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Impact of Hand Hygiene Education on Hand Hygiene Compliance among Healthcare Workers in Nigeria

Abstract

Hand hygiene is a fundamental component of infection prevention and control in healthcare settings because appropriate hand hygiene can reduce the transmission of healthcare-associated infections among patients, healthcare workers, and visitors. Healthcare workers frequently come into contact with patients, body fluids, medical equipment, and contaminated surfaces, creating opportunities for the transmission of microorganisms when appropriate hand hygiene practices are not followed. Hand hygiene education provides healthcare workers with knowledge and practical skills relating to the importance of hand hygiene, appropriate handwashing techniques, use of alcohol-based hand rubs, indications for hand hygiene, the World Health Organization's Five Moments for Hand Hygiene, appropriate duration and technique, and prevention of cross-transmission. Hand hygiene compliance refers to the extent to which healthcare workers appropriately perform hand hygiene at recommended times and according to established infection prevention and control procedures. In Nigeria, inadequate hand hygiene knowledge, limited availability of water and hand hygiene facilities, shortages of alcohol-based hand rubs and other supplies, high workloads, inadequate supervision, and weak infection prevention and control systems may affect hand hygiene compliance among healthcare workers. Effective hand hygiene education may improve healthcare workers' knowledge, skills, awareness, and adherence to recommended hand hygiene procedures. Against this background, this study investigates the impact of hand hygiene education on hand hygiene compliance among healthcare workers in Nigeria. The study is anchored on Social Cognitive Theory, the Health Belief Model, and the Knowledge-Attitude-Practice framework. Social Cognitive Theory emphasizes the interaction between knowledge, self-efficacy, behavioural capabilities, social influences, and environmental conditions in shaping infection prevention behaviour. The Health Belief Model explains preventive health behaviour through perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and cues to action, providing a basis for understanding healthcare workers' decisions to comply with recommended hand hygiene procedures. The Knowledge-Attitude-Practice framework provides a basis for examining how improved knowledge and attitudes resulting from hand hygiene education may influence compliance with hand hygiene practices. Collectively, these theoretical perspectives provide a suitable framework for explaining how hand hygiene education may influence hand hygiene compliance among healthcare workers in Nigeria. The study will adopt a quantitative quasi-experimental research design. Primary data will be collected from healthcare workers in selected public and private healthcare facilities in Nigeria using a structured self-administered questionnaire, hand hygiene knowledge assessment, and an observational hand hygiene compliance checklist. A multistage sampling technique will be employed to select states, local government areas, healthcare facilities, departments, and eligible healthcare workers. Where feasible, selected healthcare facilities or healthcare worker groups will be assigned to intervention and comparison groups. Healthcare workers in the intervention group will receive structured hand hygiene education covering the importance of hand hygiene, indications for hand hygiene, handwashing techniques, appropriate use of alcohol-based hand rubs, the WHO Five Moments for Hand Hygiene, appropriate duration and technique, prevention of cross-transmission, and common barriers to hand hygiene compliance. Hand hygiene compliance will be assessed using indicators such as performance of hand hygiene at recommended moments, correct handwashing technique, appropriate use of alcohol-based hand rubs, appropriate duration of hand hygiene, and adherence to established infection prevention and control procedures. Where feasible, direct observational assessment will be used to complement self-reported information and reduce reporting bias. Descriptive statistics will be used to summarize healthcare workers' sociodemographic and professional characteristics, hand hygiene knowledge, exposure to education, and compliance levels. Inferential statistical techniques, including chi-square tests, paired-sample tests, independent-sample tests, and logistic or multiple regression analysis, will be used to determine the impact of hand hygiene education on hand hygiene compliance. Where appropriate, pre-intervention and post-intervention compliance rates will be compared. Diagnostic tests will also be conducted to assess the reliability of the research instruments, model assumptions, goodness of fit, and robustness of the findings. The study is expected to find that hand hygiene education has a significant positive impact on hand hygiene compliance among healthcare workers in Nigeria. Healthcare workers exposed to structured hand hygiene education are expected to demonstrate improved knowledge and greater adherence to recommended hand hygiene procedures. Education may improve healthcare workers' recognition of situations requiring hand hygiene, correct handwashing techniques, appropriate use of alcohol-based hand rubs, compliance with the WHO Five Moments for Hand Hygiene, and prevention of cross-transmission. However, education alone may not guarantee sustained compliance because healthcare workers may continue to face barriers such as inadequate water supply, insufficient handwashing facilities, limited availability of alcohol-based hand rubs, heavy workloads, staff shortages, overcrowding, skin irritation, and inadequate supervision. Consequently, hand hygiene education is expected to be most effective when supported by readily accessible hand hygiene facilities and supplies, routine monitoring, workplace reminders, supportive supervision, and strong institutional infection prevention and control programmes. The study is expected to contribute to the literature on hand hygiene, infection prevention and control, healthcare-associated infection prevention, healthcare worker behaviour, health education, occupational health, and public health in Nigeria by providing empirical evidence on the impact of hand hygiene education on hand hygiene compliance among healthcare workers. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, Nigeria Centre for Disease Control and Prevention, National Primary Health Care Development Agency, state ministries of health, healthcare facility managers, infection prevention and control committees, professional healthcare associations, occupational health professionals, public health practitioners, development partners, and policymakers regarding strategies for improving hand hygiene compliance. The study will also provide evidence-based recommendations for strengthening hand hygiene education, ensuring continuous availability of water and hand hygiene supplies, improving healthcare facility infrastructure, conducting regular compliance monitoring, strengthening infection prevention and control supervision, and promoting a sustained culture of hand hygiene across healthcare facilities in Nigeria.

Keywords: Hand hygiene education, hand hygiene compliance, healthcare workers, infection prevention and control, healthcare-associated infections, handwashing, alcohol-based hand rub, healthcare safety, health education, occupational health, infection control, public health, Nigeria.