Shifting drivers: a longitudinal analysis of hand hygiene compliance in a dental hospital from the COVID-19 pandemic to the postpandemic era.

BACKGROUND

Hand hygiene is crucial for preventing infections, especially in dentistry with its high exposure to saliva, blood, and aerosols. While the COVID-19 pandemic temporarily improved practices, the long-term evolution and key drivers of hand hygiene compliance (HHC) in dental hospitals across different pandemic phases remain poorly understood.

METHODS

We conducted a longitudinal study (Jan 2020-Jun 2025) at a tertiary dental hospital in China, assessing HHC using the World Health Organization "Five Moments" framework. An Autoregressive Integrated Moving Average with Exogenous Variables (ARIMAX) model identified key drivers - facility adequacy, knowledge rate, microbial monitoring pass rate, per capita consumption, and patient visits - and examined changes in their effects between pandemic and postpandemic periods.

RESULTS

Overall HHC increased from 84.6% to over 89.0%. An ARIMAX model revealed that facility adequacy was the strongest predictor during the pandemic (β=0.74, P<0.001), but its effect diminished postpandemic (interaction β=-0.58, P=0.001). Knowledge rate and monitoring pass rate remained stable positive predictors, with knowledge's importance growing postpandemic. Nurses showed the highest HHC (>94%), while interns and cleaning staff had the lowest. Compliance was the highest "after body fluid exposure" and lowest "before touching a patient'."

CONCLUSION

HHC drivers in dental hospitals are dynamic and phase dependent. Infrastructure was critical during the pandemic, while knowledge and practice quality gained prominence postpandemic. Sustained improvement requires shifting from infrastructure investment to fostering an internalized hand hygiene culture, with targeted strategies for underperforming staff and moments.