Evaluation of Hand Hygiene Practices and Educational Interventions Among Indonesian Nursing Students: An Analysis Using ATP Wipe Tests and Hand Hygiene Checkers

Mayumi Sato; Syahrul; Tantut Susanto; Fithria; Naoki Hokama; Ruka Saito; Andi Muhammad Fiqri Muslih Djaya; Hiroshi Sugimoto

doi:10.58545/jrcnp.v3i1.476

Authors

Mayumi Sato Faculty of Nursing, Niigata University of Health and Welfare, Japan https://orcid.org/0000-0002-1664-6506
Syahrul Faculty of Nursing, Hasanuddin University, Indonesia https://orcid.org/0000-0002-3352-7672
Tantut Susanto Faculty of Nursing, Jember University, Indonesia https://orcid.org/0000-0002-9685-9869
Fithria Department of Public Health, Haluoleo University, Indonesia https://orcid.org/0000-0001-8175-3626
Naoki Hokama Faculty of Nursing, Niigata University of Health and Welfare, Japan
Ruka Saito Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Japan https://orcid.org/0000-0001-5931-2226
Andi Muhammad Fiqri Muslih Djaya Faculty of Nursing, Niigata University of Health and Welfare, Japan https://orcid.org/0000-0002-3080-7943
Hiroshi Sugimoto Faculty of Nursing, Niigata University of Health and Welfare, Japan https://orcid.org/0009-0009-1309-9242

DOI:

https://doi.org/10.58545/jrcnp.v3i1.476

Abstract

Background: Infectious diseases, including dengue fever and waterborne infections, remain major public health concerns in Indonesia. Hand hygiene is essential for reducing healthcare-associated infections; however, nursing students often fail to practice it effectively despite having sufficient knowledge. Purpose: The present study evaluated the implementation of hand hygiene among Indonesian nursing students, assessed their adherence to the “Five Moments for Hand Hygiene” during clinical training, and examined the necessity for educational improvements using a hand hygiene checker and ATP swab testing. Methods: A cross-sectional study was conducted among nursing students from three national universities in Indonesia. Data were collected through a questionnaire survey on hand hygiene knowledge and practices, self-reported adherence to the 'Five Moments for Hand Hygiene' during clinical training, and an objective evaluation using a hand hygiene checker and ATP swab testing. Results: The majority of students understood hand hygiene techniques; however, 70% failed to meet the WHO recommended handwashing duration. Over 30% of students found it challenging to perform hand hygiene before patient contact and after touching objects in the patient’s surroundings. The hand hygiene checker revealed residual contamination on the nails and fingertips, while ATP swab testing showed that 60% of students did not meet the standard threshold. Conclusions: Despite their knowledge, nursing students face challenges in implementing the proper hand hygiene practices. Knowledge alone is insufficient; practical education with visual and numerical feedback is essential. Training with hand hygiene checkers and ATP swab testing can improve self-assessment skills and enhance adherence to hand hygiene protocols.

Keywords:

ATP swab testing, Hand hygiene, Hand hygiene checker, Handwashing education, Nursing student

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Author Biographies

Mayumi Sato, Faculty of Nursing, Niigata University of Health and Welfare, Japan

Department of Nursing

Syahrul, Faculty of Nursing, Hasanuddin University, Indonesia

Department of Community Nursing

Tantut Susanto, Faculty of Nursing, Jember University, Indonesia

Department of Community Family and Geriatric Nursing

Naoki Hokama, Faculty of Nursing, Niigata University of Health and Welfare, Japan

Department of Nursing

Andi Muhammad Fiqri Muslih Djaya, Faculty of Nursing, Niigata University of Health and Welfare, Japan

Department of Nursing

Hiroshi Sugimoto, Faculty of Nursing, Niigata University of Health and Welfare, Japan

Department of Nursing

References

Asfarada, M. R., Rachmawaty, R., Setyawati, A., & Malik, G. (2024). Hand hygiene practices among nurses in South Sulawesi hospitals. Media Kesehatan Masyarakat Indonesia, 20(1), 29–38. https://doi.org/10.30597/mkmi.v20i1.31480

Avşar, G., Kaşikci, M., & Yağci, N. (2015). Hand washing of nursing students: An observational study. International Journal of Caring Sciences, 8, 618–624.

Bani, V. D., Gusti, P. K., Rawul, M. E., Pakpahan, M., & Silitonga, E. (2023). Nursing students’ knowledge and attitude in relation to COVID-19 prevention behavior. Revista Brasileira de Enfermagem, 76, 16–66. https://doi.org/10.1590/0034-7167-2022-0588

Banno M., Shimada I., Aota M., & Akita K. (2010). Evaluation of hand hygiene using a fluorescent marker. Journal of Japan Society for Environmental Infection, 25(4) 201-205. https://doi.org/https://doi.org/10.4058/jsei.25.201

Fujita, K. (2021). Lived experiences of COVID-19 on healthcare-associated infection-prevention efforts. Journal of the Japanese Medical Association, 17(17), 202–208. https://www.jstage.jst.go.jp/article/manms/17/4/17_202/_pdf/-char/ja

Fukushi, K. (2014). Health risk and environmental changes. Policy Science, 133–138. https://doi.org/10.34382/00005024

Furuse, Y., Sando, E., Tsuchiya, N., Miyahara, R., Yasuda, I., K.Ko, Y., Saito, M., Morimoto, K., Imamura, T., Shobugawa, Y., Nagata, S., Jindai, K., Imamura, T., Sunagawa, T., Suzuki, M., Nishiura, H., & Oshitani, H. (2020). Clusters of coronavirus disease in communities, Japan, January-April 2020. Emerging Infectious Diseases, 26(9), 2176–2179. https://doi.org/10.3201/eid2609.202272

Higuchi, K. (2020). Inheritance and development of quantitative text analysis and content analysis for social research (2nd ed.). Tokyo: Nakanishiya Shuppan co.ltd.

Higuchi, K., Nakamura, Y., & Chow, J. (2022). Move and learn! First text mining edition. Tokyo: Nakanishiya Shuppan co.ltd.

Iigusa, M., Kobayashi Y., Okamura A., Kurihara K., Nagano E., Suzuki N., & Haruki K. (2012). Intervention for hand hygiene promotion with culture of colonized bacteria on the hands. Japanese Journal of Environmental Infections, 27(1), 25–30. https://doi.org/10.4058/jsei.27.25

Itagaki, K. (2009). The current state of healthcare and issues in the Republic of Indonesia. Journal of International Health, 24(2), 97–105. https://doi.org/10.11197/jaih.24.97

Kakeya, M. (2006). Hand hygiene among nursing students: Comparison with hand washing and antiseptic hand rub. KIBI International University, 11–14.

Kaneko, M. (2021). Let's wash our hands with soap!: A study on socio-cultural transformation of cleanliness in Indonesia. The Setsudai review of humanities and social sciences.

Kato, T. (2015). Systematic assessment and evaluation for improvement of hand hygiene compliance. Japanese Journal of Environmental Infections, 30(4), 274–280. https://doi.org/10.4058/jsei.30.274

Kikkoman. (n.d.). Hand hygiene 2000RLU reference value. https://biochemifa.kikkoman.co.jp/kit/atp/method/guide/

Kohra, T., Owan, T., Katoh, T., Uehara, K., Tsuha, H., Sakugawa, H., Bise, T., Kuda, T., Sinzato, T., Tateyama, M., Higa, F., Sakugawa, H., Kusano, N., & Saito, A. (2004). Behaviors of handwashing and hand antisepsis seen from relations to before and after nursing practices. Environmental Infection, 19(2), 267–273. https://doi.org/10.11550/jsei1986.19.267

Kurosu, K. (2019). ATP wipe tests used to support nosocomial infection control in developing countries. In The 34th Annual Meeting of the Japanese Society of Environmental Infection Control. https://biochemifa.kikkoman.co.jp/support/casestudy/?sw2=&sp=&sc=001006

Miwaki, K. (2003). A study of teaching method for preventing infection effect of hand washing. Shizuoka Prefectural University Junior College Department Research Bulletin, 6, 1–9. https://oshika.u-shizuoka-ken.ac.jp/media/17w6.pdf

Nakagawa, H., & Sasaki, H. (2021). Nursing students’ practicums during the COVID-19 crisis and the effect on infection-prevention behavior in students: A mixed-method Approach. Medicina, 57(12), 1354. https://doi.org/10.3390/medicina57121354

Nirwati, H., Donato, C. M., Mawarti, Y., Mulyani, N. S., Ikram, A., Aman, A. T., Peppelenbosch, M. P., Soenarto, Y., Pan, Q., & Hakim, M. S. (2019). Norovirus and rotavirus infections in children less than five years of age hospitalized with acute gastroenteritis in Indonesia. Archives of Virology, 164(6), 1515–1525. https://doi.org/10.1007/s00705-019-04215-y

Nishioka, T., Okamoto K., Izawa H., Tajima S., & Hattori H. (2010). Evaluation of quick-drying hand sanitizers for improving hand hygiene compliance. Japanese Journal of Environmental Infections, 25(1), 37–40. https://doi.org/10.4058/jsei.25.37

Ohtake, C., Nishimura, R., & Yokoyama, M. (2021). Effects of a hand hygiene program on hand hygiene awareness and behavior among nursing students. Japanese Journal of Nursing Art and Science, 20, 57–67. https://doi.org/10.18892/jsnas.20.0_57

Osuka, Y. (2005a). An observational study of hand hygiene behavior: Handrub versus handwashing. Environmental Infection, 20(1), 13–18. https://doi.org/10.11550/jsei1986.20.13

Osuka, Y. (2005b). Factors influencing hand hygiene behavior of nurses. Journal of the Japanese Nursing Science Society, 25, 3–12. https://doi.org/10.5630/jans1981.25.1_3

Palaz, S. C., & Erbas, S. D. (2025). The effect of clinical observations on nursing students’ compliance with standard precautions: A cross-sectional study. American Journal of Infection Control, 1–17. https://doi.org/10.1016/j.ajic.2025.01.004

Pittet, D., Hugonnet, S., Harbarth, S., Mourouga, P., Sauvan, V., Touveneau, S., & Perneger, T. V. (2000). Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. The Lancet, 356(9238), 1307–1312. https://doi.org/10.1016/S0140-6736(00)02814-2

Santosaningsih, D., Erikawati, D., Santoso, S., Noorhamdani, N., Ratridewi, I., Candradikusuma, D., Chozin, L. N., Huwae, T. E. C. J., Donk, G. van der, Boven, E. van, Holt, A. F. V. in`t, Verbrugh, H. A., & Severin, J. A. (2017). Intervening with healthcare workers’ hand hygiene compliance, knowledge, and perception in a limited-resource hospital in Indonesia: A randomized controlled trial study. Antimicrobial Resistance and Infection Control, 6(1), 23. https://doi.org/10.1186/s13756-017-0179-y

Saraya. (n.d.). Saraya: Hand washing checker. Retrieved from https://pro.saraya.com/tearaicheker/

Sato, M., & Saito, R. (2019). Nursing students’ knowledge of hand hygiene and hand hygiene compliance rate during on-site clinical training. Journal of Environmental Infection, 34(3), 182–189. https://doi.org/10.4058/jsei.34.182

Shinoda, S. (2019). Trend of infectious diseases in South Asia: Special emphasis on diarrheal disease. Journal of Analytical Bio-Science, 42(5), 231–239. https://plaza.umin.ac.jp/j-jabs/42/42.231.pdf

Sugita, K., Yoshida, Y., Konishi, Y., Mishiro, R., Miyamoto, R., & Nishimura, T. (2005). The effects of teaching and practicing appropriate hand washing pocedures to nursing students. Environmental Infection, 20(2), 129–132. https://doi.org/10.11550/jsei1986.20.129

Sun, Y., Wang, D., Han, Z., Gao, J., Zhu, S., & Zhang, H. (2020). Disease prevention knowledge, anxiety, and professional identity during covid-19 pandemic in nursing students in Zhengzhou, China. Journal of Korean Academy of Nursing, 50(4), 533–540. https://doi.org/10.4040/jkan.20125

Taguchi, H., Higuchi, M., Kobayashi, S., Yasuda, A., Moriwaki, H., Ishida, M., Rikugawa, T., & Koizumi, N. (2020). Kanagawa Prefectural Psychiatric Center’s response to the novel coronavirus (COVID-19) : Building a healthcare delivery system and preventing nosocomial infection. Journal of Neuropsychiatry, 122, 910–929. https://journal.jspn.or.jp/jspn/openpdf/1220120910.pdf

Takeshita, Y., Yamakawa, M., & Utsumi, M. (2021). Evaluation of availability of training aid using virtual reality for hand hygiene. Journal of Japan Academy of Nursing Science, 41(0), 234–240. https://doi.org/10.5630/jans.41.234

Tanahashi, C., Shibata, Y., & Nagaya, E. (2009). The effectiveness of educational intervention on the hygienic control of hands and fingers. Medical Online, 129–136.

Terashima, T., Takemura, T., Maezawa, K., Kobayashi, N., & Kizu, J. (2009). Educational effect of handwashing for pharmacy students in pre-clinical pharmacy practice. Japanese Journal of Environmental Infections, 24 (6), 425–431. https://doi.org/10.4058/jsei.26.1

Utsumi, M. (2024). Prevention of healthcare-associated infections and hand hygiene: The potential of virtual reality utilization. Journal of Peking University Health Science Center, 133, 275–284. https://doi.org/10.32206/jkpum.133.05.275

Walker, C. L. F., Rudan, I., Liu, L., Nair, H., Theodoratou, E., Bhutta, Z. A., O’Brien, K. L., Campbell, H., & Black, R. E. (2013). Global burden of childhood pneumonia and diarrhoea. The Lancet, 381(9875), 1405–1416. https://doi.org/ 0.1016/S0140-6736(13)60222-6

WHO. (2009). WHO Guidelines. Retrieved from https://www.who.int/publications/i/item/9789241597906

WHO. (2022). WHO Global Report. Retrieved from https://www.who.int/publications/i/item/9789240051164

Yamada, C., Akemi, T., Fukami, S., & Ozaki, T. (2009). Effectiveness of hygiene education using ATP wipe tests and handwash checkers. Journal of the Japanese Society for Rural Medicine, 58 (1), 46–49. https://doi.org/10.2185/jjrm.58.46