Hand hygiene is recognized as one of the most effective measures to prevent healthcare-associated infections (HAIs), which are a significant cause of morbidity and mortality in healthcare settings. The World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) have emphasized the importance of proper hand washing practices among healthcare workers, including medical students, as a critical component of infection prevention and control programs (1,2). Despite this, adherence to hand washing protocols remains suboptimal in many healthcare institutions, particularly among medical students, who are at a formative stage in their professional development (3).

Medical students are the future frontline workers in healthcare, and their orientation towards hand hygiene is crucial for patient safety. Studies have shown that medical students often possess adequate knowledge about the importance of hand washing, but this knowledge does not always translate into practice (4). Factors contributing to poor compliance include the perception of being too busy, lack of resources, and a belief that hand washing is not always necessary (5). These behaviors not only increase the risk of HAIs but also set a poor precedent for future professional practice.

Understanding the current orientation of medical students towards hand washing practices is essential for designing targeted interventions to improve compliance. This study aims to assess the knowledge, attitudes, and practices (KAP) related to hand washing among medical students at Shri Narayan Medical Institute and Hospital, Saharsa, Bihar, and to identify barriers to proper hand hygiene. By identifying these gaps, the study seeks to contribute to the development of more effective educational strategies and policies that promote hand hygiene among medical students.

Study Design and Setting

This observational cross-sectional study was conducted at Shri Narayan Medical Institute and Hospital, Saharsa, Bihar, from July 2023 to March 2024. The study aimed to assess the knowledge, attitudes, and practices (KAP) related to hand washing among medical students.

Study Population

The study included 252 medical students, with 136 boys and 116 girls, enrolled at Shri Narayan Medical Institute and Hospital. Participants were selected using convenience sampling, ensuring representation across different academic years.

Inclusion and Exclusion Criteria

All medical students who consented to participate and were present during the data collection period were included in the study. Students who were absent or did not provide consent were excluded.

Data Collection

Data were collected using a structured, pre-tested questionnaire designed to assess the KAP regarding hand washing practices. The questionnaire consisted of four sections:

1. Demographic Information: Age, gender, academic year, and other relevant demographic details.
2. Knowledge Assessment: Questions related to the importance of hand washing, steps involved, and the role of hand hygiene in preventing infections.
3. Attitude Assessment: Statements to gauge students' perceptions and attitudes towards hand washing.
4. Practice Assessment: Questions focused on the frequency, technique, and adherence to hand washing practices.

The questionnaire was distributed in person, and participants were given sufficient time to complete it. The responses were collected anonymously to ensure confidentiality.

Statistical Analysis

Data were entered into Microsoft Excel and analyzed using SPSS software version 26.0. Descriptive statistics, such as frequencies and percentages, were used to summarize the data. Chi-square tests were employed to assess the association between demographic factors and hand washing practices. A p-value of less than 0.05 was considered statistically significant.

Demographic Characteristics of the Study Population

A total of 252 medical students participated in the study, consisting of 136 boys (53.9%) and 116 girls (46.1%). The distribution of participants across different academic years is presented in Table 1.

Table 1: Distribution of Participants by Academic Year

Knowledge of Hand Washing Practices

The majority of students (78%) demonstrated good knowledge of hand washing practices. Among them, 80% of boys and 76% of girls had a good understanding of the correct hand washing techniques and the role of hand hygiene in preventing infections. Table 2 shows the distribution of knowledge levels among the participants.

Table 2: Knowledge Levels of Hand Washing Practices

Attitudes Towards Hand Washing

Attitudes towards hand washing were generally positive, with 85% of students acknowledging its importance in preventing HAIs. However, 40% of students felt that they were often too busy to wash their hands as frequently as recommended. There was no significant difference in attitudes between boys and girls.

Hand Washing Practices

While 78% of students had good knowledge, only 62% adhered to proper hand washing practices consistently. Boys had a slightly higher adherence rate (64%) compared to girls (59%). Table 3 details the adherence to hand washing practices among the students.

Table 3: Adherence to Hand Washing Practices

Barriers to Hand Washing

The most commonly reported barriers to proper hand washing were a lack of time (45%), followed by inadequate facilities (20%) and forgetfulness (15%). Table 4 illustrates the reported barriers to hand washing among the participants.

Table 4: Reported Barriers to Hand Washing

Statistical Analysis

A significant association was found between knowledge levels and adherence to hand washing practices (p < 0.05), indicating that students with better knowledge were more likely to adhere to proper hand washing practices.

These findings highlight the need for targeted interventions to bridge the gap between knowledge and practice and to address the barriers that hinder proper hand hygiene among medical students.

This study aimed to assess the knowledge, attitudes, and practices (KAP) regarding hand washing among medical students at Shri Narayan Medical Institute and Hospital, Saharsa, Bihar. The findings reveal a substantial gap between knowledge and practice, with many students demonstrating good knowledge of hand washing but not consistently adhering to proper practices. This discrepancy is consistent with previous studies, which have also reported that knowledge does not always translate into practice among healthcare workers, including medical students (1,2).

The high level of knowledge observed in this study (78%) aligns with findings from other studies conducted in similar settings. For instance, a study conducted in India reported that 80% of medical students had good knowledge of hand hygiene practices (3). However, despite this knowledge, the adherence rate in our study was only 62%, highlighting the persistent challenge of ensuring compliance with hand hygiene protocols. This finding is similar to a study conducted in Saudi Arabia, where only 59% of medical students consistently adhered to hand washing practices, despite high levels of knowledge (4).

Several barriers to proper hand washing were identified in this study, with the most common being a lack of time, inadequate facilities, and forgetfulness. These barriers are frequently cited in the literature as significant obstacles to hand hygiene compliance among healthcare workers. A systematic review by Erasmus et al. identified similar barriers, including workload, understaffing, and the availability of hand hygiene facilities (5). Addressing these barriers is essential to improving hand hygiene practices among medical students.

Interestingly, the study found a slight difference in adherence rates between boys and girls, with boys showing a marginally higher adherence rate. This contrasts with some studies that have reported higher compliance among female healthcare workers, suggesting that gender differences in hand hygiene practices may be context-dependent (6). However, the difference in our study was not statistically significant, indicating that other factors, such as knowledge and attitudes, may play a more crucial role in determining adherence to hand hygiene practices.

The significant association between knowledge levels and adherence to hand washing practices underscores the importance of continuous education and training in hand hygiene. Educational interventions have been shown to improve both knowledge and compliance with hand hygiene practices (7). Therefore, incorporating regular hand hygiene training sessions into the medical curriculum could be an effective strategy to enhance compliance among medical students.

In conclusion, this study highlights the need for targeted interventions to bridge the gap between knowledge and practice in hand hygiene among medical students. Addressing the barriers identified and reinforcing the importance of hand hygiene through education and policy changes are crucial steps in reducing healthcare-associated infections. Future research should focus on evaluating the effectiveness of different interventions in improving hand hygiene compliance in this population.