Abstract

Respiratory infections remain an important public health concern and may pose occupational risks to healthcare workers because of their frequent contact with patients, respiratory secretions, contaminated surfaces, and healthcare environments. Healthcare workers may be exposed to respiratory pathogens through direct contact, droplets, aerosols, and contaminated hands that can facilitate the transmission of infectious agents. Hand hygiene is one of the most important and cost-effective infection prevention and control measures for reducing the transmission of pathogens within healthcare settings. Appropriate hand hygiene practices include washing hands with soap and water when indicated, using alcohol-based hand rubs when appropriate, performing hand hygiene at recommended moments during patient care, and maintaining proper hand hygiene technique and duration. In Nigeria, challenges such as inadequate access to running water, shortages of hand hygiene supplies, high workload, overcrowding, limited infection prevention training, and inconsistent compliance with hand hygiene guidelines may increase the risk of infection transmission among healthcare workers. Improving adherence to appropriate hand hygiene practices may therefore contribute to reducing occupational exposure to respiratory pathogens. Against this background, this study investigates the influence of hand hygiene practices on the occurrence of respiratory infections among healthcare workers in Nigeria. The study is anchored on the Theory of Planned Behavior (TPB), Social Cognitive Theory (SCT), and the Health Belief Model (HBM). The Theory of Planned Behavior explains hand hygiene behaviour through attitudes, subjective norms, perceived behavioural control, and behavioural intentions. Social Cognitive Theory emphasizes the interaction between individual knowledge, behavioural capabilities, environmental conditions, observational learning, and self-efficacy in shaping infection prevention practices. The Health Belief Model explains preventive behaviour through perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and cues to action. Collectively, these theoretical perspectives provide a comprehensive framework for explaining how hand hygiene practices may influence the occurrence of respiratory infections among healthcare workers in Nigeria. The study adopts a quantitative cross-sectional research design. Primary data will be collected from healthcare workers in selected public and private healthcare facilities in Nigeria using a structured self-administered or interviewer-administered questionnaire and, where feasible, a structured hand hygiene observation checklist. A multistage sampling technique will be employed to select states, local government areas, healthcare facilities, departments, and eligible healthcare workers. Hand hygiene practices will be assessed based on frequency and consistency of handwashing, use of alcohol-based hand rubs, compliance with recommended hand hygiene moments, availability and use of hand hygiene facilities, and adherence to appropriate hand hygiene techniques. The occurrence of respiratory infections will be assessed using self-reported or clinically documented episodes of respiratory illness within a defined period, including relevant symptoms and, where available, healthcare records or diagnostic confirmation. Descriptive statistics will be used to summarize respondents' sociodemographic and professional characteristics, hand hygiene practices, and reported respiratory infection history. Inferential statistical techniques, including chi-square tests, correlation analysis, and multiple logistic regression analysis, will be employed to determine the influence of hand hygiene practices on the occurrence of respiratory infections. Appropriate diagnostic tests will also be conducted to assess multicollinearity, model specification, goodness of fit, and the robustness of the findings. The study anticipates that appropriate hand hygiene practices will have a significant negative influence on the occurrence of respiratory infections among healthcare workers in Nigeria. Healthcare workers who consistently comply with recommended hand hygiene procedures are expected to have lower odds of experiencing respiratory infections compared with those who demonstrate poor compliance. Proper hand hygiene may reduce the transfer of respiratory pathogens from contaminated surfaces, patients, equipment, and hands to the healthcare worker's respiratory tract or other susceptible sites. Conversely, inadequate hand hygiene, inconsistent access to handwashing facilities, poor compliance with infection prevention guidelines, and high-risk workplace exposure may increase the likelihood of respiratory infection. However, hand hygiene is only one component of respiratory infection prevention, and infection risk may also be influenced by ventilation, personal protective equipment, vaccination, overcrowding, exposure intensity, workload, and adherence to other infection prevention and control measures. Therefore, hand hygiene promotion should form part of a comprehensive occupational infection prevention programme. This study is expected to contribute to the literature on infection prevention and control, occupational health, healthcare worker safety, respiratory infection prevention, and public health in Nigeria by providing empirical evidence on the relationship between hand hygiene practices and the occurrence of respiratory infections among healthcare workers. The findings will provide useful information for the Federal Ministry of Health and Social Welfare, state ministries of health, healthcare facility managers, infection prevention and control committees, occupational health departments, professional healthcare associations, public health practitioners, and policymakers regarding strategies for reducing occupational infection risks. The study will also provide evidence-based recommendations for strengthening hand hygiene education, ensuring continuous availability of water and alcohol-based hand rubs, improving hand hygiene monitoring and compliance, strengthening infection prevention training, improving workplace infection-control infrastructure, and integrating hand hygiene promotion into broader occupational health programmes across Nigerian healthcare facilities.

Keywords: Hand hygiene practices, respiratory infections, healthcare workers, infection prevention and control, handwashing, occupational health, respiratory disease prevention, healthcare facilities, public health, Nigeria.