Hand hygiene knowledge, attitudes, and perceptions of chiropractic students pre- and post-COVID-19 pandemic.

Objective: The objective of this study was to compare the hand hygiene knowledge, attitudes, and perceptions of chiropractic students from a graduating class before (pre-COVID-19) and after the COVID-19 pandemic (post-COVID-19) using the World Health Organization (WHO)'s standardized questionnaires. Methods: The questionnaire was distributed to participating pre-COVID-19 ( Results: Participants focused more on environmental contributions as a possible cause of healthcare-associated infections, rather than on the risk of poor hand hygiene among health care workers and the patient being a vector for cross-contamination. The participants may have perceived the transmission of pathogens to the patient as minimal after treatment of the patient and leaving the clinical or practice environment. Less consideration was also given to the risk of transmission to the health care worker before the commencement of treatment. An exceptionally high percentage use of alcohol-based hand rub was indicated, irrespective of whether it was pre-COVID-19 or post-COVID-19, which may be related to the physical requirements of the chiropractic environment. An increased need for peers or colleagues to be aware that hand hygiene was being performed, especially among the post-COVID-19 group, was noted. Conclusion: A decline in hand hygiene knowledge among chiropractors as it relates to the understanding of healthcare-associated infection transmission was noted. Misconceptions and an overemphasis on surface transfer-likely influenced by COVID-19 messaging-highlight the need for re-education aligned with WHO guidelines. The low awareness of the WHO Five Moments for Hand Hygiene model points to the importance of incorporating structured training into chiropractic education.