Hand hygiene compliance among healthcare workers before and after a CFIR-guided role-stratified intervention: a mixed-methods study in a tertiary hospital.

INTRODUCTION

This study aimed to evaluate hand hygiene compliance among healthcare workers of different roles, identify key barriers using the Consolidated Framework for Implementation Research (CFIR), and assess the effectiveness of a CFIR-guided stratified intervention in a tertiary hospital.

METHODS

An exploratory sequential mixed-methods study was conducted at Beijing Hospital, National Center of Gerontology, from December 2024 to September 2025. The observational phase included 9,767 non-announced direct observation hand hygiene observations and a survey of 275 staff (71 physicians, 173 nurses, 31 support staff), supplemented by 15 semi-structured interviews. A six-month CFIR-guided intervention was then implemented, incorporating role-specific training sessions, data-driven feedback, visual reminders, and position-based supervision tailored to physicians, nurses, and support staff. Outcomes included hand hygiene compliance and correctness, knowledge scores, and hospital-acquired infection (HAI) rates.

RESULTS

At baseline, compliance differed by role: nurses 81.6%, physicians 72.6%, and support staff 39.3% (p < 0.001). Knowledge scores were significantly lower among support staff (58.6 ± 9.4) than physicians and nurses (66.1 ± 6.9, p < 0.001). Qualitative interviews and CFIR-based surveys identified barriers including workflow constraints, insufficient supervision, inadequate training coverage, and knowledge gaps. Following the intervention, overall compliance increased from 74.9 to 85.4% (p < 0.001), with the largest improvement among support staff (39.3% vs. 56.0%, p = 0.002). Compliance improved across all "five moments," particularly before patient contact (+18.5%, p < 0.001). HAI rates were lower from 3.05 per 1,000 patient-days to 1.66 per 1,000 patient-days (p = 0.002), with reductions observed in respiratory, urinary tract, bloodstream, and surgical site infections during the study period.

CONCLUSION

Hand hygiene compliance varies substantially across healthcare worker roles, with support staff representing a critical gap. A CFIR-guided, stratified intervention was associated with increases in compliance and correctness, particularly at high-risk moments, and reduced HAI incidence, suggesting its potential value as a sustainable framework for hospital-wide infection prevention.