Qualitative and quantitative evaluation of hand hygiene knowledge, attitudes, and practices among healthcare workers in Quetzaltenango, Guatemala in the COVID-19 context

Healthcare workers and patients are at continual risk for healthcare-associated infections due to poor hand hygiene. Programs that support appropriate hand hygiene practices may mitigate this risk, although implementation is challenged by several barriers, including limited availability of hand hygiene products at the point of care, as described by the world health organization (WHO). In this study, we used mixed methodologies, including in-depth interviews and surveys to assess the knowledge, attitudes, practices, and barriers to appropriate hand hygiene practices among healthcare workers from 19 public primary and secondary healthcare facilities in Quetzaltenango, Guatemala. The qualitative data analyzed by thematic axes and quantitative data are described. We found that healthcare workers have a strong understanding of the importance of hand hygiene and how it contributes to patient health. We encountered knowledge gaps about the route of transmission of pathogens and how to prevent spread. Nevertheless, healthcare workers acknowledged the importance of training programs to strengthen hand hygiene practices. Potential barriers to improving hand hygiene practices included a lack of adequate infrastructure and resources for practicing hand hygiene with alcohol hand sanitizer, soap, and water. The results of this evaluation provide useful information for supporting hand hygiene practices in participant healthcare facilities and contributes to efforts to reduce the risks of healthcare-associated infections. Our findings likely apply to local healthcare facilities in other low- and middle-income countries and may be used to design hand hygiene educational materials for healthcare workers.