Hand hygiene performance in medical students and the general population: objective assessment and behavioural factors

Inadequate hand hygiene (HH) remains a major driver of healthcare-associated infections, with implications extending beyond healthcare workers to the general population.

To objectively assess HH performance among medical students, compare it with the general population, and examine associated attitudes and self-reported behaviours.

In this cross-sectional study, third- and fifth-year medical students (N = 192 and N = 134) and a general population sample (N = 216) performed HH using a fluorescent dye-containing alcohol-based hand rub (ABHR). Coverage was objectively quantified by digital imaging, and participants completed a study-specific questionnaire.

Mean coverage across four hand surfaces was 86.4% overall and higher in medical students than the general population (94.2% vs 74.6%; P < 0.001), and in fifth- than third-year students (96.8% vs 92.4%; P < 0.001). The dominant palm showed the highest coverage, whereas the dorsum and thumb were most often insufficiently covered. Target coverage (≥95%) across all surfaces was achieved by 37.5% overall, more frequently in medical students than the general population (58.0% vs 6.5%; P < 0.001) and in fifth- than third-year students (75.4% vs 45.8%; P < 0.001). Multi-variable analysis showed that prior HH training (odds ratio [OR]: 12.8, 95% confidence interval [CI]: 6.4-25.6), ABHR preference (OR: 10.8, 95% CI: 6.1-19.0), and self-reported adherence to HH technique (OR: 1.6, 95% CI: 1.0-2.4) independently predicted target coverage. Protection of one's own health predominated across groups; however, medical students more frequently also reported prosocial motives for ABHR.

The findings underscore the importance of strengthening HH training, shaping attitudes, and integrating real-time electronic feedback throughout medical education and the population.