Impact of Educational and Training Programs on Knowledge of Healthcare Students Regarding Nosocomial Infections, Standard Precautions and Hand Hygiene: A Study at Tertiary Care Hospital

nosocomial infections and reinforcement of the principals of standard precautions and hand hygiene.

of nosocomial infection. They also suggest that besides knowing basic guidelines, there is non-adherence to standard precautions and hand washing practices among healthcare workers. They recommend educating HCS about these concepts and formulation of guidelines for every hospital.
Therefore, it is vital for HCS, patient attendants, and patient themselves to be sensitized to principles of nosocomial infection. More importantly these skills would be useful for HCS as they begin clinical practice. Additionally, early interventions improving bAckground Nosocomial infections are localized or systemic infections due to infectious agents or their toxins which are not present or incubating at the time of admission of patient in heath care center. [1][2][3] These infections are significant public health problems in developed as well as developing countries. More than 1.4 million people all over world are suffering from infections acquired during hospital stay. 2 Among patients admitted to health centers [4][5][6] in India, studies reveal that 10-20% of the patients admitted had acquired nosocomial infections. Most healthcare centers in developing countries lack effective infection control programs, posing additional risk. 3 The presence of nosocomial infection further worsens the patient condition thus increasing the time of hospitalization, patient agony, and healthcare costs. 7 Standard precautions including the infection control measures, if used strictly by the healthcare workers, can significantly contribute to reduction in spread of pathogens. 8 The most important and effective component of this protocol is hand hygiene, which suggest basic practices of hand washing, hand sanitization, and use of gloves. 9 These basic measures have always been shown to prevent infection spread regardless of the patient symptoms. Few studies conducted in France 10 , Ghana 11 , Ethiopia 12 , and India 13 show that there is need for more emphasis on education about sources the awareness at all these patient contact levels regarding spread and control techniques are important to reduce the burden of such infections, ensuring better quality healthcare. Therefore, we planned a study to assess existing knowledge of healthcare students regarding nosocomial infection and effects of interventions to existing knowledge base.

Methods
This was a cross-sectional cum interventional, questionnaire based, single center study carried out at a tertiary care hospital of India. Ethical clearance was obtained prior to the start of study. Total 728 MBBS, BDS and BSc nursing students attending clinical postings participated in this study with characteristics mentioned above.
Students were informed about the study procedure, privacy, confidentiality, and voluntary participation in the study following which a written informed consent was obtained.
Characteristics of study population are presented in Table 1.
1st part collected basic demographic information of each participant.
2nd part consisted of some questions collecting information in the following three main domains, with 25 close-ended questions: • Nosocomial infection (5) • Standard precautions (12) • Hand hygiene (8) Response to each item was coded and scored as a • Correct answer = 2 • Don't know = 1 • Incorrect answer = 0 The maximum score for this questionnaire was 50.

Procedure
All the participants of the study were scheduled for a brief lecture cum workshop in small batches. This included a didactic session of 30 minutes covering the key concepts of nosocomial infections, universal standard precautions, and hand washing based on CDC 14 and WHO 15 guidelines. This session was followed by practical demonstration and hands-on training of taught concepts, emphasizing hand hygiene procedures. ICSQ was administered as a pretest and posttest to assess the knowledge of the participants.

Analysis
The data collected was entered into a Microsoft Excel spread sheet and statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 23.0. Intergroup comparison of continuous and categorical variables was performed using paired samples t-test. Assessment of differential levels of knowledge in each domain (nosocomial infections, standard precautions, and hand hygiene) with respect to course of participants was done. For all test, significance level was kept at p <0.05.

results
Evaluation of pretest and posttest of each HCS was done and mean ± SD of all 3 domains was calculated for MBBS, BDS and BSC nursing students as shown in Table 2 and Figure 2.
A paired-samples t-test (Table 3)    . These results highlight that there is a positive impact on HCS knowledge and compliance by timely training them with hands-on practice despite of only giving one-way lectures. Suchitra and Lakshmi 13 in their study advised a yearly educational program for retention of knowledge, attitude, and practices among various categories of healthcare workers. The same implies for the healthcare students for the reinforcement of the principals of standard precautions and hand hygiene. For this, the primary training is best time frame as they are like unbaked pitcher and can be molded into perfect shape easily.

conclusion
There is a need for regular educational and training programs for retention of knowledge regarding nosocomial infections and reinforcement of the principals of standard precautions and hand hygiene. This is expected to significantly reduce morbidity and mortality rate due to nosocomial infections as these students are the future of healthcare manpower. Due to sensitization and reinforcement, compliance to follow standard precautions will increase. For this, primary training is best time frame to inculcate the good habits of hand hygiene and to motivate them for practicing standard precautions religiously.