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

BACKGROUND: Inadequate hand hygiene (HH) remains a major driver of healthcare-associated infections, with implications extending beyond healthcare workers to the general population. AIMS: To objectively assess HH performance among medical students, compare it with the general population, and examine associated attitudes and self-reported behaviours. METHODS: 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. FINDINGS: 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). Multivariable 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. CONCLUSION: The findings underscore the importance of strengthening HH training, shaping attitudes, and integrating real-time electronic feedback throughout medical education and the population.