Date of Award

Spring 2019

Document Type

DNP Project Restricted

Degree Name

Doctor of Nursing Practice (DNP)



Committee Chairperson

Veronica Wilbur, PhD, APRN-FNP, CNE, FAANP

Committee Member

Debra S. Ruddy DNP, RN, CMSRN, NE-BC


Proper hand hygiene is the simplest, cheapest and most effective means of preventing the spread of infection. Children and adolescents are the most susceptible to infections acquired from unwashed hands given the proximity of children in schools. Proper hand hygiene reduces absenteeism and lack of hand hygiene remains an important public health challenge worldwide. This project was undertaken to assess hand hygiene practice and associated factors among students at an Upper Elementary School in Pennsylvania. The specific objectives of the project were to assess whether hand hygiene intervention could improve hand hygiene compliance before the lunchtime meal and reduce student absenteeism at the selected school. Training comprised of videos, a PowerPoint presentation, posters and brochures. Pre- and post-test surveys were used to evaluate the barriers to, as well as, practice and knowledge of hand hygiene. Also, students were directly observed at lunchtime and their hand hygiene compliance recorded using a mobile application on a hand-held electronic device. Barriers were not an important factor in hand hygiene practice among the middle school students studied. There was a statistically significant (p < 0.0001) increase in hand hygiene compliance rates among sixth, but not fifth, grade students. Sixth grade students could serve as an ideal group to consider for future studies aimed at modifying students’ hand hygiene behavior. A larger and longer-term project is recommended to fully evaluate the impact of hand hygiene training on behavior modification.

Keywords: handwashing, handrubbing, hand hygiene, compliance, elementary school, absenteeism, training, intervention, education, student, children, and behavior