending antenatal care in Uganda was conducted. (3) The purpose of this article is to test the requirement of "local independence" in the newly developed "Maternal Health Literacy" (MaHeLi) composite scale measuring health literacy in pregnant adolescents attending antenatal care. Researchers used a composite scale to measure maternal health literacy; interviews and surveys were conducted to gather data. They used a 20-item scale that was administered to 384 adolescents aged 15–19 attending antenatal care in Uganda from July through December 2013. The MaHeLi scale, developed in this study, consists of 20 polytomous items with six response categories. Seven items cover health-seeking behavior (HSB), six cover competence and coping skills (CCS), and seven cover appraisal of health information (AHS). The scale is conceptually balanced, with different aspects equally weighted throughout. Results showed that differential item functioning was observed for three items. One item had disordered response categories. One subscale brought substantial multidimensionality to the MaHeLi scale. Thus, results support the use of a 12-item version of the MaHeLi scale. The article also shows how Rasch’s analyses help us identify violations of local independence in scales.

A descriptive study on patient, family, and visitor hand hygiene knowledge, attitudes, and practices at pediatric and maternity hospitals was carried out (4). in the year 2021. The purpose of the study was to evaluate patient, family, and visitor hand hygiene knowledge, attitudes, and practices in a pediatric and maternity hospital in Vancouver, British Columbia, Canada. Surveys based on the theoretical domain framework were provided to patients, relatives, and visitors to collect cross-sectional qualitative and quantitative data. This was augmented with covert observations by qualified medical students to determine patient, family, and visitor hand hygiene rates. The study found that hand washing with soap and water was preferred over alcohol-based hand massage by 348 survey respondents. The major motivator for hand cleanliness was fear of the repercussions. Self-reported rates of hand hygiene were higher than actual rates. The total rate of hand hygiene was 10.3% (72/701), with soap and water being used for 75% of hand hygiene events. As a result, it was determined that there are misunderstandings about hand hygiene practices as well as poor hand hygiene rates among patients, families, and visitors. Interventions to enhance hand hygiene should focus on addressing misunderstandings and underscoring the implications of not performing hand hygiene in the health care context.

15. References