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Hygiene behavior in persons with type 2 diabetes

Published:April 21, 2014DOI:https://doi.org/10.1016/j.ajic.2014.03.010
      To the Editor:
      Hygiene behavior is the sum of regular practices and behaviors associated with the prevention of infection transmission.
      • Nicolle L.
      Hygiene: what and why?.
      There are safe, effective, and cost-effective methods of reducing and preventing the spread of communicable diseases.
      • Stevenson R.J.
      • Case T.I.
      • Hodgson D.
      • Porzig-Drummond R.
      • Barouei J.
      • Oaten M.J.
      A scale for measuring hygiene behavior: development, reliability and validity.
      Such behavior protects individuals against exposure to bacterial and viral infections. Good hygiene behavior is the most effective way to prevent the spread of communicable disease by interrupting the transmission of microorganisms that cause infection both in the community and in health care settings. Hygiene promotion empowers people to prevent disease.
      • Burnett E.
      Perceptions, attitudes, and behavior towards patient hand hygiene.
      Poor hygiene is one of the important behavioral risk factors contributing to the global burden of diseases.
      • Dorri M.
      • Sheiham A.
      • Watt R.G.
      Relationship between general hygiene behaviours and oral hygiene behaviours in Iranian adolescents.
      Collecting accurate information on hygiene practices is challenging.
      • Unicomb L.E.
      Food safety: pathogen transmission routes, hygiene practices and prevention.
      Therefore good hygiene behavior must be acknowledged.
      Good hygiene behavior is an issue of concern for persons with type 2 diabetes. Patients with type 2 diabetes are immune-compromised and therefore have a higher susceptibility to infections and sepsis.
      • Koh G.C.
      • Peacock S.J.
      • van der Poll T.
      • Wiersinga W.J.
      The impact of diabetes on the pathogenesis of sepsis.
      Diabetes seems to be an independent risk factor for bacterial infections, including selected types of (rare) infections.
      • Knapp S.
      Diabetes and infection: is there a link? A mini-review.
      Maintaining a high level of hygiene behavior will minimize the chances of developing infections. The hygiene behavior of persons with type 2 diabetes has not been well studied to date.
      The aim of our study was to examine the level of hygiene behavior among persons with type 2 diabetes followed in a diabetes outpatient clinic. The results could be used by health care professionals as a guide to adopting and promoting appropriate measures to improve the hygiene behavior of patients with type 2 diabetes.
      We performed a descriptive study at the University Research and Practice Hospital in Kocaeli, Turkey, during October 2013. The study was conducted in a convenience sample of patients whose treatment was being followed at the diabetes outpatient clinic. Participants volunteered to take part in the study, were literate, were older than age 18 years, and none of the woman were pregnant. Data were gathered using a patient information form and a hygiene inventory scale instrument (HI123). Participants’ consent was obtained to use their answers for the purpose of our study. Statistical analysis was performed using SPSS software (SPSS for Windows version 16.0; IBM-SPSS Inc, Armonk, NY).
      The HI23 scales have been used to identify populations' hygiene behavior.
      • Stevenson R.J.
      • Case T.I.
      • Hodgson D.
      • Porzig-Drummond R.
      • Barouei J.
      • Oaten M.J.
      A scale for measuring hygiene behavior: development, reliability and validity.
      HI23 comprises 5 subscales: general, household, food-related, handwashing technique, and personal hygiene.
      • Stevenson R.J.
      • Case T.I.
      • Hodgson D.
      • Porzig-Drummond R.
      • Barouei J.
      • Oaten M.J.
      A scale for measuring hygiene behavior: development, reliability and validity.
      • Altun I.
      • Dede Cinar N.
      • Cinar C.
      Psychometric properties of the hygiene inventory in a Turkish population.
      The HI23 scale consist of 23 items assessed in 5-point Likert scale with a potential score range 23-92, with higher scores indicating more frequent or higher levels of these practices and representing greater hygiene behavior. It has previously been shown to be a reliable and valid measure of hygiene behavior in the general population with good psychometric properties.
      • Stevenson R.J.
      • Case T.I.
      • Hodgson D.
      • Porzig-Drummond R.
      • Barouei J.
      • Oaten M.J.
      A scale for measuring hygiene behavior: development, reliability and validity.
      • Altun I.
      • Dede Cinar N.
      • Cinar C.
      Psychometric properties of the hygiene inventory in a Turkish population.
      In our study Cronbach’s alpha coefficients calculated using the whole sample (n = 120) revealed high levels of internal consistency for the total 23-item scale (Cronbach’s α = 0.83).
      Mean age of the study participants was 51.9 ± 1.1 years (range, 21-85 years), and 65.8% (n = 79) were women. Forty percent (n = 48) of participants were aged 51-61 years, 87.5% (n = 105) reported being married, and 31.7% (n = 38) had 2 children. With regard to educational status, 42.5% (n = 51) of patients were primary school graduates. With regard to the treatment regimen, 51.7% (n = 62) of patients were taking oral antidiabetic drugs. The mean duration of type 2 diabetes was 6.9 ± 0.6 years.
      The mean score was 3.28 ± 0.38; ranging from 2.46 ± 1.08 to 3.79 ± 0.84. Mean scores for general hygiene were 3.55 ± 0.39, for household hygiene were 3.71 ± 0.60, for food-related hygiene were 3.16 ± 0.49, for hand hygiene technique were 3.18 ± 0.48, and for personal hygiene were 2.65 ± 0.80.
      The mean individual item score for the HI23 was 3.28 ± 0.38, which was higher than that reported (2.90 ± 0.42) by Stevenson et al
      • Stevenson R.J.
      • Case T.I.
      • Hodgson D.
      • Porzig-Drummond R.
      • Barouei J.
      • Oaten M.J.
      A scale for measuring hygiene behavior: development, reliability and validity.
      and that reported (3.08 ± 0.94) by Altun et al.
      • Altun I.
      • Dede Cinar N.
      • Cinar C.
      Hygiene behaviour in university students in Turkey.
      In our study, higher scores resulted from questions related to household hygiene and general hygiene. In our study, lower scores resulted from questions related to personal hygiene. This result was not similar to those of the Stevenson et al
      • Stevenson R.J.
      • Case T.I.
      • Hodgson D.
      • Porzig-Drummond R.
      • Barouei J.
      • Oaten M.J.
      A scale for measuring hygiene behavior: development, reliability and validity.
      study in Australian populations. However this result is similar to those of other studies in Turkey.
      • Altun I.
      • Dede Cinar N.
      • Cinar C.
      Psychometric properties of the hygiene inventory in a Turkish population.
      • Altun I.
      • Dede Cinar N.
      • Cinar C.
      Hygiene behaviour in university students in Turkey.
      In terms of hygiene behavior profiles of persons with type 2 diabetes, items 2-11, 13, 16, and 17 recorded a median score of 4 (range, ≤3), which was significantly better than items 1, 12, 14, 15, and 18-23, which recorded a median score of 3 (range, ≤3). An important finding is that Australian populations were more likely to focus on items 20, 21, 22, and 23 than Turkish students and persons with type 2 diabetes.
      Hygiene behavior was found to be less than ideal in our study population, indicating the need for proper training and health education through health professionals (ie, physicians, nurses, and foot care specialists).

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