Assessment of Compliance Level of Healthcare Personnel at AVBRH to Appropriate Hand Hygiene Practices: A Study Protocol

Background: In COVID scenario World Health Organization (WHO) recommends washing hands with water and soap or alcohol-based hand rubs for cleaning hands. Hand hygiene has been considered a central component in every program related to infection control. It is applicable to healthcare personnel handling critical patients as well. Poor hand hygiene during intrapartum and newborn care is associated with increased death rates among newborns due to sepsis. This study aims to assess the knowledge, attitude, and practices of handwashing by healthcare staff in the hospital. Methodology: This is an observational study which is conducted among the healthcare personnel at AVBRH hospital, Wardha. A tool consisting of a self-administered observation record form on knowledge and practices of handwashing will be used for data collection from 60 healthcare workers. Data will be analyzed using appropriate statistical tests. Expected Results: Appropriate levels of knowledge and practices about proper hand hygiene are Study Protocol Ramteke et al.; JPRI, 33(60B): 3386-3393, 2021; Article no.JPRI.80850 3387 expected within healthcare workers of AVBRH. Availability of alcohol-based hand rubs, sanitizers, soap and water is expected at all times. Conclusion: Considering the pandemic situation, the availability and use of hand sanitizers can be effective to limit the spread of infections COVID -19.


INTRODUCTION
The WHO has recommended a streamline or a piece of advice for hand hygiene and its bottom line is to wash hands by using soap and water while it seems dirty or involving blood sanguineous or other body fluids or after the lavatory. Since, the guidelines of WHO suggested washing hands with water and soap or one can be used alcohol -based hand rubs for handwashing. Hand hygiene has been considered as a foundation or central component or main ingredient in every program related to infection control which is held by any of the healthcare personnel who are the supporters of a cause of infection in critical patients through their hands. WHO introduced "Five methods for Hand Hygiene" to reduce the problems concerned with hand washing. According, to the recommendation of WHO, the time duration required for the proper cleaning and removal of transient flora should be extended up to 15 -20 seconds. Due to poor hand hygiene among the HCWs, there is the major cause of spreading of Nosocomial infection which leads to the increase in morbidity and mortality within the hospitalized patients. Our developing countries lead a high prevalence of infection by 19% which is a challenge for healthcare personnel. Washing hands cleanly and neatly is effectively the simplest method to prevent 50% of infection.
Hand hygiene has been considered as the treating interference that will cause the crosstransmission of pathogens in a healthy healthcare environment and hence, Hand hygiene according, to WHO has been proven to decrease the occurrence of Nosocomial infections. Relevant hand hygiene practices have shown the reduction rates of all infections such as gastrointestinal, respiratory tract and skin infections. In today's modern period, WHO has included the implementation of alcohol-based lotions or rubs. The highest rate of infection is found in the ICU, which is the place where very critically ill patients are placed, in such critical care areas chances of infections are majorly by touching the non-movable objects which may directly lead to object contamination. The WHO has put forward an application of the evidencebased practice of hand hygiene which is referred to as "fivemethods of hand hygiene". These five moments of hand hygiene is regarding the washing of hands before performing any aseptic procedure, after the condition of being laid open to undesirable body fluids or touching a patient or its surrounding. But from another point of view, regular hand hygiene may be challenging to the health care workers (HCWs) who lead hand dermatitis because of water, detergents and disinfectants. Now when we perform this handwashing method so it includes after doing some daily activities such as after arrival at workplaces it could be anything, after removal of gloves or socks, etc, before taking meals, after excretion of any sort of body wastes urination and defecation, after coming in contact with the contaminated equipment [1]. Most of the healthcare associated infections are transmitted via healthcare workers. This is because most of the pathogenic organisms stay on the body for maximum 60 minutes [1]. WHO has recommended the five steps moments of hand hygiene which should be performed by all healthcare workers before coming in contact with the patient or performing aseptic procedures, after dealing with the highrisk body fluid procedure, etc [1]. Sometimes in many hospitals, many of the healthcare workers had bad practices of hand hygiene, as they do not wash their hands cleanly and sometimes not at all [2]. Washing hands daily for an effective measure so as to prevent the infection. In hospital's major transmission or spread of infection is mainly among the front line survivor's that is healthcare worker's [3,4]. To avoid or prevent the spreading of infection among health care workers (HCWs) they have to apply alcoholbased hand sanitizers, or other antiseptic agents [4]. The whole world is fighting with a novel coronavirus pandemic since 2019, so as the duty of healthcare worker's they can't avoid coming in contact with CoV 19 positive patients. Hence, hand hygiene is very much important for HCW [4]. The whole world is fighting with the novel coronavirus pandemic since 2019. Novel coronavirus is the type of SARS-CoV-2 hence also known as COVID-19 or CoV-19. The emergence of the novel coronavirus CoV-19 has a major challenge for the public all around the world [5].
Reducing the transmission of this pandemic COVID-19 is only by the simplest method ie., hand hygiene and this is very effective among the public [5]. The origin of the novel coronavirus which is the main cause of the current pandemic named COVID-19 is in Wuhan, China [6][7][8][9]. This infection has started in December 2019, and now the spread has reached to 113 countries [7]. SARS-CoV-2 or COVID -19 is mostly present in Human's this does not infect any animals. This disease shows some symptoms such as fever, cough, and dyspnea [7]. Just like Severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS -CoV), these SARS -CoV -2/ COVID-19 also transmitted from person to person through respiratory droplets during sneezing and also by close contact [7]. In the healthcare sector the infection is caused due to insufficient hand hygiene which is directly linked with the mortality rate, the economical burden also the patients suffer a lot [10]. Emergency Medical Service (EMS) is a highly rated contaminated department where any type of patient arrives from different surrounding and are thus a high-risk way of spreading microbial transmission. In EMS, hand hygiene practices are rarely been studied since, as we all know that this is a proven infection control intervention [10]. Healthcare-associated infections have many reasons lacking for the compliance of hand washing practices. This may include lacking required proper equipment, ratios of staff with patients which is very low, also some of them may have an allergic infection from hand washing products, incomplete knowledge of some staff regarding the risks behind the infection and procedures, regarding bio-safety some of them shows a very casual attitude towards infection control and doesn't even value time [11]. In some sectors, the main focus was given on the compliance or bad attitude of healthcare workers towards hygiene, so many studies were also done for the barriers but instead, they are lacking with the knowledge and attention-related with the pediatric settings regarding hand hygiene compliance [12]. As we all know small children are generally affected by infections and caused harmful diseases therefore, it is very much essential to give focus on such settings in hospitals. In the case of nursing education, compliance with hand hygiene is one of the most difficult tasks of outcomes [13]. It is somewhat difficult to ensure nursing students recognize the use of hand hygiene when, where, what and how in increasing rates of healthcareassociated infections [13]. Patient safety is the first most priority for any healthcare system and the most effective measure regarding hand hygiene [14]. And for this, it is very much important to know that the healthcare staff has proper knowledge about the technique and awareness about infection [14]. Otherwise, if the health staff itself doesn't have proper information then this can lead to a major increase in the compliance related to the nosocomial infection [14]. The only aim here was to analyze the effect of different methods, training related to hand hygiene and education among nursing staff to ensure whether they maintained proper awareness over time [14]. Chances of having transmission of microbial vector's such as Staphylococcus aureus and other common respiratory infections occurs mainly through facetouching behavior [15]. Most of the people had bad habits of not covering their face by using clothes before going outside. They may reach in hospital after coming from surrounding's with any type of microbial vector stuck on their face and these personnel's may come directly in contact with patients or vice versa [15]. Hand hygiene is globally a critical infection prevention or infection control practice all over the healthcare sector [16]. There are many approaches that come forward to monitor hand hygiene compliance varying from a simple methods such as observational methods or using different products to taking examples of advanced methods such as automated electronic monitoring system method. Current approach supports the multimodal supplemented by educating towards enhancement of hand hygiene performance [16]. The practice of having hand hygiene at right time is a very much effective major for the prevention of healthcare-associated infections. This can be easily undertaken by any of the healthcare professionals [17]. But in case of changing the behavior of staff requires a multifaceted approach to ensure the appropriate practice of hand hygiene. This article gives main highlights on two important aspects ie., the need for hand hygiene, when it is to be needed, and how it is to be done [17]. To convince the user's we only need to educate them and pay their attention to the importance of hand hygiene, give the evidence in reducing bacterial flora which is mostly present on the palms of both hands [18].
The present study was done in a rural hospital so as to demonstrate the presence of bacterial flora. In order to reduce the outcome of floral bacteria present on the hands. It is very important to give emphasis on teaching the healthcare workers the technique of using alcohol-based hand rub in different ways [18]. Professionals were lacking with the congruence in hand hygiene training for infection prevention and control ie., IPC. Therefore, we need to give emphasis on the approach to train the professionals using the concept of. "Train-the-Trainers"(TTT) especially for the Infection-prevention and control personnel and observe the impact on hand hygiene knowledge [19]. As we know, Hand Hygiene is an essential factor for the safety of patients, for quality care, this creates major challenges for the healthcare personnel [20]. To overcome this major challenge, especially nursing staff has the proper knowledge about hand hygiene as they stay more in contact with the patients [20]. It is very effective to provide the healthcare workers with feedback related to their daily practices of hand hygiene, to monitor the compliance of hand hygiene to improve the multidisciplinary program [21]. Product using or consumption is less time-consuming and is very much helpful in monitoring and collecting information about the frequency of hand hygiene and this information can be use as feedback for the healthcare personnel [21]. To decrease the level of pathogen transmission and nosocomial infections hand hygiene play a very important role in every healthcare facilities. However, most of the interventions have not been sustainable [22]. The given review gives an overview in the community regarding hand hygiene which includes some aspects such as hand drying, and some issues related to hand hygiene behavior [23,24]. Hand hygiene play's a role of barrier between the transmission of microbial infection both in community and healthcare sector. As of now currently we all, the whole world are dealing with the novel coronavirus, but now it is very much in control of spreading and this is only due to proper hand sanitization and covering our face with a mask. The transmission of infection is under control now. The pandemic outbreak can be achieved by self-isolation, maintaining social distancing, good hand hygiene and strictly follow up for infection control tools both in hospital premises and in public areas [25]. To achieve success on Pandemic outbreak, one needs to use formulated effective hand sanitizers agents such as water, soaps, sanitizer liquids, waterbased or alcohol-based hand sanitizer, antimicrobial soaps such that, and now at present each and every hospital are widely using these effective hand sanitizers [25]. Related evidences are reflected from GBD studies [26][27][28][29][30]. Source of Data Collection: Data will be collected by using observation recorded form.

EXPECTED OUTCOMES
This observational study will be done at Acharya Vinoba Bhave Rural Hospital, Wardha to assess the level of compliance of healthcare personnel to appropriate hand hygiene practices. To analyze the drift or direction of hand hygiene practices for 2 months. The study will be done on 60 healthcare worker's and the main focus will be given to nursing staff as they are in close contact with the patients. We had done this study so as to get good results about proper hand hygiene within HCW to reduce the rate of transmission. We expect at least 50% of the participants have a good knowledge of hand hygiene practices.

DISCUSSION
WHO recommended five-moment alcohol-based hand rubbing formula which has much better antimicrobial properties. The commonly used cleaning agents among the HCW were soap and water. Most of the HCWs had the training on handwashing, from multiple sources. Many of the doctors who directly came in contact with the patients had more training on handwashing than other HCWs. Having knowledge of hand sanitization is important because basic hand hygiene is very much important in preventing transmission of infection among patients and health workers. Some constraints may be observed among them such as lack of water and soap and knowledge of how to wash hands. For drying hands after washing most preferable method is drying in free air. Hand washing can help the people from the bacterial infection or diseases that can cause by viruses, bacteria's etc. This only protect people from transmission with direct physical contact. But this does not mean that all the germs all over the body have been killed. And the illness caused by bacteria or viruses or any type of germs can be very serious. Diseases like Diarrhea respiratory infection and many more can be preventable by simply washing our hands daily. Unwashed hands can transfer many infections from one person to another person by touching their hands to objects such as handrails, surfaces of tables, toys of small children. Most of skin and eye infections can be prevented only by hand washing. Few of the related studies were reported. Khanam et al. assessed knowledge, attitude and practice on the uses of plastic products, their disposal [31]. Khandelwal et al. assessed knowledge of Hepatitis B virus infection and its control practices among dental students [32]. Similar study about Dengue was reported by Meshram et al. [33]. Pasari

CONCLUSION
Considering the pandemic situation, the availability and use of hand sanitizers can be effective to limit the spread of infections COVID -19.

CONSENT
As per international standard or university standard, respondents' written consent will be been collected and preserved by the author(s).

ETHICAL APPROVAL
It is not applicable.