Clean Hands, Safe Care: Role of hand hygiene training interventions in improving knowledge and Hand hygiene compliance rate among healthcare workers

Background: Hand hygiene (HH) is proven low-cost crucial intervention to curtail the problem of hospital-acquired infection (HAI). Appropriate adherence to HH practices by health care workers (HCWs) reduces the risk of transmission of pathogens and thus the incidence of hospital acquired infections (HAIs), in health care settings. Regular HH training with strict monitoring and auditing of this simple, cost-effective intervention is very important, as it significantly contributes in reducing the HAIs. Methodology: The study was performed amongst HCWs of all cadres (doctors, nurses, hospital attendants and sanitary attendants) of a 250 bedded surgical centre of a large tertiary care hospital over 2 years (2022-2023). Various interventions were performed to educate staff which included: frequent 1-hour training session on the WHO's 5 moments of HH; various quiz/ contests on HH; display of HH posters/ education material throughout the facility showing the 5 moments of HH as well as the method of hand wash; appreciation of the best HH performer with encouragement to all others. HH audits were conducted in the ICUs and wards daily, by the trained infection control nurses (ICNs), using direct observation method based on World health organization (WHO) HH observational forms. The results were compiled separately for all the cadres of HCWs. An assessment of the knowledge, attitude and practice of the HCWs was assessed towards the Hand Hygiene methodology, necessity and their compliance was also assessed. The knowledge was checked using a set of 25 questions given pre- and post- training. Results: The intervention significantly improved HH knowledge levels and compliance rates among the participants. The average compliance amongst the doctors increased from 51% to 53%; amongst nurses from 46.8% to 50%; amongst hospital attendants from 42.5% to 50.5% and amongst sanitary attendants from 35.4% to 47.1%. a statistically significant hand hygiene compliance rate was observed amongst the sanitary attendants (p value =0.02). Discussion: This study underscores the potential of training and education in elevating HH compliance and knowledge among healthcare workers. Routine incorporation of such interventions into the infection control programs in the healthcare facilities would help decrease the risk of Healthcare Associated Infections as well as improve patient and HCW safety. However, continuous monitoring and reinforcement with timely feedback for intervention and regular auditing is necessary to improve and maintain the appropriate HH practices among the HCWs. However, more research is needed to understand how much of a reduction in HAI is directly associated with efficient HH by health workers. Conclusion: Low- and middle-income countries need to focus more on Hand Hygiene compliance, a simple low-cost promising measure, to combat the increasing HAI rates.