title: Use of a simulation intervention to examine differences in nursing students' hand hygiene knowledge, beliefs, and behaviors.
abstract: BACKGROUND
  Although hand hygiene remains an essential aspect of quality care, adherence to best patient safety practices continues to pose major challenges.
  
  
  OBJECTIVE
  The objectives of this study are to examine hand hygiene knowledge, beliefs, practices, perceived importance and behaviors using Social Cognitive Theory and simulation-based intervention.
  
  
  METHODS
  Participants were taken from a convenience sample of 131 undergraduate nursing students enrolled in a nursing fundamentals course at an urban university in the midwestern United States, and then randomly assigned to their respective groups. Using an experimental pretest-posttest design, control and intervention groups received the same lecture pertaining to hand hygiene and 3 data collection points where van de Mortel's Hand Hygiene Questionnaire (HHQ) was administered. In addition, the intervention group viewed a 6.5min video related to healthcare acquired infection and participated in 4 simulated situations requiring hand hygiene, based on World Health Organization guidelines. For all students, the hand hygiene technique was assessed through the use of Glo Germ, followed by handwashing and photography under ultraviolet light (posttest only). Image illumination was analyzed using image processing software. Microbiological sampling plates (pretest-posttest) were assessed quantitatively by colony counting.
  
  
  RESULTS
  Study findings did not support differences in the intervention group for the 5 hypothesized relationships. Social desirability responding and negative item confusion were found to occur with the HHQ in the student population. There was a significant difference in the UV hand photographs, with students in the afternoon having lower values than students in the morning.
  
  
  CONCLUSIONS
  Given the study results, there were no definitive educational recommendations to teach hand hygiene to nursing students. Future research should continue to further examine multi-focal modalities to enhance adherence to hand hygiene practices, as well as control for extraneous mediating or moderating variables found in educational settings.
authors.affiliation: Wright State University, College of Nursing and Health, 3640 Colonel Glenn Hwy, Dayton, Ohio 45435, United States. Electronic address: tara.konicki@wright.edu.
authors.forename: Tara
authors.initials: T
authors.lastname: Konicki
authors.affiliation: University of Cincinnati, College of Nursing, Cincinnati, Ohio, United States.
authors.forename: Elaine
authors.initials: E
authors.lastname: Miller
mesh_terms: D001291:Attitude of Health Personnel; D003428:Cross Infection / Q000517:prevention & control; D005260:Female; D006235:Hand Disinfection; D063373:Hand Hygiene; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D010465:Perception; D017410:Practice Guidelines as Topic; D013338:Students, Nursing / Q000523:psychology*