Behaviors and Associated Factors of Hand Hygiene and Mask-Wearing among Higher Education Students during the COVID-19 Pandemic: A Cross-sectional Study from Kingdom of Saudi Arabia

1. Introduction

The coronavirus disease 2019 (COVID-19) plays a significant role in the current global pandemic that has a harmful impact on the health and the development of the population across the world 1. The death toll due to this COVID-19 has tremendously increased and it is exponentially higher than the similar sorts of pandemic reported in certain countries. The total global death rate due to COVID-19 was 6,159,474 deaths across the world in early April 2022 which has happened within the time frame of four as soon as it has been declared by the World Health Organization (WHO) as a pandemic 2-4. According to the recent literatures the SARS-CoV-2 spreads through small droplets during normal conversation, coughing or sneezing 5.

Although the asymptomatic cases of SARS-CoV-2 started to increase throughout the globe and it also further increases the transmission of diseases which substantially increased the mortality rate. As a result of it SARS-CoV-2 has become a most serious issue in the entire world and the experts started to explore the scientific evidence in order to control the spread and mitigate the effect of COVID-19 6-7.

Currently both therapeutic and the non- therapeutic measures are available for limiting the transmission of infection caused by the SARS-CoV-2. Though the pharmaceutical are highly effective but it may not work in case of an outbreak that are caused by the variants SARS-CoV-2 pathogens. However non-pharmaceutical measures plays a vital role in reducing the risk and it also establishes the barriers to control the aerosol spread. It plays a pivotal role in protecting the vulnerable population against SARS-CoV-2 by implementing an appropriate non-medical intervention 8-9.

The Center for Disease Control and Prevention (CDC) recommends several non-medical interventions in order to control the spread of SARS-CoV-2 that includes washing hands frequently, sanitizes surface regularly, social distancing and protecting the mouth and nose with the help of face masks 10. Hand hygiene either washing the hands with the help of soap or using a chemical to disinfect the hand are considered to be the most effective non-medical interventions that could help us to prevent the nosocomial infection especially during this pandemic crisis 11-12.

A study conducted in China reported that 60% of the students in the school did not wash their hands properly even during this COVID-19 pandemic 13. However the literatures suggest that compliance with the hand hygiene completely rely on the perception and the knowledge of an individual person 14-15. Continuous efforts have been made in order to increase the compliance of hand hygiene practices especially during the pandemic crisis.

Wearing a face masks is another significant response behavior among the individual persons in order to tackle the public health problems of COVID-19. Mask is considered to be the most useful tool that helps the individuals to protect themselves against the spread of influenza pandemic and the acute respiratory infections 16. World Health Organization (WHO) recommends the healthy individual to use the non-medical masks for controlling the spread of COVID-19 particularly in the locations in which the social distancing cannot be maintained 17.

It is quite evident that even the non-medical face masks reduce the transmission of infections that is caused through the droplets and infectious aerosols 18-19. Wearing face masks not only helps the individuals who are wearing it in order to safeguard themselves but it can also provide protection for others from contracting the infection 20.

During the current pandemic situation washing hands and wearing a face masks are considered to be very important recurrently highlighted and successful preventive measures among the population across the entire world 13. During this COVID-19 pandemic crisis young adult especially the college students faced more challenges including academic pressure, employment pressure and family pressure and are considered to be the most vulnerable groups for contracting COVID-19. In order to full fill the gaps and to have a better understanding about the current trend the present study has been primarily designed to evaluate the behaviors and associated factors of hand hygiene and mask-wearing among higher education students in the Riyadh, Dammam, Jeddah, Abha, Tabuk region of the kingdom of Saudi Arabia.

2. Materials and Methods

2.1 Study design: This was a cross-sectional study.

2.2 Study setting & Study period: This study was conducted among registered students of Saudi Electronic University from all the branches during May 2021 to July 2021.

2.3 Sample size calculation: The sample size was calculated by the Raosoft statistical program 21 by taking the population (students from all branches of specialization) size as 27855, The hypothesized frequency of outcome factor in the population is 50% at a significance level of 0.05, a design effect of 1 and confidence interval of 95% ending with a minimum sample size equal 379.

2.4 Sampling technique and procedure: Students from all the colleges of Saudi Electronic University from all the branches were invited to participate in this study. Convenience sampling technique was used to recruit the study participants.

2.5 Ethical Permission: Ethical permission was obtained from the Institutional Research Ethics Committee, Saudi Electronic University, Riyadh, Kingdom of Saudi Arabia. A written informed consent was obtained from the study participants.

2.6 Study instrument and procedure:

An online structured questionnaire was developed based on the extensive literature search from various databases and the previously published scholarly literature 13 on behaviors and associated factors of hand hygiene and mask-wearing was identified, selected and used to frame the questionnaire. The first part of the questionnaire included questions on socio-demographic characteristics of the study participants (Gender, Age, Educational level, Area of specialization, Working history, Marital status & Family type). The second part of the questionnaire comprised of questions exploring the hand hygiene among the students (washing hands before eating, after toilet, after returning home, after touching public goods, before and after wearing mask, after handling animal wastes, after contacting with saliva, tears & sputum, after sneeze/cough & after rubbing nose, eyes, mouth with hands). The Third parts of the questionnaire had questions related to the masks wearing behavior of the students (kind of mask, size of mask, change of mask, correct operation of wearing a surgical mask, touching mask with hands, take off & pulling of face mask).

The behavior has been classified as good or poor based on the total scores. The score of hand hygiene behavior more than or equal to 6 points (out of 9 points) and mask wearing behavior more than or equal 5 points (out of 10 points) was classified as good behavior. (1=good; 0=poor).

2.7 Validity and Reliability: The questionnaire was validated by conducting a pilot study and test-retest reliability was done by Alpha (Cronbach's) for internal consistency and it was >0.70.

2.8 Data management and analysis: The data analysis was carried out by using SPSS (Version 16.0, SPSS Inc. Chicago, IL, USA). The demographic characteristics, hand hygiene and mask wearing behavior are described as frequencies and percentages. The association between the demographic variables and the hand hygiene and mask wearing behavior was evaluated by using the chi-square test.

3. Results

3.1 Demographic characteristics of the study population

Six hundred and thirty five students from all the branches of Saudi Electronic University from various regions of kingdom of Saudi Arabia were participated in this study. Table 1 shows the demographic characteristics of the study population; Majority (61.7%) of the participants in the study was females and 28.5% of them were in the age group between 20 to 25 years. Most of those (45.5%) were in the preparatory year; 37.5% of the students in the study were belonging to the speciality of administrative and financial sciences. More than half of the participants in the study were not working and single. However 57.8% of them living in a joint family and 60.2% of the study participants were having children at home.

Table 1: Sociodemographic characteristics of respondents (n=635)
Characteristics	Total subjects N=635
Frequency (n)	Percentage (%)
Gender
Male	243	38.3
Female	392	61.7
Age (years)
<20	94	14.8
20-25	181	28.5
26-30	162	25.5
31-35	96	15.1
>35	102	16.1
Education level
Preparatory year	289	45.5
Bachelor	275	43.3
Master	71	11.2
Specialization
Health sciences	197	31
Computing and informatics	89	14
Science and theoretical studies	99	15.6
Administrative and Financial science	238	37.5
Others	12	1.9
Currently working
Yes	292	46
No	343	54
Working Sector
Government	160	25.2
Private	124	19.5
Self-Employed	9	1.4
Unemployed	342	53.9
Marital status
Single	370	58.3
Married	240	37.8
Divorced	23	3.6
Widowed	02	0.3
Family type
Nuclear	268	42.2
Joint	367	57.8
Children at home
Yes	382	60.2
No	253	39.8

3.2 Hand Hygiene behavior among students

Hand Hygiene behavior of the students were described in the table 2. Majority of the participants in the study were washing their hands before eating, after going to toilet, after returning home after touching the public goods, after contacting with animals & animal waste, after contacting with tears, sputum and saliva, after covering with cough/sneeze. However more than half of the participants in the study did not wash their hands before and after wearing a mask. Most (44.2%) of the students in the study wash their hands with running water and scrub with hand sanitizer or soap and only 10.1% of the study participants wash their hands while rubbing eyes, nose or mouth with their hands.

Table 2: Hand Hygiene among students (n=635)
Hand Hygiene	Total subjects N=635
Frequency (n)	Percentage (%)
Wash hands
Before Eating
Yes	570	89.8
No	19	3
Not sure	46	7.2
After going to the toilet
Yes	612	96.4
No	6	0.9
Not sure	17	2.7
After returning home
Yes	530	83.5
No	35	5.5
Not sure	70	11
After touching the public goods
Yes	461	72.6
No	62	9.8
Not sure	112	17.6
Before and after wearing a mask
Yes	183	28.8
No	339	53.4
Not sure	113	17.8
After contacting with animals or handling animal feces
Yes	592	93.2
No	11	1.7
Not sure	32	5
After contacting with tears, snot, sputum and saliva
Yes	453	71.3
No	45	7.1
Not sure	137	21.6
After covering with cough or sneeze
Yes	332	52.3
No	169	26.6
Not sure	134	21.1
How do you usually wash your hands?
Use running water and scrub with hand sanitizer or soap for at least 20 seconds, and the standard seven step hand washing method was adopted	235	37
Wash your hands with the water in the basin	90	14.2
Rinse under running water	29	4.6
Use running water and scrub with hand sanitizer or soap	281	44.2
Rub your eyes, nose or mouth with your hands
Always	64	10.1
Often	289	45.5
Seldom	249	39.2
Never	33	5.2

Table 3 explains the comparison of good rate of hand hygiene among students; A positive significant association was established between the hand hygiene of students and gender (p=0.005), educational level (p=0.001) and working sector (p=0.047).

3.3 Mask-Wearing behavior among students

Mask wearing behavior and comparison of good rate of mask wearing behavior among students are illustrated in the table 4; Majority (75.4%) of the students in the students was using the mask while going out. Most (66.9%) of them were using the disposable medical mask and 30.2% of the students were always choosing the right size of the mask based on its features. 44.6% of the participants in the study were daily changing their mask and more than half of the study participants were wearing the mask by themselves in a correct way. 46.8% of the students were touching the front of the mask with their hands and majority (80.3%) of the students were feel free to take off the mask of them or others. 36.1% of the students in the study pulled the mask down to reveal the nose or mouth.

A positive significant association was established between the mask wearing behavior among study participants and currently working (p=0.012) and working sector (p=0.025).

4. Discussion

The present study focused on assessing the behaviors and associated factors of hand hygiene and mask-wearing among higher education students in the kingdom of Saudi Arabia. It appeared that greater portion of students in the study had good behavior regarding the hand hygiene and wearing the face mask however it was witnessed from this study that considerable numbers of students were still having a poor compliance in performing an essential and also basic preventive measures towards COVID-19 like hand washing and wearing a face mask.

The findings of the current study were based on the nationally represented student population of kingdom of Saudi Arabia. The present study also highlights the importance of preventive behaviors inclusive of hand hygiene and mask wearing during the ongoing pandemic situation.

The results of the present study declared that greatest numbers of the participants in the study were adequately using most of the preventive measures against COVID-19 which is similar to the findings of several studies that has been conducted in different parts of the world 22-26. Amongst the several hand hygiene moments practiced by the participants in the current study higher compliance was observed during contact with animals or handling animal feces. However previously conducted studies 27 reported higher compliance rate of hand washing was observed during the high touch surfaces which were in contrast to the findings of the present study.

The unique finding of the current study is the hand hygiene behavior varies based on the gender. The study found a statistically significant positive association between the hand hygiene behavior and gender. Similarly a study conducted by Olaimat et al. 28 in Jordan found that the female students were more appropriately practicing the hand hygiene in comparison with their male counterparts and this may be due to the cautious nature of females which is similar to the findings of the present study.

Approximately fifty percent of the students in the present study were washing their hands after sneezing or coughing. Likewise in a study conducted in Vietnam 29 less than half of the participants in the study were washing their hands after sneezing or coughing which is comparatively a lesser proportion than the present study. Another important finding of the current study is that a positive association was established between the hand hygiene and the working sector.

In the present study; most of the students used running water and scrub with hand sanitizer or soap to wash their hands. However in the study conducted among the university students in Vietnam 29 used alcohol-based handrub in all the circumstances including those requiring hand washing with water and soap which is in contrast to the findings of the current study.

Three-fourth of the students in this study were always using a face mask while going out; Nevertheless in the study conducted in Greece 30 showed that almost three fourth of the participants in their study were using face mask while going out of their home which is similar fraction in comparison with the present study. Likewise in a study conducted by Falk et al 31 among the students in the rural k-12 schools in the United States regarding the mask wearing behavior found that the compliance was higher among the students; however still there was quite alarming rate of non-compliance among the students which is similar to the findings of the current study.

Similarly a study that has been conducted in the United States 32 among the high school students reported that the majority of the students wore mask all the time in the classroom; however lower compliance on wearing mask was reported on the school buses, restroom and during extra-curricular activities which is also supporting the findings of the present study. Likewise a study carried out by Al Naam et al 33 in the kingdom of Saudi Arabia among the children and the young adults found that three fourth of the study participants were having a good compliance score of wearing mask which is acknowledging the results of this study.

The current study showed no significant positive association between the mask wearing and the age group. However a study carried out by Beckage et al 34 in the United States among the community members found that mask wearing behavior decreases with decreasing age and increases with increasing age which clearly shows that the usage of face mask varies based on the age group which is in contrast to the findings of the present study. Likewise a study carried out by Szablewski et al 35 also explained that the mask wearing compliance among the students varied based on the age group; it increased with increasing ages which is controversial to the findings of the current study.

There was no statistically significant association between the mask wearing behavior and the gender in the present study. In a study conducted in china among the students by Hou et al 36 there was a positive association between the gender and the mask wearing behavior which clearly stated that girls were less likely to wear mask in comparison with the boys which is contradictory to the findings of this study. Similarly, a study conducted in china 37 among the students found that the mask wearing behavior varies based on the gender which is also opposite to the findings of the present study.

The present study showed only slightly higher than one-fourth of the students were wearing the mask correctly. A study carried out by the Mueller et al 38 showed that almost three-fourth of the students in the study were wearing the mask properly which is higher fraction in comparison with the findings of the current study. The unique findings of the present study are there was a statistically significant positive association between the mask wearing behavior and the working status and the working sector.

There was no positive association between the mask wearing behavior and the educational level of the students in the present study. A study conducted by DeJonckheere et al 39 found that there was no statistical significance between the mask wearing behavior among the students and their educational level which is in concurrence with the results of the present study.

5. Limitations

The results of the study should be interpreted with the following limitations. The participants in the study were enrolled using the convenience sampling therefore there may be selection bias that affects the generalizability of the results. This was a cross-sectional study which failed to identify the longitudinal factors of the purpose of wearing face mask in order to overcome this there is a need to conduct a longitudinal studies in the near future for determining the hand hygiene and mask wearing behavior among the university students.

6. Conclusion

Majority of the participants in the study were showing an adequate hand washing and mask wearing behavior. However it is also evident that some of the students were still not having the compliance with the preventive behavior inclusive of hand washing and mask wearing even during this ongoing pandemic situation. There is a need for routine behavioral educational programs at the university level that particularly emphasizing on the significance of hand hygiene and wearing mask in preventing the infectious diseases. The government and the policy makers also should create awareness among the students by sensitizing the problems and advocating the need for proper preventative measures.

References

1. Santarpia JL, Rivera DN, Herrera V, Morwitzer J, Creager H, Santarpia G, et al. Transmission potential of SARS-CoV-2 in viral shedding observed at the University of Nebraska Medical Center. medRxiv 2020.

2. Mallapaty, S. Why does the coronavirus spread so easily between people? Available from: https://www.nature.com/ articles/. Accessed August 16, 2021.

3. World Health Organization (WHO). Severe Acute Respiratory Syndrome (SARS). Available from: https:// www.who.int/ith/diseases/sars/en/. Accessed August 16, 2021.

4. Centers for Disease Control and Prevention (CDC). (2020). National Center for Immunization and Respiratory Disease (NCIRD). How to protect yourself and others. Available from: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html. Accessed August 16, 2021.

5. Howard J, Huang A, Li Z, Tufekci Z, Zdimal V, van der Westhuizen HM, et al. An evidence review of face masks against COVID-19. Proc Natl Acad Sci U S A. 2021; 118.

6. Cowling BJ, Ali ST, Ng TWY, Sang TKT, Julian CMLi, Fong MW, et al. Impact assessment of non-pharmaceutical interventions against coronavirus disease 2019 and influenza in Hong Kong: an observational study. Lancet Public Health 2020;5:279-88.

7. Paules CI, Marston HD, Fauci AS. Coronavirus infections— more than just the common cold. The Journal of the American Medical Association. 2020;323:707-708.

8. Aiello, A.E, Perez, V, Coulborn, R.M., Davis, B.M, Uddin, M., Monto, A.S. Facemasks, Hand Hygiene, and Influenza among Young Adults: A Randomized Intervention Trial. PLoS ONE 2012, 7: 29744.

9. E Aledort J, Lurie N, Wasserman J A, Bozzette S. Non-pharmaceutical public health interventions for pandemic influenza: an evaluation of the evidence base. BMC Public Health. 2007, 7: 208.

10. Davis R. E, Sharma M., Simon K E, Wilkerson AH. Conceptualization of College Students' COVID-19 Related Mask-Wearing Behaviors Using the Multi-Theory Model of Health Behavior Change. Health Promotion Perspectives, 2021; 11:194-201.

11. WHO guidelines on hand hygiene in health care. World Health Organization. 2019. https://www.who.int/publications/i/item/whoguidelines-on-hand-hygiene-in-health-care. Accessed August 16, 2021.

12. Hagel S, Ludewig K, Pletz MW, Frosinski J, Moeser A, Wolkewitz M, et al. Effectiveness of a hospital-wide infection control programme on the incidence of healthcare-associated infections and associated severe sepsis and septic shock: a prospective interventional study. Clin Microbiol Infect. 2019:462–468.

13. Chen X, Ran L, Liu Q, Hu Q, Du X, Tan X. Hand hygiene, mask-wearing behaviors and its associated factors during the COVID-19 epidemic: a cross-sectional study among primary school students in Wuhan, China. Int J Environ Res Public Health. 2020;17:2893.

14. Shiina A, Niitsu T, Kobori O, Idemoto K, Hashimoto T, Sasaki T, et al. Relationship between perception and anxiety about COVID-19 infection and risk behaviors for spreading infection: a national survey in Japan. Brain Behav Immun Health. 2020;6;100101.

15. Lammers J, Crusius J, Gast A. Correcting misperceptions of exponential coronavirus growth increases support for social distancing. Proc Natl Acad Sci. 2020; 117:16264-16266.

16. Smith JD, MacDougall CC, Johnstone J, Copes RA, Schwartz B, Garber GE. Effectiveness of N95 respirators versus surgical masks in protecting health care workers from acute respiratory infection: a systematic review and meta-analysis. CMAJ 2016;188:567-74.

17. World Health Organization, “Advice on the use of masks in the context of COVID-19: Interim guidance, 2020” (Rep. WHO/2019-nCov/IPC_Masks/2020.4, World Health Organization, 2020).

18. Leung NHL, Chu DKW, Shiu EYC, Chan KH, McDevitt JJ, Hau BJP, et al., Respiratory virus shedding in exhaled breath and efficacy of facemasks. Nat. Med. 2020; 26: 646–680.

19. Eikenberry SE, Mancuso M, Iboi E, Phan T, Eikenberry K, Kuang Y, et al. To mask or not to mask: Modeling the potential for face mask use by the general public to curtail the COVID-19 pandemic. Infect Dis Model. 2020; 5:293-308.

20. K. A. Prather, C. C. Wang, R. T. Schooley, Reducing transmission of SARS-CoV-2. Science.2020;368:1422–1424.

21. Raosoft, Sample size calculator, 2004. Available from http://www.raosoft.com/samplesize.html.

22. Nivette A, Ribeaud D, Murray A, Steinhoff A, Bechtiger L, Hepp U, et al. Non-compliance with COVID-19-related public health measures among young adults in Switzerland: Insights from a longitudinal study. Soc SciMed. 2021; 268: 113370.

23. Ferdous MZ, Islam MS, Sikder MT, Mosaddek ASM, Zegarra-Valdivia JA, Gozal D. Knowledge, attitude, and practice regarding COVID-19 outbreak in Bangladesh: an online-based cross-sectional study. PLoS One. 2020;15: e0239254.

24. Glabska D, Skolmowska D, Guzek D. Population-based study of the influence of the COVID-19 pandemic on hand hygiene behaviors- polish adolescents’ COVID-19 experience study. Sustainability. 2020;12:4930.

25. Taghrir MH, Borazjani R, Shiraly R. COVID-19 and Iranian medical students; a survey on their related-knowledge, preventive behaviors and risk perception. Arch Iran Med. 2020;23: 249-254.

26. Natnael T, Alemnew Y, Berihun G, Abebe M, Andualem A, Ademe S, et al. Facemask wearing to prevent COVID-19 transmission and associated factors among taxi drivers in Dessie City and Kombolcha Town, Ethiopia. PLoS One. 2021; 12;16:0247954.

27. Liyanage, G., Dewasurendra, M., Athapathu, A, Magodarathne L. Hand hygiene behavior among Sri Lankan medical students during COVID-19 pandemic. BMC Med Educ, 2021;21:333.

28. Olaimat, A. N., Aolymat, I., Elsahoryi, N., Shahbaz, H. M., & Holley, R. A. Attitudes, Anxiety, and Behavioral Practices Regarding COVID-19 among University Students in Jordan: A Cross-Sectional Study. American Journal of Tropical Medicine and Hygiene, 2020;103.

29. Duong MC, Nguyen HT, Duong BT, VU MT. An assessment of hand hygiene practices of university students in Vietnam amid the COVID-19 pandemic: A brief report. Disaster Medicine and Public Health Preparedness 2021; 1–11.

30. Mouchtouri VA, Agathagelidou E, Kofonikolas K, Rousou X, Dadouli K, Pinaka O, et al. Nationwide survey in Greece about knowledge, risk perceptions, and preventive behaviors for COVID-19 during the general lockdown in 2020. Int J Environ Res Public Health.2020;17:8854.

31. Falk A, Benda A, Falk P, Steffen S, Wallace Z, Hoeg TB. COVID-19 cases and transmission in 17 K-12 schools - Wood County, Wisconsin, 2020. MMWR Morb Mortal Wkly Rep 2021;70:136-40.

32. COVID-19 Stats: percentage of middle and high school students aged 13-21 years attending in-person classes who reported observing fellow students wearing a mask all the time, by school setting and activity - United States, 2020. MMWR Morb Mortal Wkly Rep. 2021;70:223. Available from: https://doi.org/10.15585/mmwr.mm7006a5.

33. Al Naam YA, Elsafi SH, Alkharraz ZS, Alfahad OA, Al-Jubran KM, Al Zahrani EM. Community practice of using face masks for the prevention of COVID-19 in Saudi Arabia. PloS One. 2021;16:0247313.

34. Beckage B, Buckley TE, Beckage ME. Prevalence of face masks wearing in northern Vermont in response to the COVID-19 pandemic. Public Health Rep. 2021;136:451-6.

35. Chu VT, Yousaf AR, Chang K, Schwartz NG, McDaniel CJ, Lee SH, et al. Household transmission of SARS-CoV-2 from children and adolescents. N Engl J Med. 2021.

36. Hou Z, Song S, Du F, Shi L, Zhang D, Lin L, et al. The influence of the COVID-19 epidemic on prevention and vaccination behaviors among Chinese children and adolescents: cross-sectional online survey study. JMIR Public Health Surveill. 2021;7:26372.

37. Zhang M, Li Q, Du X, Zuo D, Ding Y, Tan X, et al. Health behavior toward COVID-19: the role of demographic factors, knowledge, and attitude among Chinese college students during the quarantine period. Asia Pac J Public Health. 2020;32:533-5.

38. Mueller AS, Diefendorf S, Abrutyn S, Beardall KA, Millar K, O'Reilly L, et al. Youth mask-wearing and social-distancing behavior at in-person high school graduations during the COVID-19 pandemic. J Adolesc Health. 2021;68:464-71.

39. DeJonckheere M, Waselewski M, Amaro X, Frank A, Chua KP. Views on COVID-19 and use of face coverings among U.S. youth. J Adolesc Health. 2021; 68:873-81.

Table 3: Comparison of good rate of hand hygiene among students (n=635)
Category	Group	Hand Hygiene
Good/Poor rate χ2 p
Gender	Male Female	147/96 20.17 0.005*293/99
Age	<2020-2526-3031-35>35	116/65 40.87 0.055114/4868/2871/2371/31
Educational Level	Preparatory yearBachelorMaster	214/75 21.95 0.001*185/9041/30
Area of Specialization	Health sciencesComputing and informaticsScience and theoretical studiesAdministrative and Financial scienceOthers	134/63 35.54 0.15555/3468/31175/6308/04
Currently working	YesNo	189/103 13.42 0.063251/92
Working sector	Government Private Self-Employed Unemployed	112/48 32.92 0.047*72/5206/03250/92
Marital status	Single	251/119 16.81 0.723
Married	168/72
Divorced	19/04
Widowed	00/02
Family type	Nuclear	184/84 05.34 0.618
Joint	256/111
Children at home	Yes	267/115 03.53 0.832
No	173/80

*P<0.05, Statistically Significant

Table 4: Mask wearing behavior & Comparison of good rate of mask wearing behavior among students (n=635)
Mask wearing behavior	Total subjects N=635
Frequency (n)	Percentage (%)
How often do you wear a mask when you go out?
Always	479	75.4
Often	120	18.9
Seldom	28	4.4
Never	8	1.3
What kind of mask do you usually choose?
Cotton yarn mask	79	12.4
Disposable medical mask	425	66.9
Medical surgical mask	43	6.8
Medical protective mask	41	6.5
Particulate protective mask	15	2.4
Other types	32	5
Will you choose the right size mask according to your features?
Always	192	30.2
Often	168	26.5
Seldom	129	20.3
Never	146	23
How often do you change your mask?
2-4 hours	214	33.7
1 day	283	44.6
2-5 days	74	11.7
More than 5 days	24	3.8
I do not replace the new mask, and continue to use it after cleaning	40	6.3
What is the correct operation for wearing a surgical mask?
Distinguish the inside and outside of the mask, as well as the top and bottom. The mask is light inside and dark outside, and there are metal strips (nose clips) on the top	297	46.8
Fully unfold the folded face of the mask to cover the nose, mouth and chin	94	14.8
Put the fingertips of both hands on the nose clip, start from the middle position, and shape the nose clip according to the shape of the nose bridge	104	16.4
Check whether the edge of the mask fits your face	43	6.8
Wear at will regardless of the front and back	63	10
Never wear a mask	34	5.4
How do you usually wear a mask?
Wear it by yourself, but never in the correct way	36	5.7
Wear it by yourself, but rarely in the correct way	35	5.5
Wear it by yourself, and often in the correct way	200	31.5
Wear it by yourself, and always in the correct way	341	53.7
Never wear a mask	23	3.6
Touch the front of the mask with your hand
Yes	297	46.8
No	187	29.4
Not sure	151	23.8
Feel free to take off the mask of yourself or others
Yes	510	80.3
No	56	8.8
Not sure	69	10.9
Take off the mask and put it back on
Yes	307	48.3
No	233	36.7
Not sure	95	15
Pull the mask down to reveal the nose or mouth
Yes	229	36.1
No	289	45.5
Not sure	117	18.4

Category	Group	Hand Hygiene
Good/Poor rate χ2 p
Gender	Male Female	21/222 13.07 0.11046/346
Age	<2020-2526-3031-35>35	13/81 34.64 0.34321/16018/14412/8403/99
Educational Level	Preparatory yearBachelorMaster	36/253 11.88 0.75226/24905/66
Area of Specialization	Health sciencesComputing and informaticsScience and theoretical studiesAdministrative and Financial scienceOthers	27/170 32.98 0.41906/8311/8822/21601/11
Currently working	YesNo	24/268 07.75 0.012*43/300
Working sector	Government Private Self-Employed Unemployed	16/144 28.97 0.025*22/10200/0943/299
Marital status	Single	49/321 20.33 0.678
Married	16/224
Divorced	02/21
Widowed	01/01
Family type	Nuclear	26/242 05.81 0.670
	Joint	41/326
Children at home	Yes	41/341 06.97 0.540
	No	26/227

*P<0.05, Statistically Significant