Hand Hygiene Knowledge and Practices among Domestic Hajj Pilgrims: Implications for Future Mass Gatherings Amidst COVID-19

Abstract

This study examined Hajj pilgrims’ knowledge and reported practice of hand hygiene. In Hajj 2019, a cross-sectional survey was undertaken in Mina, Makkah, Saudi Arabia, of domestic Saudi pilgrims aged ≥18 years by using a self-administered Arabic questionnaire that captured data on pilgrims’ socio-demographics, hand hygiene knowledge, and reported practices of hand cleaning following certain actions. A total of 348 respondents aged 18 to 63 (median 32) years completed the survey, of whom 200 (57.5%) were female. The mean (±standard deviation (SD)) hand hygiene knowledge score was 6.7 (±SD 1.9). Two hundred and seventy one (77.9%) and 286 (82.2%) of respondents correctly identified that hand hygiene can prevent respiratory and gastrointestinal infections respectively, but 146 (42%) were not aware that it prevents hand-foot-mouth disease. Eighty-eight (25.3%) respondents erroneously reported that hand hygiene prevents HIV. Washing hands with water and soap was the most preferred method practiced before a meal (67.5% (235/348)), after a meal (80.2% (279/348)), after toilet action (81.6% (284/348)), when hands were visibly soiled (86.2% (300/348)), and after waste disposal (61.5% (214/348)). Hajj pilgrims demonstrated a good knowledge and practice of hand hygiene, but there are gaps that are vital to control outbreaks such as COVID-19.

Hand Hygiene Knowledge, Perception, and Practices among Domestic Visitors to the Prophet’s Mosque in Al Madinah City Amid the COVID-19 Pandemic: A Cross-Sectional Study

“…When participants were asked about their hand hygiene practices at specific high-risk situations, soap and water was the most preferred method reportedly used, followed by alcohol-based hand rubs. This finding is in parallel with the results of formerly conducted studies among attendees of Hajj and Umrah pilgrimage that found hand washing with soap and water was more prevalent than other hand hygiene methods [ 15 , 26 , 27 , 28 ]. It is also noteworthy that Saudi Arabian citizens have a preference for using soap and water to ABHR as a preventive measure against COVID-19 [ 19 ].…”

“…Similarly, approximately 27% of the Saudi Arabian citizens did not wash their hands after nose-blowing, coughing, or sneezing amidst the COVID-19 pandemic [ 17 ]. Conversely, hand hygiene compliance in this study improved slightly following other high-risk actions, e.g., about 98% of visitors of the mosque cleaned their hands after touching a patient and 99% cleaned hands following waste disposal, whereas 85% and 90% of pilgrims, respectively, during the 2019 Hajj complied [ 15 ]. Another survey involving Umrah pilgrims conducted in 2019 showed that over 90% of pilgrims washed their hands with soap and water or sanitisers after coughing and sneezing, before eating or preparing food, and after using the bathroom [ 29 ].…”

“…In spite of the recommendations of washing hands after sneezing or coughing and following handshakes to prevent contracting and spreading infections, it seems that the low compliance of hand hygiene during these situations is an issue that persists even during the pandemic. This survey shows a relatively poor hand hygiene behaviour after sneezing or coughing, with only 25.6% washing hands with soap and water and 12.6% using alcoholic hand sanitiser, as well as following handshakes (28% and 26.8%, respectively), and the largest proportion (27.6%) used a handkerchief following a sneeze, while previously, they washed hands with water and soap [ 15 ]. Similarly, approximately 27% of the Saudi Arabian citizens did not wash their hands after nose-blowing, coughing, or sneezing amidst the COVID-19 pandemic [ 17 ].…”

“…The questionnaire was devised using some exemplary questions used in a published survey conducted in 2019 by the study authors [ 15 ] and was revised by taking the COVID-19 pandemic into consideration and feedback from MG and infectious disease experts. Following the revision, the final version was prepared and grammatical discrepancies in both Arabic and English were fixed.…”

“…Studies found that hand hygiene was the most favoured infection prevention method among Hajj pilgrims prior to the COVID-19 crisis [ 12 , 13 , 14 ]. A survey conducted by our team during the Hajj 2019 demonstrated that domestic Hajj pilgrims had sound hand hygiene knowledge and practice, but there are gaps in areas that are now considered vital to contain and mitigate outbreaks such as the COVID-19 pandemic [ 15 ]; however, anecdotally, it is believed that COVID-19 campaigns may have improved the situation. The Saudi general population have shown acceptable awareness and practices towards COVID-19 [ 16 , 17 , 18 , 19 ].…”