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A Study To Assess The Effectiveness Of Video Assisted Teaching
Programme On Knowledge Regarding Importance Of Hand Washing
And Its Technique Among Middle School Children At Selected School
Mysore
PROFORMA FOR REGISTRATION OF
SUBJECT FOR DESERTATION
SUBMITTED BY
ANANDA.R
1ST YEAR M.SC NURSING
CHILD HEALTH NURSING
YEAR: 2012-2014
CAUVERY COLLEGE OF NURSING
TERESIAN COLLEGE CIRCLE
SIDDARTHANAGAR
MYSORE
1
2
3
4
ANANDA.R
NAME OF THE CANDIDATE AND
ADDRESS
CAUVERY COLLEGE OF NURSING, MYSORE.
CAUVERY COLLEGE OF NURSING,
NAME OF THE INSTITUTION
COURSE
1st YEAR M.sc NURSING,
OF
STUDY
MYSORE-570007
AND MASTER
SUBJECT
OF
NURSING
–CHILD
HEALTH
NURSING.
DATE OF ADMISSION TO COURSE
16-08-2012
Effectiveness Of Video Assisted Teaching
Programme
5.1
On
Knowledge
Regarding
Importance Of Hand Washing And Its
TITLE OF THE STUDY
Technique Among Middle School Children
At Selected School Mysore.
A Study To Assess The Effectiveness Of
Video Assisted Teaching Programme On
5.2
STATEMENT OF THE
PROBLEM
Knowledge Regarding Importance Of Hand
Washing And Its Technique Among Middle
School Children At Selected School Mysore.
2
6. BRIEF RESUME OF THE INTENTED STUDY
6.1 INTRODUCTIN
My child“ren are my pride and joy. I wash my hands to protect them.” (Machakos district
Hand washing for hand hygiene is the act of cleaning the hands with or without the use
of water or another liquid, or with the use of soap, for the purpose of removing soil, dirt,
and/or microorganisms.1
Infectious diseases affect the world unequally. Sixty-two percent of all deaths in
Africa and 31% of all deaths in SE Asia are caused by infections (Global Health Council,
2005). At the same time only 5% of all deaths in Europe are from infectious causes. Reducing
this disparity in rates of infection and mortality is a priority for the global community.
However, the two biggest killers of children, the diarrhoeal diseases and the Acute
Respiratory Infections remain relatively neglected by a public health fraternity engaged in
combating HIV/AIDS, malaria and TB. A half of all child deaths each year are due to
diarrhoea and ARIs, both of which are transmitted from person to person during everyday
interaction, through the air, through skin contact and through contamination of the
environment1. One of the most important ways of preventing these infections is handwashing
with soap (HWWS). This is because handwashing can remove the agents of infection both at
the time that they are emitted from the primary host and prevent them reaching secondary
hosts. Regular handwashing with soap is thus an excellent way of preventing the transmission
of microbes from one person to another.Indeed, current epidemiological evidence has
handwashing with soap one of the best of all infection prevention methods. This simple act is
thought to be capable of preventing about 47% of child diarrhoeas2 and 23% of respiratory
infections3 4, which, between them, account for over 4-6m deaths of children under five
around the world 1. A recent review of the cost effectiveness of interventions for the
prevention of disease put hygiene promotion, including handwashing, at the very top5,
costing only about $5 for each disability-adjusted-life-year saved. If HWWS was consistently
practiced around the world it would act like a do-it-yourself vaccine, reducing the
unnecessary death and suffering caused by these common but life-threatening diseases.
HWWS is likely also to be an effective means of preventing other diseases which are
transmitted via the faecal-oral route, including worm infections and epidemics of cholera and
3
typhoid. . However, HWWS is not a common practice. Studies put rates of HWWS at key
times, such as after the toilet or after cleaning up a child, at only about 5-15% of occasions6.
Even in the UK one study found only 43% of mothers HWWS after changing a dirty nappy7.
Introducing what is, for most, a brand new habit to the private, domestic realm across the
world remains a major challenge. We now know that the solution is not as simple as
providing health education about handwashing 8 9-- often a majority know about
handwashing’s health importance, but still do not practice it. This challenge has been taken up
by a number of organisations: soap companies, NGOs, donor and implementation agencies,
Universities and Governments have begun to work separately and together to tackle the
problem. In particular, the Global Public-Private 7 Partnership for Handwashing is seeking to
combine the skills and resources of all actors towards concerted large scale national efforts to
promote HWWS. Partners include the World Bank, the Water and Sanitation Programme,
USAID, Unicef, WSSCC, LSHTM, AED-HIP,JHUCCP, Unilever, Colgate-Palmolive and
Procter and Gamble, country Governments and small scale soap manufacturers. Now active in
15 countries, the programmes combine the upto-date best practice of public health and
consumer marketers in high impact strategic communications programmes which aim at
measurably improving handwashing practices across whole countries10. To date over $30m
has been raised internationally for these programmes.2
Germs are everywhere. Washing your hands is the easiest way to stop germs
from spreading. Think about all the things you’ve touched today that are touched by others,
from handrails to doorknobs. Washing your hands at least five times a day reduces your risk
of getting a cold, the flu and other infections.3
Hand washing is an important hygienic habit to stay hale and hearty. It not only
helps in preventing germs and bacteria, but also helps in maintaining a good healthy life free
from diseases. we all come in contact with multitude of germs and bacteria in our day to day
living. These micro organisms are present all around us, on the door knobs, water taps, light
switches, railings and yes, even on your mouse! While it is impossible to live without
touching these objects, it is imperative to be cautious to stay disinfected. Touching the eyes,
nose, ears or any other body part and eating food with the infected hand are common ways by
which we unknowingly inject the germs and bacteria in our body, thereby making ourselves
vulnerable to diseases. Therefore, it is very important to indulge in the habit of washing our
hands frequently. The knowledge and importance of washing hands would help you in staying
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free from germs and bacteria. Go through the following lines and explore the importance of
hand washing. Also, know when you should washhands. The most important reason of hand
washing is to prevent getting infected with dangerous aliments. People who don’t wash their
hands regularly are at the higher risk of getting infected with diseases like cold or flu. Eating
without washing the hands often causes gastrointestinal troubles and diarrhea, which can
spread within the family. In some cases, improper or no hand washing can cause pneumonia
in elderly people and those who are facing chronic diseases. As such, washing hands is
prototypical for staying in the pink of health. Remember, prevention is always better than
cure. Hence, always clean your hands and stay germ free. By indulging in this easy activity,
you would not only stay fit but also avoid unnecessary medical bills, as there would be fewer
chances of you getting sick
It is important know when to wash your hands as this will help you to stay
disinfected from various germs and bacteria. Hands should be washed after the following
tasks:

Hands need to be washed after using the toilets at home or at any public places.

After visiting a patient at hospital, it is very important to wash your hands.

Hands must be washed before and after eating meals to stay disinfected from germs
and bacteria.

Hands should be properly washed before cooking meals and cutting or handling food
like meat, fist and poultry.

Hands need to be washed properly after changing a baby’s diaper.

Wash your hand after touching or cleaning your pets.

Wash your hands before touching infant kids.

Hands need to wash before and after touching the injured areas or after changing the
dressings of a person.

After handling garbage and dirty things, make sure you wash your hands thoroughly.

. Hands should be washed after sneezing, coughing and blowing nose. This reduces
the chances of spreading the contagious diseases.4
Washing hands with soap and water to prevent death may sound unrealistic but
studies conducted by different agencies and analyzed by Unicef Jharkhand confirms that life of as
many as 6,000 children in Jharkhand could be saved annually by this simple act of hand washing.
5
According to government figures, around 47,500 children in the state in the age
group of zero-five years die every year because of different reasons, including infections. Out
of these deaths, 10-15% is because of pneumonia and diarrhoea, which in turn is preventable
by a simple precaution of washing hands.5
Still today, individuals of all ages carry a great amount of bacteria and viruses on
their hands. When hands are not washed at appropriate times, or if they are not washed
properly,bacteria and viruses may be spread to others. These bacteria and viruses may cause
illnesses such as colds or diarrhoea, or may lead to serious, even life-threatening diseases.
When performed correctly and at appropriate times, handwashing may help to prevent some
illnesses by stopping the spread of bacteria and viruses.6
The most common way germs are spread is by people's hands. Germs are often
harmless but they can also cause illnesses such as colds, flu, and tummy bugs.
Washing your hands properly with soap and warm water is the single most
important thing you can do to help reduce the spread of infections and help protect you, your
family and those around you.
It is vitally important that all children are made aware of the importance and
benefits of washing your hands properly.
Encouraging children to wash their hands at appropriate times will help to ensure
that this practice becomes a lifelong habit.
Materials were developed for children for use in primary schools and nurseries and
were distributed in the Autumn of 2007.7
Every year, millions of school days are lost due to illness. It is estimated that a
great number of these days could be reduced if children washed their hands regularly.
Therefore, it is imperative to educate children on the importance of adopting good hand
hygiene practices in order to keep both themselves and others healthy.
Recent studies have shown that hand washing is by far the best way to prevent the
spread of many illnesses. Good hand hygiene in children will help to prevent the spread of
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germs that cause common illnesses, such as colds and tummy bugs, from home to school and
back again.
Therefore, it is essential that a child understands why their hands are important; they help
them to eat, play and have fun, as well as learn why it is important to wash their hands:
a) Hands carry ‘nasty germs’ called micro-organisms or bacteria
b) These can spread when we touch things or can be passed to people
Encouraging children to wash their hands will also help to influence their hand washing
practices at home as well as at school.8
A teacher demonstrating the importance of hand washing can go a long way
toward keeping students healthy by instilling good habits, says the author of a study on
preventing school-based gastrointestinal outbreaks.
Prof. Marilyn Lee, who teaches in Ryerson University’s School of Occupational
and Public Health, says that lack of hand washing and improper food handling are two of the
major reasons for the spread of gastrointestinal diseases.
Lee is the lead author of A Review of Gastrointestinal Outbreaks in Schools:
Effective Infection Control Interventions. The study, in the December 2010 issue of the
Journal of School Health, deals with food preparation in schools from kindergarten through
university/college.
Typically, gastrointestinal illnesses are short-lived and their symptoms —
cramps, fever, vomiting and diarrhea — don’t require medical treatment. Some children,
however, require hospitalization and even, in the case of E. coli contamination, can die from
their condition.20
7
Six stage handwashing technique9
1. Palm to palm
2. Backs of hands
3. Between the fingers
8
4. Fingertips
5. Thumbs and wrists
6. Nails in the palm of the hand
9
6.2. NEED FOR THE STUDY
Hand washing, when done correctly, is the single most effective way to prevent
the spread of communicable diseases. Good hand washing technique is easy to learn and can
significantly reduce the spread of infectious diseases among both children and adults.10
Removing all dirt and contaminants from the skin is extremely important. Hands
and other soiled parts of the body should be cleaned at least at the end of each work period,
prior to breaks, or when visiting the toilet.11
A number of infectious diseases can be spread from one person to another by
contaminated hands, particularly gastrointestinal infections, influenza and hepatitis A.
Washing your hands properly can help prevent the spread of the organisms that cause these
diseases.
Some forms of gastroenteritis can cause serious complications, especially for
young children, the elderly, or those with a weakened immune system. Drying your hands
properly is as important as washing them.
Washing hands properly after using the toilet, changing nappies, handling
animals and before and after handling food helps prevent the spread of various forms of
gastroenteritis, some of which can cause serious health problems. Use soap and warm running
water and wash hands for at least 10 seconds. Liquid soap is best.12
Washing hands lowers the risk of having diarrhea and developing intestinal
infections, an important benefit particularly for children. Diarrheal disease is one of the
leading causes of death in children under 5 throughout the world, according to the WHO.
Contact with fecal matter causes such illnesses and can be prevented by washing hands with
soap. It may also prevent complications connected to intestinal worms.
The spread of bacterial eye infections, such as trachoma, can be reduced through
regular hand washing. It can also lower the likelihood of contracting conjunctivitis, or pink
eye. This irritating eye condition causes eye pain, itching, light sensitivity and discharge. It is
spread a number of ways, with the most common being through viruses, according to the
10
National Institutes of Health's MedlinePlus. Always wash your hands before putting in
contacts, as being a contacts wearer increases your risk of having pink eye.
You can lower your chances of developing an acute respiratory infection by
making hand washing a priority. The pathogens that cause respiratory complications are
commonly found on surfaces and hands. Some of the pathogens associated with diarrhea also
cause respiratory problems. Hand washing cuts your chances of getting sick greatly. In fact, a
2004 study appearing in "The Lancet" found that washing hands cut pneumonia-related
infections by more than half in Pakistani children under the age of 5.13
According to the demographic healthy survey, 2003, the under-five mortality
(per 1,000 live births) is 115. The mortality is higher in rural areas compared to urban areas
(117 rural and
94 urban). It is high among the poor compared to the rich (149 for the lowest
wealth quintile and 91for the highest wealth quintile). Central province has the lowest underfive mortality at 54, followed by rift valley at 77. Under-five mortality is highest in nyanza
(206); this is followed by eastern and western (163and 144, respectively). World health
organization statistics, 2006, records that diarrheal diseases caused 16 percent of deaths
among children under five years of age in 2002–03. Prevalence of diarrhea among children
under five years, measured by the incidence of diarrhea in the last two weeks, was recorded at
16 percent in 2003. Coast and western provinces recorded the highest prevalence at
23.1percent and 21.9 percent, respectively. Central had the lowest prevalence at 7 percent.
When kids come into contact with germs, they can unknowingly become
infected simply by touching their eyes, nose, or mouth. And once they're infected, it's usually
just a matter of time before the whole family comes down with the same illness.
Good hand washing is the first line of defense against the spread of many
illnesses, from the common cold to more serious illnesses such as meningitis, bronchiolitis,
influenza, hepatitis A, and most types of infectious diarrhea.14
Proper hand washing has been credited for reducing illnesses in child care
centers, school settings, and the workplace (Master, Longe, & Dickson, 1997; Niffenegger,
1997; Krilov, Barone, Mandel, Cusak, Gaber, & Rubino, 1996; Kotch, Weigle, Weber,
Clifford, Harms, Loda, Gallagher, Edwards, Laborde, McMurrary, Rolandelli, & Faircloth,
1994; Black, Dykes, Anderson, Wells, Gary, Hatch, & Gangarosa, 1981). This reduction in
11
illness then leads to a reduction of absenteeism and missed days of work by the staff. Not
only is proper handwashing important in the school, home, and community setting, it is 4 also
important in the hospital setting. Though the rate for acquiring an infection from the hospital
is extremely high, particularly in the pediatric setting due to immature immune systems of the
pediatric population, handwashing provides a significant means for preventing the spread of
germs that may lead to illness (Pittet, Hugonnet, Harbarth, Mourouga, Sauvan, Touveneau, &
Perneger, 2000).15
6.3. STATEMENT OF THE PROBLEM
A Study To Assess The Effectiveness Of Video Assisted Teaching Programme On
Knowledge regarding Importance of Handwashing And Its Technique among middle school
children at selected school Mysore.
6 .4.
OBJECTIVES

To assess the pre test level of knowledge of middle school children regarding
importance of handwashing and its technique.

To assess the post test level of knowledge of middle school children regarding
importance of handwashing and its technique.

To find out the effectiveness of video assisting programme in terms of knowledge
among middle school children at selected school, Mysore.

To associate the pre test level of knowledge regarding importance of handwashing
and its technique among middle school students with their selected demographic
variable.
6.5.
RESEARCH HYPOTHESIS
H1: The mean post test score of middle school children will be significantly higher than
the mean pre test score knowledge regarding importance of handwashing and its technique
among middle school children.
H2: There will be a significant association between the knowledge on importance of
handwashing and its technique among middle school children with their selected demographic
variable.
6.6.
OPERATIONAL DEFINITIONS

Assessment
12
The method of estimating the outcomes of video assisted teaching on knowledge
among
the middle School Children regarding importance of handwashing and its
technique.

Effectiveness
Effectiveness is a measure of the ability of video assisted programme regarding
importance of hand washing and its technique to produce a specific desired effect by
improving their knowledge and skills.

Video Assisted Teaching Programme
It refers to the systematically developed instructional method and video assisted
teaching aids designed for middle school Children to provide information on
importance of hand washing and its technique.

Knowledge
In this study knowledge refers to the correct response from the middle school
Children
regarding the importance of hand washing and its technique. It will be
measured by knowledge assessment.

Middle School Children
In this study middle school children refers to the students who are studying 5th ,
6th , & 7th standard and in the age group of 10 – 12 years .

Importance of Hand washing and its techniques.
Hand washing not only helps in preventing germs and bacteria, but also helps in
maintaining a good healthy life free from diseases. we all come in contact with multitude of
germs and bacteria in our day to day living.
There is more to hand washing than you think! By rubbing your hands
vigorously with soapy water, you pull the dirt and the oily soils free from your skin. The soap
lather suspends both the dirt and germs trapped inside and are then quickly washed away.
6.7. DELIMINATIONS
 The study is limited to the middle school children.
 The data collection period is limited to 4- 6 week only.
 Study is limited to 60 samples
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6.8. REVIEW OF LITRATURE
A review of literature is a key step in research process. Review of literature
refers to an extensive, exhaustive and systematic examination publications relevant to the
research project. Literature reviews can serve a number of important functions in the research
as well as important functions for nurses seeking to develop an evidence based practice.16
The Review of literature is defined as a broad, comprehensive in depth,
systematic and critical review of scholarly publication, unpublished scholarly print materials
audiovisual materials and personal communication.17
Researcher almost never conduct a study in an intellectual vacuum, their are
usually undertaken within the context of an existing knowledge base. Researcher undertake a
literature review to familiarize themselves with that knowledge base and deliberately bypass
an in depth literature search before entering the field to avoid having their inquiries
constrained or biased by prior work on the topic. Literature reviews helps to lay foundation
for the study and can also inspire new research ideas and also plays a role at the end of the
study.16
Literature review can play in a research project and the kinds of materials covered
and provided on finding references, reading research reports, recording information,
organizing and drafting a written review. A researcher analyses existing knowledge before
delving into a new area of study while conducting a study, when interpreting the result of the
study and when making judgements about application of a new knowledge in nursing
practice.17
1) Mr. Guinan, McGuckin-Guinan, & Sevareid, (1997) conducted a
descriptive observational study to determine the handwashing habits of high school students
after using the restroom. The study observed, measured, and compared the duration and
techniques of male and female high school students. The researchers recorded the following
observational data: sex of the student, location, use of soap, and whether or not the length of
handwashing was greater than five seconds. The data showed that 58% of female students
washed their hands after using the restroom, compared with only 48% of male students.
Twenty-eight percent of female students used soap versus only 8% of males. Female students
also washed their hands for a longer duration than did the male students, with 50% of female
14
students washing their hands longer than five seconds, and only 23% of male students
washing their hands longer than five seconds.18
2.)A study was conducted selected school of New Zealand. Clean hands play
an important role in preventing infectious disease transmission. This study assessed the
physical quality of toilet and handwashing facilities used by 9 year olds at 68 primary schools
in three cities in the South Island of New Zealand. The facilities were assessed for
availability, functionality and provision of hand basins, hygiene products and drying facilitie
Nineteen schools (28%) followed the New Zealand Ministry of Education Code of Practice
for toilet and bathroom facilities in schools, by providing warm water, liquid soap at every
basin and functioning hand drying facilities. A further 25 schools (37%) would have met the
standards except they provided only cold water (21 schools) or the cloth roller towels were
unusable (4 schools). The other 24 schools' toilet facilities were deficient in some way,
including one with no soap and six that provided no drying facilities. School socioeconomic
position and toilet facility quality were not related.: These results suggest hat a significant
number of New Zealand children do not currently have access to high quality hygiene
facilities at school19.
3) A study was conducted by Georgia's public Schools.In this School do not
provide soap and paper towels or hand dryers in student restrooms. Even though some schools
do provide these supplies, problems such as vandalism by students make it difficult to
maintain supplies, thereby preventing consistent and effective hand washing by students.
Because hand washing is the single most preventive measure for reducing the spread of
contagious diseases and because it is a fundamental personal hygiene practice that is often not
done when necessary or is ineffectively done, this study compiles existing information and
tools and produces new tools for improving the accessibility and practice of hand washing in
schools. This study does this by assessing the availability of hand washing supplies, problems
maintaining these supplies and education provided to promote hand washing by students in
Georgia's public schools. This study also provides and tests interventions in a sample
community of students in three schools for three months. The results include (a) two
trainingoutlines: one for elementary level students and another for middle and high
schoolstudents, (b) hand washing posters for reminding students to wash their hands, (c) a
training video for promoting hand washing among students, and (d) recommendations for
15
controlling maintenance of hand washing supplies and providing ongoing education to
promote effective hand washing among students.20
4) A Study was conducted day care and pre education centre. A review of
literature in the MEDLINE, LILACS and Cochrane Library databases, found using the
descriptors daycare, infection, infection control and infectious diseases and focusing on
studies that have compared the risk of infectious diseases for children cared for in and out of
the home, related risk to the type of out-of-home care and assessed the effectiveness of
preventative measures. Children cared for at daycare or in preschool education exhibit a two
to three times greater risk of acquiring infections, which impacts both on individual health
and on the dissemination of diseases through the community. Among other factors, the risk is
associated with the characteristics of daycare centers, and simple preventative measures are
effective for reducing transmission of diseases. Recommended measures include: appropriate
hand washing after exposure; employment of standard precautions; standardized routines for
changing and disposal of used diapers, location and cleanliness of changing area, cleaning and
disinfection of contaminated areas; use of disposable tissues for blowing noses; separate
workers and area for handling foods; notification of infectious diseases; training of workers
and guidance for parents.In the face of growing utilization of daycare and preschool education
and their association with increased risk of acquired infections, control measures are
indispensable to the prevention and control of infectious diseases21.
5)A study was conducted orthopaedic department for the purpose of a crossover
study of hand washing Effective hand-washing is essential for reducing the spread of
infection in hospitals. They
aimed to evaluate hand-washing performance of hospital
personnel and to determine if this could be improved by education .A total of 55 personnel
working in the orthopaedic department were asked to clean their hands using an alcohol gel
containing a clear fluorescent substance. They were unaware of the assessment method.
Performance was assessed by examining their hands under UV light to identify areas that had
been neglected. Subjects could visualise which areas they had missed and were then educated
regarding hand-washing technique and retested after 7 days .Of the 55 subjects, 53 completed
the study. Individual performance varied widely. Following a simple educational intervention,
49 out of 53 subjects improved from an average of 7.8% to 2.3% area missed (P < 0.001).22
16
6 ) A study was conducted Menofia University Hospital. this study was carried
out to assess hand washing knowledge, attitude and practices of nurses in medical and
surgical wards and compare efficacy of six alternative hand disinfectant agents with and
without drying. A cross-sectional interventional study was conducted including a random
sample of (120) nurses in medical and surgical wards. Data were collected through a
predesigned questionnaire and check list. The number and types of bacteri on hands of nurses
before and after disinfection with alternative agents and after drying were evaluated by the
standard microbiological method. The results revealed that, the compliance of nurses with
hand washing between patients’ contact is quite poor (1.7%) which referred mainly to work
overload (94.9%) and lack of resources (39.8%). The majority of nurses have transient
bacterial flora (97.5%). The frequency of Staphylococcal aureus, E. coli, Klebsiella and
Streptococcal faecalis hand infections was (47.5%), (30%), (5%)and (4.2%), respectively.
The betadine and alcohol disinfectants have the highest efficacy (95.5%) and (90%) in
medical ward and (90.9%) and (82.9%) in surgical ward, respectively. The efficacy of
alternative hand disinfectants generally improved after hand drying with paper towel. For
plain soap and tap water the efficacy after drying became nearly similar to betadine and
alcohol. In conclusion, scientific evidence and easy use support the use of plain soap and tap
water with drying with paper towel for routine hand hygiene. Thus implementation of an
effective and applicable hand disinfection system for health care workers should be
considered.23
7) A study was conducted relating to hospital-acquired infections, long-term care
facilities, immuno-compromised and elderly people were excluded. They independently
evaluated all studies, and inclusion decisions were reached by consensus. From a primary list
of 410 articles, eight interventional studies met the eligibility criteria. All eight eligible
studies reported that handwashing lowered risks of respiratory infection, with risk reductions
ranging from 6% to 44% [pooled value 24% (95% CI 6-40%)]. Pooling the results of only the
seven homogenous studies gave a relative risk of 1.19 (95% CI 1.12%-1.26%), implying that
hand cleansing can cut the risk of respiratory infection by 16% (95% CI 11-21%).
Handwashing is associated with lowered respiratory infection. However, studies were of poor
quality, none related to developing countries, and only one to severe disease. Rigorous trials
of the impact of handwashing on acute respiratory tract infection morbidity and mortality are
urgently needed, especially in developing countries.24
17
8)A study review seeks to identify the most effective hand-washing and handcleansing practice that could be used in primary care. Healthcare associated infection is a
major problem in the UK causing 5000 deaths every year. Current guidelines indicate expert
opinion is the level of evidence for hand washing as an activity to reduce infection. This
review has found a lack of evidence for hand-washing techniques being undertaken in
practice today. Findings from hand-washing technique studies were inconclusive and
methodological issues exist resulting in sparse reliable evidence. There is an urgent need to
undertake methodologically sound studies of hand-washing techniques for use in the ever
expanding scope of primary care practice.Evidence for hand-washing and hand-cleansing
techniques will inform healthcare professional practice, and contribute to the overall
management of infection control in primary care.25
9) This study was investigated the entire group of sixth-grade students (N =
2323) and their parents (N = 2089) at 11 elementary schools randomly selected from the
Seoul Metropolitan Area, Korea. The results show that parents' handwashing practice, parent
and child bonding, and shared time have a significant correlation with children's hand hygiene
practice. The thoroughness of hand cleansing is more likely to be associated with health
education, parents' practice of proper handwashing, greater parent-child bonding, and a
greater amount of shared time with parents. Parent-child bonding and shared time are crucial
in promoting children's hand hygiene. These results imply that public health policies need to
be targeted at not only providing health education but at increasing parent-child bonding and
shared time in order to promote children's health more effectively.26
10 ) A study was conducted less than five year children, Diarrhoea is a common
cause of morbidity and a leading cause of death among children aged less than five years,
particularly in low- and middle-income countries. It is transmitted by ingesting contaminated
food or drink, by direct person-to-person contact, or from contaminated hands. Hand washing
is one of a range of hygiene promotion interventions that can interrupt the transmission of
diarrhoea-causing pathogens. Randomized controlled trials, where the unit of randomization
is an institution (eg day-care centre), household, or community, that compared interventions
to promote hand washing or a hygiene promotion that included hand washing with no
intervention to promote hand washing.Fourteen randomized controlled trials met the inclusion
criteria. Eight trials were institution-based, five were community-based, and one was in a
18
high-risk group (AIDS patients). Interventions promoting hand washing resulted in a 29%
reduction in diarrhoea episodes in institutions in high-income countries (IRR 0.71, 95% CI
0.60 to 0.84; 7 trials) and a 31% reduction in such episodes in communities in low- or middleincome countries (IRR 0.69, 95% CI 0.55 to 0.87; 5 trials). Hand washing can reduce
diarrhoea episodes by about 30%. This significant reduction is comparable to the effect of
providing clean water in low-income areas. However, trials with longer follow up and that
test different methods of promoting hand washing are needed.27
11) A study was reviewed evidence of hand-washing compliance in
community settings during the 2003 SARS outbreak. Literature was searched through
PubMed, Cochrane Library, Wan Fang database and Google. Studies containing data on
hand-washing, self-reported or directly observed, in community settings were selected. Casecontrol studies and studies in healthcare settings were excluded. Self-reported hand-washing
compliance increased in the first phase of the SARS outbreak and maintained a high level 22
months after the outbreak. The decline of hand-washing in Hong Kong after SARS was
relatively slow. A significant gender difference in hand-washing compliance (female > male)
was found in eight studies. The importance of family support and 'significant female others' in
hand hygiene promotion are noted. The impact of education is uncertain. Perceived
susceptibility to and severity of SARS, and perceived efficacy of hand-washing in preventing
SARS, also predicted self-reported hand-washing compliance.28
12) A study was conducted home and community setting for the purpose of to
reduce of infection. Infectious diseases (ID) circulating in the home and community remain a
significant concern. Several demographic, environmental, and health care trends, as reviewed
in this report, are combining to make it likely that the threat of ID will increase in coming
years. Two factors are largely responsible for this trend: first, the constantly changing nature
and range of pathogens to which we are exposed and, secondly, the demographic changes
occurring in the community, which affect our resistance to infection. This report reviews the
evidence base related to the impact of hand hygiene in reducing transmission of ID in the
home and community. The report focuses on developed countries, most particularly North
America and Europe. It also evaluates the use of alcohol-based hygiene procedures as an
alternative to, or in conjunction with, hand washing. The report compiles data from
intervention studies and considers it alongside risk modeling approaches (both qualitative and
19
quantitative) based on microbiologic data. The main conclusions are as follows: (1) Hand
hygiene is a key component of good hygiene practice in the home and community and can
produce significant benefits in terms of reducing the incidence of infection, most particularly
gastrointestinal infections but also respiratory tract and skin infections. (2) Decontamination
of hands can be carried out either by hand washing with soap or by use of waterless hand
sanitizers, which reduce contamination on hands by removal or by killing the organisms in
situ. The health impact of hand hygiene within a given community can be increased by using
products and procedures, either alone or in sequence, that maximize the log reduction of both
bacteria and viruses on hands. (3) The impact of hand hygiene in reducing ID risks could be
increased by convincing people to apply hand hygiene procedures correctly (eg, wash their
hands correctly) and at the correct time. (4) To optimize health benefits, promotion of hand
hygiene should be accompanied by hygiene education and should also involve promotion of
other aspects of hygiene.29
13) This review examines the literature, including literature in
Chinese, on the effectiveness of handwashing as an intervention against severe acute
respiratory syndrome (SARS) transmission. Nine of 10 epidemiological studies reviewed
showed that handwashing was protective against SARS when comparing infected cases and
non-infected controls in univariate analysis, but only in three studies was this result
statistically significant in multivariate analysis. There is reason to believe that this is because
most of the studies were too small. The evidence for the effectiveness of handwashing as a
measure against SARS transmission in health care and community settings is suggestive.30
14) A study was conducted in low- and middle-income communities, schools
and health care settings using behavioural outcome measurement and temporal study
design.Peer-reviewed and grey literature was screened for handwashing studies that evaluated
behaviour change. Relevant articles were assessed by their research approach, including the
investigator's selected outcome measure and time frame of various study components (e.g.,
formative research, intervention and evaluation).The initial search yielded 527 relevant
articles. After application of exclusion criteria, we identified 27 unique studies (30 total
articles). Of the 27 articles, most were focused in the community setting. Fifteen (56%)
documented observed handwashing behaviour, while 18 (67%) used proxy measures (e.g.,
soap presence, diarrhoea) and 14 (52%) used self-reported behaviour. Several studies used
20
multiple outcome measures. While all studies had an evaluation of behaviour change, there
was a dearth of studies that evaluated long-term maintenance of behaviour change after the
intervention's .While the literature is replete with a variety of handwashing studies in
community, school and health care settings, none have been able to definitively document
long-term behaviour change, thereby challenging the sustainability of various interventions.
Additionally, there is a need to better understand which research approach is most effective in
promoting long-term behaviour compliance in global low- and middle-income settings.31
15) A Study was conducted Hand World Health Organization. Hygiene is
considered to be the most effective measure to prevent microbial pathogen cross-transmission
and healthcare-associated infections. In October 2005, the World Health Organization (WHO)
World Alliance for Patient Safety launched the first Global Patient Safety Challenge 20052006, 'Clean Care is Safer Care', to tackle healthcare-associated infection on a large scale.
Within the Challenge framework, international infection control experts and consultative
taskforces met to develop new WHO Guidelines on Hand Hygiene in Healthcare. The
taskforce was asked to explore aspects underlying hand hygiene behaviour that may influence
its promotion among healthcare workers. The dynamics of behavioural change are complex
and multi-faceted, but are of vital importance when designing a strategy to improve hand
hygiene compliance. A reflection on challenges to be met and areas for future research are
also proposed.32
16) A Study was conducted The World Health Organization (WHO) First
Global Patient Safety Challenge, Clean Care is Safer Care, pledged to tackle the problem of
health care-associated infection at its launch in 2005 and has elaborated a comprehensive set
of guidelines for use in both developed and developing countries worldwide. The final
version of the WHO Guidelines on Hand Hygiene in Health Care was issued in March 2009
and includes recommendations on indications, techniques, and products for hand hygiene. In
this review, we discuss the role of hands in the transmission of health care-associated
infection, the benefits of improved compliance with hand hygiene, and the recommendations,
implementation strategies and tools recommended by WHO. We also stress the need for
action to increase the pace with which these recommendations are implemented in facilities
across India.33
21
17) A study was conducted to assess the effectiveness of the Handwashing
University on teaching youth the benefits of proper handwashing. The Handwashing
University is an interactive display with several successive stations through which
participants move to learn necessary skills for proper handwashing. Upon completion of the
Handwashing University, 87% of youth completing a program assessment survey indicated
they felt handwashing was more important. The majority of youth surveyed (66.7%) indicated
specific changes they would make in their handwashing behavior. Overall, results indicate
participation in the Handwashing University prompts youth and their families to practice
proper handwashing techniques.34
18)Hand hygiene promotion is considered as the cornerstone for healthcareassociated infection prevention. Over the past years, hand hygiene guidelines have been
developed by different agencies at international, national and subnational levels. A
comparison of these documents could help in understanding recommendations in different
parts of the world and the methods used for their development. Guidelines were identified
through search engines, electronic libraries, and personal contacts, and their content was
analysed using an adapted version of a tool from the European DG XII-funded HARMONY
project. Twenty-two guidelines were retrieved and 21 were evaluated. Documents varied in
scope, approach, content and terminology. Some were primarily advisory directives, whereas
others focused on the technical issues of why, when, and how to perform hand hygiene. The
extent to which evidence was collected and assessed varied considerably and details were
provided only in very few. Grading systems and definitions to indicate the strength of
evidence and recommendations also differed. The intended outcome was to improve hand
hygiene practices in healthcare, thus leading to a reduction of healthcare-associated infections
and/or antimicrobial resistance. Although overall agreement on indications and procedures
was noted, the range and depth of recommendations on best practices and implementation
varied. Essential aspects such as compliance measurement and audits to assess guideline
effectiveness were neglected in most documents. In conclusion, there is a need for a more
consistent approach leading to recommendations based on a thorough evaluation of evidence
and applicable worldwide. Aspects related to implementation and impact monitoring deserve
greater attention.35
7. MATERIALS AND METHOD OF STUDY
22
7.1 SIGNIFICANT OF THE STUDY
The study implies the importance of increasing knowledge regarding importance of
handwashing and its techniques in middle school children and evaluating the effectiveness of
the video assisted teaching programme on importance of handwashing and its techniques
among middle school children.
7.2 SOURCE OF DATA
The data will be collected from the middle school children in selected school.
7.3 RESEARCH APPROACH AND DESIGN
The research approach in the study was a quantitative approach, as the study aims to
evaluate the effectiveness of video assisted teaching programme in selected middle school at
Mysore.
Pre-experimental one group pre test- post test design will be adopted for the study.
Group
Pre-test
Middle School Students
01
Treatment
Post-test
X
02
Keys:

01 → Pre-test knowledge of middle school children regarding importance of
handwashing and its technique.

X → Application of video assisted teaching programme on importance of
handwashing and its technique.

02 → Post test knowledge of middle school children regarding the importance
of handwashing and its technique.
7.4 METHOD OF DATA COLLECTION
Data collection is planned through using a structured questionnaire on their
knowledge regarding importance of hand washing and its technique .
23
Part A : Demographical variables include age, gender, education, etc
Part b : Structured knowledge questionnaire regarding the importance of hand washing and its
technique.
7.5 CRITERIA FOR SAMPLE SELECTION
Inclusion Criteria

Middle school students both male and female

students who are available at data collection period

Students in the age group of 10-12 years

Students who are willing to participate in the programme
Exclusion Criteria

Students who are exposed to any similar training programme in the last 6 months.

Students who are absent during the data collection period

Students who are not willing to participate
7.6 SAMPLING PROCEDURE
Non Probability Convenient Sampling Technique will be used to select the samples.
7.7 POPULATION
The target population selected for this study is all students studying in middle school.
7.8 SAMPLE
Samples for the study are Middle School Students studying in 5th, 6th, &7th in selected
school at mysore.
7.9 SAMPLE SIZE
Sample size consists of 60 middle School students.
7.10 SETTING
The setting for the study is class room in selected middle school at Mysore.
7.11 PILOT STUDY
For the pilot study 10 percent of sample will be selected and those samples will be
excluded in the main study.
24
7.12VARIABLES
INDEPENDENT VARIABLE
Video assisted teaching programme on Importance of hand washing and its
techniques.
DEPENDENT VARIABLE
Knowledge of Middle School Children regarding Importance of hand washing
and its techniques.
8. PLAN FOR DATA ANALYSIS PLAN
Both Descriptive and Inferential statistics will be used for data analysis. Inferential
statistics will be used for finding the effectiveness of video assisted teaching programme
and to find the association
8.1 PROJECTED OUTCOME

The study will enable to identify the knowledge on Importance of hand washing
and its techniques among middle school children.

The findings of the study will help the student to be efficient in dealing hand
washing by giving knowledge about Importance of hand washing and its
techniques among middle school children.

The study will help to create awareness among middle school Children
regarding the early identification of Infection.
9. ETHICAL OUTCOME
Ethical clearance will be obtained from the institutions authorities concerned to
particular settings and also from ethical committee.

Does study require any investigation or intervention to be conducted on middle school
children?
-

Yes
Has ethical clearance been obtained from school authorities in case study requires
investigation?
-

Yes
Informed consent will be taken from the respondents & the concerned authorities of
the school?
-
Yes
25
10. REFERENCES
1)
Hand washing available from:URL: http://en.wikipedia.org/wiki/Hand_washing
2) Hand hygiene available from:URL:
http://www.hygienecentral.org.uk/pdf/FR%20Review%20Lifebuoy.pdf
3) Germs are every where available from:URL:
http://www.healthyalberta.com/Documents/Snacktivity_Box_handwashing_section.pdf
4) Lily July 9th2011 Importance of Hand Washing available from:URL:
http://www.unp.me/f150/importance-of-hand-washing-90918/
5) Jaideep Deogharia Washing hand can prevent 6000 child death available from:URL:
http://articles.timesofindia.indiatimes.com/2011-10-14/ranchi/30278701_1_washinghands-hand-sanitizer-soap-and-water
6) Using education to improve the handwashing habits of preschool children available
from:URL:http://www3.uakron.edu/witt/rmfcs/hollythe1.pdf
7) Why is hand hygiene so important. available
from:URL:http://www.washyourhandsofthem.com/hand-hygiene--you.aspx
8) Why Hand washing Important? available from:URL:
http://www.debgroup.com/uk/learning-zone/education-zone/school/why-handwashing-important
9) Six stage of hand washing
available from:URL:https://www.nuh.nhs.uk/our-
services/all-services/clean-your-hands/six-stage-handwashing-technique/
10) Good hand washing technique available from:URL:
http://www.health.gov.on.ca/english/public/program/pubhealth/handwashing/handwas
hing_mn.html
11) Correct hand washing technique available from:URL:
http://www.debgroup.com/uk/learning-zone/handwashing-technique/correct-handwashing-technique
12) Hand washing is important. available
from:URL:http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/handwashi
ng_why_it%27s_important
13) By Rachel morgan What are the benefits of hand washing available from:URL:
http://www.livestrong.com/article/353130-what-are-the-benefits-of-hand-washing/
26
14) Why handwashing so important. available from:URL:
http://kidshealth.org/parent/general/sick/hand_washing.html
15) Proper handwashing available
from:URL:http://www3.uakron.edu/witt/rmfcs/hollythe1.pdf
16) Polit DF, Beck CT. Nursing Research principles and methods. 7th ed. Library of
congress cataloging in publication data. P.88.
17) Basavanthappa BT. Nursing research. 2nd ed. Jaypee brothers’ medical publishers.
P.92
18) Available from:URL:http://www3.uakron.edu/witt/rmfcs/hollythe1.pdf
19) Reeves LM, Priest PC, Poore MR.School toilets:facilitating hand hygiene ? A review
of primary school hygiene facilities in a developed country.[ABSTRUCT] available
from ; http://www.ncbi.nlm.nih.gov/pubmed/22490432
20) Available from :URL:http://www.geha
online.org/Attachments/Publications/Hand%20Washing%20in%20GA.pdf
21) Nesti MM, Goldbaum M. Infectious diseases and Day care and Preschool education
[abstruct]2007 Jul-Aug ;83(4) available from
http://www.ncbi.nlm.nih.gov/pubmed/17632670
22) Duncan JM, Macdonald,Improving hand washing Performance [abstruct]2006
may;83(3):289-291 available from http://www.ncbi.nlm.nih.gov/pmc/articles
/PMC1963687/
23) Available from:URL:http://www.ems.org.eg/elmgala_elalmia/SMJ_oct_03/data/6.pdf.
24) Rabie T, Curtis V ,handwashing and risk of respiratory infection:A quantitative
systematic review [abstruct]2006 March 11(3) available from: URL
:http:// www. ncbi. nlm.nih.gov/pubmed/16553905
25) Smith SM.Areview of handwashing techniques in primary care and community
settings.[abstract]2009 Mar 18 (6) available
from:URL:http://www.ncbi.nlm.nih.gov/pubmed/19239662
27
26) Song IH, Kim SA Park WS, Family factors associated with childrens hand washing
hygiene behaviour [abstract]2012 nov28 available from
http://www.ncbi.nlm.nih.gov/pubmed/23197385
27) Ejemot RI, Ehiri JE,Meremikwu MM,Critchley JA.Handwashing for preventing
diarrhoea.2008 Jan 23;(1) Abstract available from
http://www.ncbi.nlm.nih.gov/pubmed/18254044
28)Fung IC, Cairncross S.How often do you wash your hands? available from,
http://www.ncbi.nlm.nih.gov/pubmed/17479381
29)Sally F,Bloomfield,B pharm ,Phd,Allison E.Aiello,Phd,Ms.redusing the risk of
infection in home and community setting, available from
http://www.ajicjournal.org/article/S0196-6553%2807%2900595-0/abstract
30)Fung IC,CairnCrossS. Effectiveness of handwashing in preventing SARS: a
review [abstruct]2006 Nov;11(11) available from
http://www.ncbi.nlm.nih.gov/pubmed/17054756
31) Vindigni SM,Riley PL, Jhung M.Systematic review:hand washing behaviour
in low-to middle- income countries:out come measures and behaviour maintenance
.2011Arl 16(4) available from http://www.ncbi.nlm.nih.gov/pubmed/21226794
32) Whitby M, Sax H, Larson E, Seto,WH,Donaldson L, Pittet D.Behavioural
consideration for hand hygiene practices:tae basic building blocks.[abstruct]2007Jan
65(1)available from http://www.ncbi.nlm.nih.gov/pubmed/17145101
33) Mathai E, Allegranzi B Kilpatrick c, Pittet D. Prevention and control of health
care associated infections through improved hand hygiene [ABSTRUCT]2010 AprJun ;28(2) Available from http://www.ncbi.nlm.nih.gov/pubmed/20404452
28
34) Ginger Fenton,Rama Radhakrishna Catherine Nettles Cutter.Participation in
Handwashing university available from,
http://www.joe.org/joe/2010february/rb7.php
35) Cookson B, Mathai E Allegranzi B,Pessoa-Silva CL,Bagheri Nejad S,Scheide
A. Tschoppc, Wentt C,Pittet D. Comparison of national and sub national
Guidelines for hand hygiene .2009 Jul;72(3)available from
nlm.nih.gov/pubmed/19481295
29
http://www.ncbi.
11.
SIGNATURE OF THE CANDIDATE
12.
REMARKS OF THE GUIDE
13.
NAME AND DESIGNATION OF THE
GUIDE (IN BLOCK LETTERS)
13.1.
GUIDE
13.2.
SIGNATURE
13.3.
CO-GUIDE (IF ANY)
13.4.
SIGNATURE
13.5.
HEAD OF THE DEPARTMENT
13.6.
SIGNATURE
14.
14.1.
REMARKS OF THE CHAIRMAN
AND PRINCIPAL
SIGNATURE
30