**5. Discussions and conclusion**

#### **5.1 Discussions**

Different studies have concluded that there are other factors affecting hand hygiene behavior. For example, Zimakoff et al. [25] concluded by identifying few other factors affecting hand hygiene such as skin irritation and dryness as the leading factors affecting handwashing in health care. The same authors affirmed that there are other possible factors not covered in the scope of the research. Likewise, in 1982, Larson and Killien concluded that it is imperative to identify factors that are the antecedents to whether the individual decides to wash one's hands or not as they are critical in the prevention or intervention plans to improve handwashing practice. The same authors further ascertained that most emphases are placed on the importance of handwashing instead of other factors affecting people's behavior toward handwashing compliance. The results of this study supported that there are other factors different from training people and showing people how to practice hygiene properly. Researchers are now focusing on the growing literature about the other factors affecting hand hygiene behavior.

Day by day, researchers are focusing on other factors that could affect hand hygiene behavior, none or few have looked into the structure and redesign of restrooms. This study investigated the people's experience in the restroom, why handwashing compliance is low, and other factors, which could affect hand hygiene behavior. A significant proportion of the participants requested for restroom redesign for their health safety. A significant finding from this study is that about 83% of the participants suggested alert systems to remind restroom users to wash hands after use. The participants also reported the significance of other factors like an automated sink, soap dispenser, water dispenser, dryer devices as well as ergonomically designed doors. The participants unanimously believe that ergonomically designed door (pull and push type) would reduce touch and greatly enhance health safety. The above data results reflect restroom equipment, structure, cleanliness, and comfortability have significant effects on hand hygiene behavior. The results from this study supported other researchers who found that there are other factors

affecting hand hygiene behavior, rather than just training and those factors should be focused on in order to improve handwashing practices.

### **5.2 Conclusion**

The handwashing procedure is a little monotonous, especially for healthcare professionals, and can be frustrating or become things of no interest when relevant factors are not available and very challenging in different ramifications. The low compliance of handwashing is a significant issue around the world as reported in several literatures. Appropriate handwashing practices can reduce the risk of foodborne illness and prevent transmission of viral infections, especially those that spread through droplets from coughs and sneezes. Besides, among many other hygiene practices, poor handwashing is the most common practice among the younger generation. The message and the information about handwashing or hand hygiene has been around for over 200 years, yet the level of compliance is low as revealed from this study. Thus, this study details another factor affecting handwashing hygiene after the use of public restrooms and suggests how hand hygiene could be improved in human daily behavior. The findings of this study revealed that restroom designs and structures have significant effects on hand hygiene behavior based on participant's opinions from the survey. Redesign to include visual and auditory alerts will be necessary for most of the public restrooms to enhance user's awareness for handwashing after use. Findings from this study suggest for a restroom redesign to include auto-sensor soap and water dispenser, dryers, and touchless doors. Findings further revealed that inclusion of hygiene training in all college's education curriculums at every level would encourage user's handwashing hygiene lifestyle and behavior. The findings from this study could help identify the design structures for ensuring more compliance with handwashing hygiene and health safety practice among the public. Further research is needed in this direction to investigate how other factors aside from the aforementioned could potentially discourage individuals from making hand hygiene a daily behavior.
