Students' observations of hand hygiene in nursing homes using the five moments of hand hygiene.

Aims and objectives To use nursing students to observe hand hygiene adherence in nursing homes and to explore whether the students' reflections after observing hand hygiene practices gives them a deeper understanding of the subject matter. Background Residents in nursing homes worldwide have low tolerance for healthcare‐associated infections that require antibiotics, and hand hygiene is the single most effective action to reduce infections. Design Observational study using (a) World Health Organization's (WHO) “Five moments for hand hygiene” validated tool to record indications and adherence and (b) an exploratory study of individual reflection notes from students conducted during and after observations. Methods From February 12–15, 2018, 26 nursing students in their second semester of a 3‐year bachelor programme participated as observers in five wards in four nursing homes in the Oslo metropolitan area. This study was performed according to the STROBE statement. Results Hand hygiene was performed for 57.2% of the 2,393 indications observed and recorded. Adherence differed significantly by type of personnel and by location. Four thematic categories emerged from the reflection notes: (a) practical awareness and introspection; (b) visualisation and enhancement of understanding of practice learning; (c) incorrect hand hygiene practices; and (d) stimulation to increase essential knowledge. Conclusion Hand hygiene adherence was too low to prevent healthcare‐associated infections and to reduce the use of antibiotics. The students' reflection notes indicated more “insight and understanding of the complexity of hand hygiene.” We suggest using nursing students in clinical placement as a means of incorporating different interventions as part of their learning skills and become “living reminders” of the importance of hygiene and infection prevention. Relevance for clinical practice Improving the student's activity about hygiene and infection prevention in clinical placement may help to raise awareness by healthcare workers in nursing homes.