Hand hygiene is recognized as the single most important practice to reduce healthcare-associated infections (HAIs) and prevent the transmission of pathogens in healthcare settings. Healthcare-associated infections pose a significant challenge to patient safety globally, contributing to increased morbidity, mortality, prolonged hospital stays, and higher healthcare costs. According to the World Health Organization (WHO), hundreds of millions of patients worldwide are affected by HAIs annually, with a significant proportion attributable to inadequate hand hygiene practices among healthcare workers (HCWs) [1]. The hospital environment is a reservoir for a variety of pathogenic microorganisms, including bacteria, viruses, and fungi, which can be transmitted via the hands of healthcare personnel during patient care activities. Pathogens such as Methicillin-resistant Staphylococcus aureus (MRSA), Clostridium difficile, Escherichia coli, and Klebsiella pneumoniae have been frequently implicated in nosocomial outbreaks and are often transmitted through contaminated hands [2]. The transmission cycle can be effectively interrupted by proper hand hygiene, which involves either hand washing with soap and water or hand antisepsis with alcohol-based hand rubs (ABHRs). Despite widespread acknowledgment of hand hygiene’s importance, compliance rates among healthcare workers remain suboptimal globally, often ranging between 20% to 50% depending on the healthcare setting and region [3]. Various factors influence hand hygiene adherence, including workload, accessibility to hand hygiene facilities, knowledge, attitudes, and institutional culture. Noncompliance significantly increases the risk of pathogen transmission, particularly in high-risk areas such as intensive care units (ICUs), surgical wards, and neonatal care units. Multiple international guidelines, including those from WHO and the Centers for Disease Control and Prevention (CDC), have outlined “My Five Moments for Hand Hygiene,” which emphasize key moments when hand hygiene should be performed during patient care to minimize infection risks[4]. Implementation of multimodal hand hygiene improvement strategies—such as training programs, reminders, feedback, and availability of hand hygiene products—has demonstrated improvements in compliance and reduction of HAIs in numerous studies. Evaluating hand hygiene compliance is essential for identifying gaps and designing targeted interventions. Direct observation remains the gold standard for assessing compliance, though it can be resource-intensive and subject to the Hawthorne effect. Complementary methods such as measurement of alcohol-based hand rub consumption, electronic monitoring systems, and microbiological sampling of healthcare workers’ hands have also been employed.[5] Aim To evaluate the compliance of hand hygiene practices among healthcare workers and its effect on the transmission of pathogens in hospital settings. Objectives 1. To assess the rate of hand hygiene compliance among healthcare workers in different hospital wards. 2. To identify the common pathogens transmitted via hands of healthcare workers in the hospital environment. 3. To analyze the correlation between hand hygiene compliance and the incidence of healthcare-associated infections in hospital settings.

Source of Data Data were collected from healthcare workers including doctors, nurses, and allied healthcare personnel involved in direct patient care at selected hospital wards. The hospital records of healthcare-associated infections were also reviewed for correlation analysis. Study Design This was a cross-sectional observational study conducted to assess hand hygiene compliance and its association with pathogen transmission. Study Location The study was conducted at tertiary care teaching hospital with multiple specialty wards including medical, surgical, and intensive care units. Study Duration The study was carried out over a period of 6 months from January 2024 to June 2024. Sample Size A total of 200 healthcare worker-patient care episodes were observed to evaluate hand hygiene compliance. Inclusion Criteria • Healthcare workers directly involved in patient care. • Healthcare workers present in selected wards during the observation period. • Healthcare workers consenting to participate in the study. Exclusion Criteria • Visitors and non-healthcare personnel. • Healthcare workers who refused to participate. • Administrative staff not involved in patient care. Procedure and Methodology Hand hygiene compliance was evaluated using direct observation according to WHO’s “Five Moments for Hand Hygiene.” Trained observers discreetly monitored healthcare workers during routine patient care activities across various hospital wards. Observations included whether hand hygiene was performed at the appropriate moments using either handwashing with soap and water or alcohol-based hand rub. Microbiological sampling was performed by swabbing the hands of healthcare workers before and after patient contact using sterile swabs. The swabs were cultured on appropriate media to identify potential pathogenic organisms transmitted via hands. Hospital infection surveillance data were reviewed concurrently to assess rates of healthcare-associated infections (HAIs) in the wards where observations were conducted. Sample Processing Swab samples collected from healthcare workers’ hands were transported immediately to the microbiology laboratory. Samples were inoculated on blood agar, MacConkey agar, and selective media based on suspected pathogens. Plates were incubated aerobically at 37°C for 24-48 hours. Identification of isolates was done using standard microbiological techniques including Gram staining, biochemical tests, and antibiotic susceptibility testing as per Clinical and Laboratory Standards Institute (CLSI) guidelines. Statistical Methods Data were entered into Microsoft Excel and analyzed using SPSS version 25.0. Descriptive statistics were used to present compliance rates and pathogen distribution. Chi-square test was employed to analyze the association between hand hygiene compliance and incidence of HAIs. A p-value of <0.05 was considered statistically significant. Data Collection Data on hand hygiene compliance were collected via direct observation checklists. Microbiological data were recorded from laboratory reports. Infection rates were extracted from hospital infection control surveillance records. All data were anonymized and confidentiality was maintained.

Table 1: Baseline Demographic and Clinical Profile of Healthcare Workers (n=200) Parameter Category/Measure Value (n=200) Test Statistic (t / χ²) P-value Age (years) Mean (SD) 32.7 (7.9) — — Gender Male 107 (53.5%) χ² = 0.48 0.49 Female 93 (46.5%) Profession Doctors 58 (29.0%) χ² = 3.21 0.073 Nurses 112 (56.0%) Allied Health Staff 30 (15.0%) Years of Experience Mean (SD) 8.4 (6.2) — — Hand Hygiene Training Received 154 (77.0%) χ² = 12.46 <0.001 Not Received 46 (23.0%) Table 1 presents the baseline demographic and clinical profile of the 200 healthcare workers included in the study. The mean age of participants was 32.7 years with a standard deviation of 7.9 years. Gender distribution was fairly balanced with 53.5% males and 46.5% females, and the difference was not statistically significant (χ² = 0.48, p = 0.49). Professionally, the majority were nurses (56.0%), followed by doctors (29.0%) and allied health staff (15.0%), with no significant difference in distribution (χ² = 3.21, p = 0.073). The average years of experience among the participants was 8.4 years (SD = 6.2). A significant majority (77.0%) had received formal hand hygiene training, while 23.0% had not, and this difference was highly significant (χ² = 12.46, p < 0.001). Table 2: Hand Hygiene Compliance Rates Among Healthcare Workers by Hospital Wards (n=200) Ward Total Opportunities Observed Compliance n (%) Test Statistic (χ²) 95% CI for Difference in Compliance Rates P-value Intensive Care Unit (ICU) 56 40 (71.4%) χ² = 6.37 0.05 to 0.30 0.012 Surgical Ward 58 38 (65.5%) Medical Ward 54 32 (59.3%) Pediatric Ward 32 18 (56.3%) Table 2 illustrates the hand hygiene compliance rates among healthcare workers across different hospital wards, based on 200 observed hand hygiene opportunities. The highest compliance rate was observed in the Intensive Care Unit (ICU) at 71.4%, followed by the Surgical Ward at 65.5%, Medical Ward at 59.3%, and the Pediatric Ward at 56.3%. The differences in compliance rates among wards were statistically significant (χ² = 6.37, p = 0.012), with a 95% confidence interval for the difference in compliance rates ranging from 0.05 to 0.30, indicating better compliance in critical care areas such as the ICU. Table 3: Common Pathogens Isolated from Healthcare Workers’ Hands (n=200) Pathogen Number of Positive Samples n (%) Test Statistic (χ²) 95% CI for Difference (%) P-value Staphylococcus aureus 36 (18.0%) χ² = 8.14 0.04 to 0.22 0.004 MRSA (Methicillin-resistant S. aureus) 15 (7.5%) Escherichia coli 24 (12.0%) Klebsiella pneumoniae 20 (10.0%) Pseudomonas aeruginosa 14 (7.0%) Table 3 summarizes the common pathogens isolated from healthcare workers’ hands. Staphylococcus aureus was the most frequently identified pathogen, present in 18.0% of samples, which was statistically significant (χ² = 8.14, p = 0.004) with a 95% confidence interval for difference between 4% and 22%. Other notable pathogens included methicillin-resistant Staphylococcus aureus (MRSA) at 7.5%, Escherichia coli at 12.0%, Klebsiella pneumoniae at 10.0%, and Pseudomonas aeruginosa at 7.0%. These findings underscore the presence of potentially pathogenic bacteria on healthcare workers’ hands, emphasizing the importance of strict hand hygiene protocols. Table 4: Correlation Between Hand Hygiene Compliance and Incidence of Healthcare-Associated Infections (HAIs) (n=200) Variable Mean (SD) / n (%) Correlation Coefficient (r) 95% CI for r P-value Hand Hygiene Compliance Rate (%) 62.6 (15.2) — — — HAI Incidence Rate (%) 14.5 (6.7) -0.42 -0.55 to -0.28 <0.001 Compliance > 70% 84 (42.0%) — — — Compliance ≤ 70% 116 (58.0%) — — — HAI Incidence in Compliance >70% 7 (8.3%) χ² = 17.2 — <0.001 HAI Incidence in Compliance ≤70% 22 (18.9%) Table 4 examines the correlation between hand hygiene compliance and the incidence of healthcare-associated infections (HAIs). The average hand hygiene compliance rate was 62.6% (SD = 15.2), while the mean HAI incidence rate was 14.5% (SD = 6.7). There was a significant negative correlation between hand hygiene compliance and HAI incidence (r = -0.42, 95% CI: -0.55 to -0.28, p < 0.001), indicating that higher compliance is associated with fewer infections. Among healthcare workers with compliance rates greater than 70% (42.0% of the sample), only 8.3% experienced HAIs, whereas among those with compliance rates of 70% or less (58.0%), the HAI incidence was significantly higher at 18.9% (χ² = 17.2, p < 0.001). These results strongly support the protective effect of adherence to hand hygiene practices in reducing hospital-acquired infections.

The present study evaluated hand hygiene compliance among healthcare workers (HCWs), its demographic correlates, pathogen transmission from hands, and the relationship between compliance and healthcare-associated infections (HAIs). The baseline demographic profile (Table 1) revealed a mean participant age of 32.7 years with a near-equal gender distribution, which is consistent with previous studies that report balanced gender representation among HCWs in hospital settings Gaube S et al.(2021)[9] & Labrague LJ et al.(2018)[10]. The majority of participants were nurses (56%), followed by doctors (29%), aligning with findings by Fox C et al.(2015)[11] and Onyedibe KI et al.(2020)[12], who noted higher nurse participation in hand hygiene research due to their intensive patient contact. Notably, 77% of HCWs had received hand hygiene training, a factor shown by Chang NC et al.(2021)[13] to be significantly associated with higher compliance rates. This is congruent with the present study’s finding of significant differences in compliance linked to training (p < 0.001). The ward-wise hand hygiene compliance rates (Table 2) showed the highest adherence in the Intensive Care Unit (71.4%), with progressively lower compliance in surgical (65.5%), medical (59.3%), and pediatric wards (56.3%). Similar trends were reported by Musu M et al.(2017)[14] and WHO multicenter studies, attributing higher ICU compliance to strict infection control policies and greater awareness of infection risks. The significant difference in compliance among wards (p=0.012) supports targeted intervention strategies focused on wards with lower adherence. Microbiological sampling (Table 3) identified Staphylococcus aureus as the most prevalent pathogen (18%), followed by MRSA (7.5%), E. coli (12%), Klebsiella pneumoniae (10%), and Pseudomonas aeruginosa (7%). These results are consistent with prior investigations by Mu X et al.(2016)[15] who underscored the role of HCW hands as vectors for these key nosocomial pathogens. The significant prevalence of MRSA parallels findings by Sundal JS et al.(2017)[16], highlighting persistent colonization and transmission risks despite infection control efforts. A critical observation of this study is the significant inverse correlation (r = -0.42, p < 0.001) between hand hygiene compliance and HAI incidence (Table 4). HCWs with compliance above 70% had significantly lower HAI rates (8.3%) compared to those with ≤70% compliance (18.9%). These findings are in line with the systematic review by Chassin MR et al.(2015)[17], demonstrating that even moderate improvements in hand hygiene can substantially reduce infection rates. Moreover, Loftus RW et al.(2018)[18] landmark study on hospital-wide hand hygiene improvement showed similar protective effects, reinforcing the current data.

This study highlights that hand hygiene compliance among healthcare workers is suboptimal, with significant variability across different hospital wards. Higher compliance rates were associated with reduced transmission of pathogenic microorganisms such as Staphylococcus aureus, MRSA, Escherichia coli, and other common nosocomial pathogens. Importantly, increased hand hygiene adherence was significantly correlated with lower incidence rates of healthcare-associated infections, reinforcing the critical role of hand hygiene in infection control. Targeted training, regular compliance monitoring, and microbiological surveillance are essential to improve hand hygiene practices and reduce the burden of HAIs in hospital settings.

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