Infection prevention in practice · 2025
Determinants of hand hygiene compliance among healthcare workers in public and private hospitals of Addis Ababa, Ethiopia.
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Melaku A, Admasu T, Ambelu A
Аннотация
INTRODUCTION: Hand hygiene is crucial for preventing hospital-acquired infections (HAIs), but compliance and resource availability still fall short in developing countries. This study examined hand hygiene compliance and its determinants among healthcare workers in selected hospitals in Addis Ababa, Ethiopia.
METHODS: A mixed-methods, cross-sectional study was conducted in both public and private hospitals from December 2024 to January 2025, involving 506 healthcare workers across 19 hospitals. Twenty in-depth interviews were conducted with healthcare workers. Kobo Toolbox was used for quantitative data collection, and SPSS was used for analysis. Binary and multi-nomial logistic regression identified determinants of hand hygiene compliance (P<0.05). Thematic analysis was used to analyse qualitative data.
RESULTS: Hand hygiene compliance showed a disparity: self-reported compliance was 71% (54.7% in public hospitals vs 87.3% in private hospitals), while observed compliance was much lower at 20.4% (11% public vs 29.8% private). Infrastructural assessment found that 79.2% of hospitals had handwashing sinks (70.9% public vs 98.6% private), 16% of which were non-functional (24.7% public vs 1.3% private). Additionally, 49.4% of hospitals lacked running water (66.8% public vs 8.6% private), and 54.6% lacked soap (79.5% public vs 9.8% private). Compliance was significantly associated with availability of a functional sink [adjusted odds ratio (AOR) 2.29, 95% confidence interval (CI) 1.17-4.51], touch-free taps (AOR 3.39, 95% CI 1.6-7.17), soap (AOR 2.11, 95% CI 1.05-4.25), training (AOR 2.39, 95% CI 1.43-4.00), and a hand hygiene protocol (AOR 7.50, 95% CI 2.84-19.81). The main barriers to compliance were infrastructural deficits, glove dependency, low risk perception, and insufficient institutional prioritization.
CONCLUSION: Hand hygiene compliance and material provision in hospitals in Addis Ababa are low, with a notable disparity between public and private hospitals. As the presence of infrastructure alone does not ensure compliance, the availability of a functional sink with water and soap at the point of care (or alcohol-based hand rub), regular hygiene training, adequate WASH funding, and strong institutional commitment are essential.
METHODS: A mixed-methods, cross-sectional study was conducted in both public and private hospitals from December 2024 to January 2025, involving 506 healthcare workers across 19 hospitals. Twenty in-depth interviews were conducted with healthcare workers. Kobo Toolbox was used for quantitative data collection, and SPSS was used for analysis. Binary and multi-nomial logistic regression identified determinants of hand hygiene compliance (P<0.05). Thematic analysis was used to analyse qualitative data.
RESULTS: Hand hygiene compliance showed a disparity: self-reported compliance was 71% (54.7% in public hospitals vs 87.3% in private hospitals), while observed compliance was much lower at 20.4% (11% public vs 29.8% private). Infrastructural assessment found that 79.2% of hospitals had handwashing sinks (70.9% public vs 98.6% private), 16% of which were non-functional (24.7% public vs 1.3% private). Additionally, 49.4% of hospitals lacked running water (66.8% public vs 8.6% private), and 54.6% lacked soap (79.5% public vs 9.8% private). Compliance was significantly associated with availability of a functional sink [adjusted odds ratio (AOR) 2.29, 95% confidence interval (CI) 1.17-4.51], touch-free taps (AOR 3.39, 95% CI 1.6-7.17), soap (AOR 2.11, 95% CI 1.05-4.25), training (AOR 2.39, 95% CI 1.43-4.00), and a hand hygiene protocol (AOR 7.50, 95% CI 2.84-19.81). The main barriers to compliance were infrastructural deficits, glove dependency, low risk perception, and insufficient institutional prioritization.
CONCLUSION: Hand hygiene compliance and material provision in hospitals in Addis Ababa are low, with a notable disparity between public and private hospitals. As the presence of infrastructure alone does not ensure compliance, the availability of a functional sink with water and soap at the point of care (or alcohol-based hand rub), regular hygiene training, adequate WASH funding, and strong institutional commitment are essential.