Hand Washing of Nursing Students : An Observational Study

Introduction

After the global COVID-19 pandemic, when infection control became more important, hand hygiene has once again become a key part of patient safety (Moore et al., 2021). Pre-registration nursing students who take part in clinical placements must follow hand hygiene guidelines not only as a requirement, but also as a duty (Gniadek et al., 2021). Since there are more health challenges and antimicrobial resistance in the UK, it is important to use strong educational programmes to encourage people to maintain good hygiene habits for life (Bloomfield and Ackerley, 2023). This report analyses how using evidence-based and behavioural approaches in education can help nursing students comply with hand hygiene and develop an infection prevention culture at the place where care is given.

Importance of Hand Hygiene

Hand hygiene is considered by everyone to be the most important way to avoid Healthcare-Associated Infections (HCAIs) (Cloutman-Green, 2023). Health authorities say that good hand hygiene can decrease the chance of HAIs by 35% to 70% (WHO, 2023). As a result, about 10% of hospital patients in developed countries get HAIs which leads to them staying in the hospital longer, facing extra expenses and thousands of avoidable deaths each year (Rosenthal et al., 2022). Hand washing by healthcare staff helps to get rid of harmful germs which protects patients, staff and the community.

Nursing Students’ Role

Even though they are still learning, nursing students spend a lot of time working with registered nurses in clinical settings. Nurses touch many patients and different surfaces during a shift, so they may easily spread infections. Also, students will become nurses in the future, so it is necessary to teach them good hygiene practises during their training (Liyanage et al., 2021). It has been noted that student nurses are less likely to follow hygiene rules than experienced staff because they do not feel confident enough to address these issues (Livshiz-Riven et al., 2023). Yet, they are more willing to learn which makes them important people to teach about infection control. Making sure students practise and demonstrate good hand hygiene is very important for patient safety during their placements and afterwards.

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Literature Review

Current Compliance

It is consistently shown by research that nursing students do not practise proper hand hygiene. In their scoping review, Sierra et al. (2022) noticed that nursing students’ knowledge and practise of hand hygiene were usually low to moderate. As an example, students could talk about how to stay clean but did not always do it correctly (Gniadek et al., 2021). Avşar et al. (2015) also observed 106 first-year students and found that only 4.7% washed their hands for the right amount of time and half of them washed their hands only once or twice when they should have. The main reason students washed their hands was to protect themselves, not to protect the patients (Adib-Hajbaghery, et al., 2021). It was found in another study that students’ knowledge did not always lead to actual practise (Carless-Kane and Nowell, 2023). All in all, there is a regular difference between understanding the importance of washing and actually doing it well.

Regulatory, Educational and Practice-Based Frameworks

UK healthcare policy and regulation should be used to understand how nursing students follow hand hygiene rules. According to the Nursing and Midwifery Council (NMC) Code from 2018, all nurses and students are required to ensure safety and effective practise which means they must stick to infection prevention protocols (Gallagher et al., 2023). In addition, NHS England and NHS Improvement have advised trusts to use different ways to promote hand hygiene such as training staff, providing hand rubs and carrying out regular cheques (Lizzie, 2021; Greene, 2022). HEE has made standardised hand hygiene modules a part of nursing courses within its Quality Framework for clinical education (HEE, 2021). In 2024, the Council of Deans of Health found that most UK nursing programmes use simulation-based education, but the amount used is not the same, mainly because of a shortage of resources and the skills required. These rules and gaps are useful for learning how educational measures can change nursing students’ compliance.

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Behavioural and Educational Models of Compliance

To explain hand hygiene behaviour among student nurses, it is necessary to use both research data and a theory. Bandura’s Social Learning Theory says that people learn by watching others, copying them and being rewarded for what they do (Rumjaun and Narod, 2025). When mentors and registered nurses regularly wash their hands in the clinical setting, nursing students tend to do the same (Hamed et al., 2024). Ajzen (1991) also suggests that students’ compliance is linked to their knowledge, their feeling of control over hand hygiene and the norms they follow in the ward (Sanya, 2023). The Kirkpatrick Model of Training Evaluation allows for checking the impact of educational interventions on knowledge (Level 2), behaviour (Level 3) and outcomes for patients (Level 4) (Alsalamah and Callinan, 2022). Including these frameworks makes hand hygiene training initiatives in nursing education more effective and easy to review.

Trends and Tensions in Intervention Effectiveness

All the literature agrees that educational interventions can boost hand hygiene compliance among student nurses, but there are important differences when looking at the details of each study. Both Gholizad et al. (2025) and Soboksa et al. (2021) found that compliance increased after the intervention, but only Gholizad’s study included a follow-up period and discovered that after three months, adherence dropped by 20% which might suggest that the behaviour was not reinforced. Meza Sierra et al. (2023) pointed out that using simulations in education helped people keep their knowledge for longer than didactic teaching alone, especially when combined with immediate feedback. At the same time, Avşar et al. (2015) pointed out that knowing something is not enough; practise is still needed. All of these studies agree that effective intervention depends on how deeply it is carried out, how long it lasts and how much it is supported by the environment. Experts agree that using different methods and focusing on behaviours is better than a single session of knowledge sharing, especially when working in clinical placements.

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Observational Study Methodologies

People’s hand hygiene is usually checked by observing them directly. A usual method is the WHO’s “Five Moments for Hand Hygiene,” which involves trained people watching to see if healthcare workers wash their hands at important times (e.g. before contact with patients, after coming into contact with body fluids) (McKay et al., 2022). In student studies, there are many approaches: some researchers use non-participant structured observation, like Avsar, to watch students during clinical work without getting involved. Usually, these observers are people working alongside the staff or trained professionals who use checklists to note hand hygiene actions. To prevent the Hawthorne effect, observers usually do not let people know who is watching and when (Berkhout, et al., 2022). Sometimes, researchers use video cameras or automatic counters, but these are not widely used because they raise privacy and ethics issues. Most of the reviewed observational studies used a cross-sectional approach and were done at a single site which may make it hard to generalise the results.

Educational Interventions and Effectiveness

As students do not often follow the rules at the start, a lot of interventions focus on their education. Some of these are workshops, simulation exercises, multimedia training and feedback systems. To illustrate, Gholizad et al. (2025) offered a 3-hour workshop on WHO hand hygiene, with demonstrations and quizzes; as a result, student compliance improved a lot at all five WHO hand-washing moments. Also, Meza Sierra et al. (2023) discovered that almost all effective interventions focused on education and training. Programmes were available in different formats, from short videos to long courses and they were designed using WHO/CDC guidelines.

Some programmes also use simulation: for example, students apply UV-sensitive lotion or powder to their hands and after washing, the UV lights show any spots that were not cleaned. Feedback is often used such as displaying students’ non-compliance or having other students remind them. It appears that using several approaches at once is the most effective way. Soboksa et al. (2021) mentioned that the best results are achieved by using didactic teaching, scenario-based simulation and regular audits. Most studies indicate that compliance improves a lot after intensive interventions and this change is usually measured right after the interventions.

Critical Appraisal

Even though these findings are positive, there are some issues that should be noted. In many intervention studies, the samples are chosen easily and there are no control groups, so it is possible for biases to increase the results’ effectiveness. Also, most companies cheque if employees follow the rules only right after training; few cheque if the improvements are still there after a few months. Sometimes, studies depend partly on what people say they do, but researchers prefer to watch their actions directly. Observational methods can show actual behaviour, but they may require a lot of resources and can be affected by the observer’s personal views. Since Avsar’s study had peers as observers, it could have lessened bias, but the research was done with only one class at one school. As a result, we should be careful when looking at the findings.

Institutional Barriers: Organisational Inertia and Cultural Conflicts in Practice

Even the best educational programmes can fail because of barriers that exist in the clinical environment. Many nursing students say that senior staff sometimes do not follow hand hygiene rules which makes it seem less important to them. Having to work fast or with fewer colleagues makes it harder for nurses to stick to the rules. When there are no sinks, no sanitiser or no reminders at the point of care, it makes the issue worse. Also, the way teachers are seen in the classroom may stop students from speaking up about infection risks, even if they know about them. Such factors are often seen as the reason for a ‘compliance-performance gap’. If the problems within the organisation are not resolved by frequent staff training, sticking to expectations at all levels and the institution’s commitment to role modelling, educational efforts might only lead to short-term or shallow improvements in student compliance.

Recommendations and Future Research

Based on what we have found, we suggest adding comprehensive hand hygiene education to nursing programmes. You could teach students about microbiology and HCAI in class and then let them practise in workshops and labs. As an illustration, using UV germ-simulation in OSCEs can help students practise the correct way of using UV light (Al-Hashimi et al., 2023). It is important to use audit and feedback during clinical placements: infection control nurses should update students and mentors with the latest compliance data (Thomas, 2023). It is important for institutions to have role models (with supervisors demonstrating proper hygiene) since students are affected by the senior staff.

In the future, it would be helpful to conduct larger studies that follow people over a long period. They would observe cohorts of students to cheque if the training works for a long time or if they need to repeat it later. A randomised controlled trial could provide a better way to test a new gamified app against the usual lecture. In addition, qualitative research could bring out issues that quantitative studies do not notice such as when interviews with nursing students point out practical barriers (e.g. not having sanitizer or having too much work) that affect them (Oyefolu and Gronval, 2025).

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Conclusion

Hand hygiene among nursing students is very important to stop HCAIs. The research shows that education is effective; especially when it is active and practical; but it needs to be reinforced all the time. When nursing programmes use evidence-based training such as workshops, simulations, feedback, and observe their results closely, they can greatly improve future nurses’ hygiene and patient safety.

References

Adib-Hajbaghery, M., Sabery, M., Ghadirzade, Z. and Nematian, F., 2021. Investigation of knowledge, attitudes, and practice of nursing, midwifery, and surgical technology students regarding standard precautions and self-protection in the clinical setting. International Archives of Health Sciences, 8(2), pp.74–78. https://doi.org/10.4103/iahs.iahs_130_20

Al-Hashimi, K., Said, U.N. and Khan, T.N., 2023. Formative objective structured clinical examinations (OSCEs) as an assessment tool in UK undergraduate medical education: a review of its utility. Cureus, 15(5), e38519. https://doi.org/10.7759/cureus.38519

Alsalamah, A. and Callinan, C., 2022. The Kirkpatrick model for training evaluation: bibliometric analysis after 60 years (1959–2020). Industrial and Commercial Training, 54(1), pp.36–63. https://doi.org/10.1108/ICT-12-2020-0115

Avşar, G., Kaşıkcı, M. and Yağcı, N., 2015. Hand washing of nursing students: An observational study. International Journal of Caring Sciences, 8(3), pp.618–624. Available at: https://www.internationaljournalofcaringsciences.org/docs/12_12-Avsar_original_8_3.pdf [Accessed 4 June 2025].

Berkhout, C., Berbra, O., Favre, J., Collins, C., Calafiore, M., Peremans, L. and Van Royen, P., 2022. Defining and evaluating the Hawthorne effect in primary care: A systematic review and meta-analysis. Frontiers in Medicine, 9, Article 1033486. https://doi.org/10.3389/fmed.2022.1033486

Bloomfield, S.F. and Ackerley, L.M., 2023. Developing resilience against the threat of infectious diseases and anti-microbial resistance: Putting targeted hygiene into practice in home and everyday lives. Public Health in Practice, 5, p.100362. https://doi.org/10.1016/j.puhip.2023.100362

Carless-Kane, S. and Nowell, L., 2023. Nursing students learning transfer from classroom to clinical practice: An integrative review. Nurse Education in Practice, 71, p.103731. https://doi.org/10.1016/j.nepr.2023.103731

Cloutman-Green, E., 2023. Infection prevention and control: healthcare-associated infection. In: B.F. Gilmore and S.P. Denyer, eds. Hugo and Russell’s Pharmaceutical Microbiology. 9th ed. Chichester: Wiley-Blackwell, pp.304–320.

Council of Deans of Health and Anglia Ruskin University, 2024. Simulation in Nursing Education: An Evidence Base for the Future. [pdf] Council of Deans of Health. Available at: https://www.councilofdeans.org.uk/wp-content/uploads/2024/01/CoDH-ARU-Simulation-in-Nursing-Education-Report-Jan-2024.pdf [Accessed 4 June 2025].

Gallagher, A., Deering, K. and De Luca, E. eds., 2023. Nursing Practice and Education: Aspiring to Excellence through Seven Pillars of Learning. 1st ed. London: Routledge, Taylor & Francis.

Gholizad, A., Rezaei-Adaryani, M., Dadkhah, B., and Hamedani, Z., 2025. The impact of an educational intervention on hand hygiene compliance among nursing students: A longitudinal quasi-experimental study. BMC Nursing, 24, p.75. https://doi.org/10.1186/s12912-025-03075-z

Gniadek, A., Ogórek-Tęcza, B., Inglot, A., Nowacka, A. and Micek, A., 2021. Hand areas which are commonly missed during hand disinfection by nursing students who completed a basic educational course in hand hygiene. International Journal of Environmental Research and Public Health, 18(5), p.2590. https://doi.org/10.3390/ijerph18052590

Greene, C., 2022. Electronic monitoring systems for hand hygiene in hospitals: Relationship to practice and exploration of clinical perceptions. Doctoral thesis, University of West London. https://doi.org/10.36828/xvqy0504

Hamed, A.M., Moralejo, D., Pike, A. and Curran, V., 2024. Impact of and strategies to address negative role models and adherence of nursing students to standard precautions: An integrative review. Journal of Professional Nursing, 54, pp.92–99. https://doi.org/10.1016/j.profnurs.2024.06.019

Health Education England (HEE), 2021. HEE Quality Framework from 2021. [pdf] Health Education England. Available at: https://nshcs.hee.nhs.uk/wp-content/uploads/2022/02/HEE-Quality-Framework-from-2021.pdf [Accessed 4 June 2025].

Lillekroken, D., Kvalvaag, H.M., Lindeflaten, K., Abrahamsen, J. and Lyberg, A., 2024. Educating the nurses of tomorrow: Exploring first-year nursing students’ reflections on a one-week senior peer-mentor supervised inspiration practice in nursing homes. BMC Nursing, 23, p.132. https://doi.org/10.1186/s12912-024-01768-5

Livshiz-Riven, I., Hurvitz, N., Grinberg, K., Halperin, O., Spitz, A., Itzhaki, M., Grinstein Cohen, O., Blau, A., Ziv-Baran, T., Westbrook, J., Urwin, R., Li, L., Barnoy, S. and Reicher, S., 2023. Nursing students’ experiences of unprofessional behaviours and associations with guideline compliance: A multicenter survey. Nurse Education in Practice, 71, p.103739. https://doi.org/10.1016/j.nepr.2023.103739

Liyanage, G., Dewasurendra, M., Athapathu, A., Jayasinghe, S., Kulatunga, A. and Senanayake, S., 2021. Hand hygiene behavior among Sri Lankan medical students during COVID-19 pandemic. BMC Medical Education, 21, p.333. https://doi.org/10.1186/s12909-021-02783-9

Lizzie, Y.N.S., 2021. Infection prevention and control in the adult critical care unit. In: A. Gallagher, K. Deering and E. De Luca, eds. Nursing Practice and Education: Aspiring to Excellence through Seven Pillars of Learning. London: Routledge, Taylor & Francis.

McKay, K.J., Li, C. and Shaban, R.Z., 2022. Using video-based surveillance for monitoring hand hygiene compliance according to the World Health Organization (WHO) Five Moments framework: A pragmatic trial. Infection Control & Hospital Epidemiology, 43(10), pp.1473–1480. https://doi.org/10.1017/ice.2021.509

Meza Sierra, C.U., Pérez Jaimes, G.A. and Rueda Díaz, L.J., 2023. Interventions to improve knowledge or compliance to hand hygiene in nursing students: A scoping review. Journal of Infection Prevention, 24(1), pp.30–44. https://doi.org/10.1177/17571774221127696

Meza Sierra, C.U., Pérez Jaimes, G.A. and Rueda Díaz, L.J., 2023. Interventions to improve knowledge or compliance to hand hygiene in nursing students: A scoping review. Journal of Infection Prevention, 24(1), pp.30–44. https://doi.org/10.1177/17571774221127696

Moore, L.D., Robbins, G., Quinn, J. and Arbogast, J.W., 2021. The impact of COVID-19 pandemic on hand hygiene performance in hospitals. American Journal of Infection Control, 49(1), pp.30–33. https://doi.org/10.1016/j.ajic.2020.08.021

Oyefolu, O. and Gronvall, G.K., 2025. Exploring challenges and policy considerations in point-of-care testing for hospital preparedness ahead of infectious disease emergencies: A qualitative study. Infection, Disease and Health, 30(2), pp.111–118. https://doi.org/10.1016/j.idh.2024.10.001

Rosenthal, V.D., Yin, R., Lu, Y., Rodrigues, C., Myatra, S.N., Kharbanda, M., Valderrama-Beltran, S.L., Mehta, Y., Daboor, M.A., Todi, S.K., Aguirre-Avalos, G., Guclu, E., Gan, C.S., Jiménez-Alvarez, L.F., Chawla, R., Hlinkova, S., Arjun, R., Agha, H.M., Zuniga-Chavarria, M.A., Davaadagva, N., Mohd Basri, M.N., Gomez, K., Aguilar-De-Moros, D., Tai, C.-W., Sassoe-Gonzalez, A., Aguilar-Moreno, L.A., Sandhu, K., Janc, J., Aleman-Bocanegra, M.C., Yildizdas, D., Cano-Medina, Y.A., Villegas-Mota, M.I., Omar, A.A., Duszynska, W., BelKebir, S., El-Kholy, A.A., Alkhawaja, S.A., Horhat, G.F., Medeiros, E.A., Tao, L., Memish, Z.A. and Jin, Z., 2022. The impact of healthcare-associated infections on mortality in ICU: A prospective study in Asia, Africa, Eastern Europe, Latin America, and the Middle East. American Journal of Infection Control, 51(3), pp.1–8. https://doi.org/10.1016/j.ajic.2022.08.024

Rumjaun, A. and Narod, F., 2025. Social Learning Theory—Albert Bandura. In: B. Akpan and T.J. Kennedy, eds. Science Education in Theory and Practice. Cham: Springer, pp.55–66. https://doi.org/10.1007/978-3-031-81351-1_5

Sanya, B.K., 2023. Attitudes, subjective norms, and perceived behavioral control of perianesthesia nurses’ intentions to engage in mindful self-care. Doctoral thesis, University of North Dakota. Available at: https://www.proquest.com/openview/98310571ff639c2b46f2d9d3e0772fc2/1?pq-origsite=gscholar&cbl=18750&diss=y [Accessed 4 June 2025].

Soboksa, N.E., Negassa, B., Kanno, G.G., Ashuro, Z. and Gudeta, D.B., 2021. Hand hygiene compliance and associated factors among healthcare workers in Ethiopia: A systematic review and meta-analysis. Journal of Environmental and Public Health, 2021, Article ID 7235248. https://doi.org/10.1155/2021/7235248

Thomas, S., 2023. Infection prevention in clinical placement: Experience of nursing students. Doctoral dissertation. Available at: https://lsmu.lt/cris/bitstreams/09c75fb4-c902-467f-859f-de94b9861ded/download [Accessed 4 June 2025].

World Health Organization (WHO), 2023. First-ever WHO research agenda on hand hygiene in health care to improve quality and safety of care. World Health Organization, 12 May. Available at: https://www.who.int/news/item/12-05-2023-first-ever-who-research-agenda-on-hand-hygiene-in-health-care-to-improve-quality-and-safety-of-care [Accessed 4 June 2025].