ORIGINAL RESEARCH article
Front. Public Health
Sec. Public Health Education and Promotion
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1669928
The impact of hand hygiene knowledge on self-efficacy among Spanish nursing students: a cross-sectional study
Provisionally accepted
- Universitat de Valencia Departament d'Infermeria, Valencia, Spain
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Background: Hand hygiene (HH) is a good ally to prevent healthcare-associated infections (HAIs). Nevertheless, its incidence continues to concern global bodies such as the World Health Organization (WHO). Nursing student (NS) education will be crucial to reducing HAIs. Objective: The aim of this current study was to establish the level of HH knowledge among Spanish NS in order to identify gaps in their understanding. We also evaluated self-efficacy among NS as a key strategy for infection control (IC). Methods: We conducted a cross-sectional study of 483 NS in their second, third, or fourth years in the Faculty of Nursing at University of Valencia (Spain). Participants were recruited by convenience sampling; we collected their sociodemographic data, information on their level of knowledge regarding HH using a WHO questionnaire, and their self-efficacy in IC using a questionnaire based on the Health Belief Model, previously validated and showing moderate to high reliability (ICC = 0.63). Results: The mean knowledge score was 63.2%, with fourth-year NS achieving significantly higher scores than second-year NS (p < 0.001). The poorest results were those for the WHO "5 Moments for Hand Hygiene" item: only 10.6% identified the need for HH before injections, 19.2% recognised alcohol-based hand rub as more effective than handwashing, and just 21.4% responded correctly regarding HH after patient environment contact. Only 18% correctly identified the main source of pathogens causing HAIs. Self-efficacy scores increased significantly with academic experience (p < 0.001) and correlated positively with HH knowledge. Conclusions: In this single-site study, we found that NS had a moderate knowledge of HH, with those in their third or fourth year scoring better than those in their second year. Self-efficacy in IC might play an important role in preventing HAIs and so it is crucial to enhance the effectiveness of HH among NS to improve clinical competence, student self-confidence, and quality of patient care. These data contribute to a body of knowledge that can help improve the NS training curricula endorsed by international organisations with a view to help prevent HAIs.
Keywords: Hand Hygiene, Infection Control, Nursing, self-efficacy, Education
Received: 21 Jul 2025; Accepted: 19 Sep 2025.
Copyright: © 2025 De Maya-Martinez, Cauli, Giménez-Espert and Buigues. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: María del Carmen Giménez-Espert, maria.c.gimenez@uv.es
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