Knowledge, Attitude, and Practice of Handwashing and Hand Hygiene Among Municipal Sanitary Workers and Sweepers: A Cross-Sectional Study

Objectives: To assess the knowledge, attitude, and practice (KAP) of handwashing and hand hygiene among sanitary workers and sweepers in Kundrathur Municipality, Tamil Nadu; to describe the discrepancy between self-reported handwashing knowledge and reported practices at key occupational critical times; and to identify factors independently associated with good hand hygiene practice. Material and Methods: A community-based descriptive cross-sectional study was conducted from December 2025 to May 2026 among 200 sanitary workers employed by Kundrathur Municipality, Kancheepuram district, Tamil Nadu, selected by simple random sampling. Knowledge, attitude, and practice were assessed using a pre-tested, interviewer-administered questionnaire, with good hand hygiene practice defined as reporting handwashing at four or more of six occupational critical times. Factors independently associated with good practice were identified using multivariable binary logistic regression. Results: Of 200 participants (56.5% male), 57.0% demonstrated adequate knowledge (mean score 6.78 ± 2.16) and 56.0% expressed a favorable attitude (mean 27.77 ± 3.99), yet only 46.5% reported good hand hygiene practice. A knowledge–practice discrepancy was identified: 27.5% ( 55) possessed adequate knowledge but reported poor practice. Training (adjusted OR [aOR] 8.78; 95% CI 3.59–21.48; p < 0.001), soap availability (aOR 4.69; 95% CI 2.31–9.54; p < 0.001), and middle/secondary education (aOR 7.88; 95% CI 2.27–27.27; p = 0.001, versus illiteracy) were independently associated with good practice. Unexpectedly, adequate knowledge was inversely associated with good practice after adjustment (aOR 0.38; 95% CI 0.16–0.90; p = 0.027). The most commonly reported barrier was the absence of soap or water at the worksite (67.5%). Conclusion: Reported handwashing practice was suboptimal despite reasonable knowledge among municipal sanitary workers, associated primarily with inadequate training and lack of soap at worksites. Findings suggest that skills-based training and reliable provision of soap and water at worksites may be high-priority, modifiable targets for municipal health programs.