Effectiveness of health education package on hand hygiene knowledge, attitude, and practices among food handlers in a tertiary care hospital in Delhi

BACKGROUND: Food handlers can serve as a medium for potential foodborne infections through contaminated hands, posing a public health hazard. Poor handwashing practices among them can be a source of foodborne illnesses through cross-contamination. Health education intervention using multiple channels is one of the most effective tools for improving hand hygiene behavior. OBJECTIVE: This study aimed to determine the change in hand hygiene knowledge, attitude, and practices (KAP) among study participants following the implementation of a health education intervention package. MATERIALS AND METHODS: A before-and-after intervention study on 111 food handlers of food establishments in a tertiary care hospital in Delhi was conducted in 2021-2022. A tool was prepared with a scoring system to rate the hand hygiene KAP of food handlers. Health education was given to all, and scores on the same tool were reassessed after 8 weeks using an interview schedule and observational checklist based on the World Health Organization (WHO)'s five keys and Food Safety and Standards Authority of India (FSSAI) guidelines. The intervention package included a health talk, audiovisual aids, and a demonstration of handwashing steps. RESULTS: The mean scores of hand hygiene KAP improved significantly after the intervention with a difference of 5.24 +/- 0.95 (P = 0.02), 3.14 +/- 0.42 (P = 0.03), and 4.18 +/- 1.97 (P = 0.03) out of total scores of 7, 5, and 15, respectively, with maximum improvement seen in practices of a duration of handwashing >20 seconds improving from 6.3% to 81.1% (P < 0.05) after the intervention and least improvement in use of towel or napkin to turn off tap improving from 2.7% to 4.5% after the intervention, respectively. CONCLUSIONS: The study findings conclude that handwashing with soap and water and following the steps of handwashing are one of the most important practices to improve hand hygiene practices. It emphasizes the need to ensure the implementation of the existing guidelines for food establishments strictly in medical institutions. Thus, education on hand hygiene using a combination of channels in medical institutions should be meticulously planned and held at regular intervals to achieve the desired change.