Publication date: Jun 03, 2025

Proper hand hygiene (HH) is crucial to prevent healthcare-associated infections, including coronavirus disease 2019 (COVID-19), which disproportionately affects patients in low-and middle-income countries. As part of COVID-19 response, we evaluated key factors associated with HH practices in healthcare facilities (HCF) across five countries. From December 2020 to June 2021, we observed HH practices among healthcare personnel in 88 HCFs; observations occurred before and after patient contact. HH adherence (HHA) was defined as the use of alcohol-based hand rub (ABHR) or handwashing with soap and water. HH materials (soap and water, ABHR, or gloves) in patient care areas during observation were recorded in Belize, Uganda, and Kenya, and whether HHA occurred during invasive or noninvasive procedures. Descriptive methods and regression models were conducted. Overall, 3,940 HH observations were completed; average HHA was 32% (23-52% by country). Adjusted odds ratios (aORs) of HHA among nurses (aOR = 0. 58; 95% CI = 0. 44-0. 77) and laboratory technicians (aOR = 0. 41; 95% CI = 0. 25-0. 67) were lower than those among physicians, higher after versus before patient contact (aOR = 2. 84; 95% CI = 2. 44-3. 28), higher with invasive procedures versus noninvasive (aOR = 1. 45; 95% CI = 1. 18-1. 78), and higher when both ABHR and water and soap were available (aOR = 2. 04, 95% CI = 1. 73-3. 53) or only ABHR was available (aOR = 1. 86, 95% CI = 1. 12-3. 06) versus only water and soap were available. Our assessment highlights the need for behavioral and infrastructural interventions to improve HH practices in five resource-limited countries across two regions globally.

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