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Effect of Infection Prevention Education on Hand Hygiene Compliance among Healthcare Workers in Nigerian Hospitals

Abstract

Hand hygiene is one of the most important measures for preventing the transmission of infectious agents within healthcare facilities and reducing the occurrence of healthcare-associated infections. Healthcare workers may transmit microorganisms between patients, healthcare environments, equipment, and themselves through contaminated hands, particularly when hand hygiene is not performed at appropriate moments or is performed incorrectly. Infection prevention education provides healthcare workers with knowledge and practical skills relating to the principles of infection prevention and control, the importance of hand hygiene, the appropriate moments for hand hygiene, correct handwashing techniques, use of alcohol-based hand rubs, appropriate use of soap and water, and the role of hand hygiene in preventing healthcare-associated infections. Hand hygiene compliance refers to the extent to which healthcare workers perform hand hygiene correctly and at recommended opportunities during patient care and other healthcare activities. In Nigeria, inadequate infection prevention training, high workloads, insufficient staffing, limited availability of water and hand hygiene supplies, inadequate access to alcohol-based hand rubs, overcrowding, and weak compliance monitoring may affect hand hygiene practices among healthcare workers. Effective infection prevention education may improve healthcare workers' knowledge, practical skills, risk perception, and adherence to recommended hand hygiene procedures. Against this background, this study investigates the effect of infection prevention education on hand hygiene compliance among healthcare workers in Nigerian hospitals. 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 healthcare workers' 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' motivation to comply with hand hygiene recommendations. The Knowledge-Attitude-Practice framework provides a basis for examining how improved knowledge and attitudes resulting from infection prevention education may influence hand hygiene compliance. Collectively, these theoretical perspectives provide a suitable framework for explaining how infection prevention education may influence hand hygiene compliance among healthcare workers in Nigerian hospitals. The study will adopt a quantitative quasi-experimental research design. Primary data will be collected from healthcare workers in selected public and private hospitals in Nigeria using a structured self-administered questionnaire, infection prevention knowledge assessment, and direct observational hand hygiene compliance checklist. A multistage sampling technique will be employed to select states, local government areas, hospitals, departments or units, and eligible healthcare workers. Where feasible, selected hospitals or healthcare worker groups will be assigned to intervention and comparison groups. Healthcare workers in the intervention group will receive structured infection prevention education covering healthcare-associated infections, standard precautions, the importance of hand hygiene, recommended hand hygiene moments, appropriate handwashing techniques, use of alcohol-based hand rubs, appropriate use of soap and water, hand hygiene before and after patient contact, hand hygiene after contact with body fluids and contaminated surfaces, and common barriers to compliance. Hand hygiene compliance will be assessed using indicators such as performance of hand hygiene at recommended opportunities, correct handwashing technique, appropriate duration of handwashing, appropriate use of alcohol-based hand rub, correct use of soap and water, and compliance before and after relevant patient-care activities. Direct observation will be prioritized where feasible to reduce reliance on self-reported behaviour. Descriptive statistics will be used to summarize healthcare workers' sociodemographic and professional characteristics, infection prevention knowledge, exposure to education, and hand hygiene compliance. 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 effect of infection prevention 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 infection prevention education has a significant positive effect on hand hygiene compliance among healthcare workers in Nigerian hospitals. Healthcare workers exposed to structured infection prevention education are expected to demonstrate improved knowledge of hand hygiene and greater compliance with recommended hand hygiene procedures. Education may improve compliance before and after patient contact, after exposure to body fluids, after contact with patient surroundings, and during other critical points in healthcare delivery. It may also improve healthcare workers' ability to correctly perform hand hygiene using soap and water or alcohol-based hand rubs. However, education alone may not guarantee sustained compliance because healthcare workers may continue to face barriers such as inadequate water supply, insufficient handwashing facilities, shortages of alcohol-based hand rubs and soap, heavy workloads, staff shortages, overcrowding, skin irritation, and weak institutional monitoring. Consequently, infection prevention education is expected to be most effective when supported by continuous availability of hand hygiene supplies, accessible hand hygiene facilities, regular compliance monitoring, supportive supervision, feedback, visual reminders, and strong hospital infection prevention and control programmes. The study is expected to contribute to the literature on infection prevention and control, hand hygiene, healthcare-associated infections, healthcare worker behaviour, patient safety, occupational health, health education, and public health in Nigeria by providing empirical evidence on the effect of infection prevention education on hand hygiene compliance among healthcare workers in Nigerian hospitals. 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, hospital management authorities, infection prevention and control committees, healthcare professional 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 infection prevention education, ensuring continuous availability of hand hygiene supplies, improving hospital infrastructure, strengthening compliance monitoring and feedback systems, conducting regular refresher training, and promoting a sustained culture of hand hygiene and patient safety in Nigerian hospitals.

Keywords: Infection prevention education, hand hygiene compliance, healthcare workers, Nigerian hospitals, infection prevention and control, healthcare-associated infections, hand hygiene practices, patient safety, occupational health, health education, hospital safety, public health, Nigeria.