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Influence of Hand Hygiene Facilities on Hand Hygiene Compliance among Healthcare Workers in Nigeria

Abstract

Hand hygiene is one of the most important measures for preventing the transmission of infections within healthcare settings. Healthcare workers frequently come into contact with patients, body fluids, medical equipment, and environmental surfaces, creating opportunities for the transmission of infectious agents when appropriate hand hygiene practices are not followed. Hand hygiene facilities refer to the infrastructure, equipment, materials, and supplies provided within healthcare facilities to enable healthcare workers to perform appropriate hand hygiene. These facilities include running water, handwashing sinks, soap, alcohol-based hand rubs, disposable towels, waste bins, and appropriately located hand hygiene stations. Hand hygiene compliance refers to the extent to which healthcare workers perform hand hygiene at the recommended moments and according to established infection prevention and control procedures. In Nigerian healthcare facilities, inadequate access to water, insufficient handwashing stations, irregular availability of soap and alcohol-based hand rubs, poor placement of facilities, overcrowding, and inadequate maintenance may limit healthcare workers' ability to comply with recommended hand hygiene practices. Conversely, adequate, accessible, and functional hand hygiene facilities may facilitate compliance and strengthen infection prevention and control. Against this background, this study investigates the influence of hand hygiene facilities on hand hygiene compliance among healthcare workers in Nigeria. The study is anchored on Donabedian's Structure-Process-Outcome Model, the Theory of Planned Behavior, and Systems Theory. Donabedian's Model identifies hand hygiene infrastructure as an important structural component that can influence healthcare workers' infection prevention processes and patient outcomes. The Theory of Planned Behavior explains how healthcare workers' attitudes, perceived expectations, and perceived control over performing hand hygiene may influence their compliance with recommended practices, while the availability of appropriate facilities represents an important environmental condition supporting such behaviour. Systems Theory views hand hygiene compliance as part of an interconnected infection prevention system involving healthcare workers, infrastructure, supplies, hospital management, patients, and environmental conditions. Collectively, these theoretical perspectives provide a suitable framework for explaining how hand hygiene facility availability may influence compliance among healthcare workers. The study will adopt a quantitative cross-sectional research design. Primary data will be collected from selected healthcare facilities in Nigeria using structured facility assessment checklists, healthcare worker questionnaires, direct observation tools, and infection prevention and control records. A multistage sampling technique will be employed to select states, healthcare facilities, departments, healthcare workers, and relevant patient-care areas. Hand hygiene facilities will be assessed using indicators such as availability and functionality of handwashing stations, access to running water, availability of soap, availability of alcohol-based hand rub, availability of disposable or reusable hand-drying materials, placement of hand hygiene stations, accessibility at points of care, adequacy of facilities relative to patient and staff volume, frequency of supply interruptions, maintenance of facilities, and availability of waste bins. Hand hygiene compliance will be assessed using indicators such as compliance with recommended hand hygiene opportunities, hand hygiene before patient contact, hand hygiene before aseptic procedures, hand hygiene after exposure to body fluids, hand hygiene after patient contact, hand hygiene after contact with patient surroundings, appropriate handwashing technique, and appropriate use of alcohol-based hand rub. Direct observation of healthcare workers will be used where feasible because observed compliance provides a stronger measure than self-reported behaviour. Descriptive statistics will be used to summarize the availability and condition of hand hygiene facilities and levels of compliance. Inferential statistical techniques, including chi-square tests, correlation analysis, and multiple regression analysis, will be used to determine the influence of hand hygiene facilities on compliance. Diagnostic tests will also be conducted to assess the reliability of research instruments, model assumptions, goodness of fit, multicollinearity, and robustness of the findings. The study is expected to find that adequate and accessible hand hygiene facilities have a significant positive influence on hand hygiene compliance among healthcare workers in Nigeria. Healthcare workers operating in facilities with reliable water supply, accessible handwashing stations, consistently available soap and alcohol-based hand rub, appropriate hand-drying materials, and strategically located hygiene facilities are expected to demonstrate higher compliance with recommended hand hygiene practices. Adequate facilities are expected to reduce practical barriers to hand hygiene and make it easier for healthcare workers to perform hand hygiene at the appropriate moments during patient care. Conversely, inadequate facilities, water shortages, unavailable soap or alcohol-based hand rub, poorly positioned sinks, and poorly maintained infrastructure are expected to contribute to lower compliance. However, the availability of facilities alone may not guarantee high compliance because healthcare worker knowledge, attitudes, workload, perceived risk, institutional monitoring, leadership commitment, and infection-control training may also influence hand hygiene behaviour. Therefore, facility improvement should be accompanied by appropriate monitoring, training, and infection prevention programmes. The study is expected to contribute to the literature on hand hygiene facilities, hand hygiene compliance, infection prevention and control, healthcare workers, patient safety, healthcare quality, and public health in Nigeria by providing empirical evidence on the importance of facility availability in supporting appropriate hand hygiene behaviour. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, Nigeria Centre for Disease Control and Prevention, state ministries of health, hospital management boards, primary healthcare authorities, infection prevention and control committees, healthcare facility administrators, healthcare workers, development partners, and policymakers regarding strategies for improving hand hygiene practices. The study will also provide evidence-based recommendations for increasing the number and accessibility of handwashing stations, ensuring reliable water supply, maintaining continuous availability of soap and alcohol-based hand rub, improving hand hygiene facility placement, strengthening facility maintenance, monitoring supply interruptions, and incorporating hand hygiene infrastructure into infection prevention and control standards across Nigerian healthcare facilities.

Keywords: Hand hygiene facilities, hand hygiene compliance, healthcare workers, Nigeria, infection prevention and control, handwashing, alcohol-based hand rub, patient safety, healthcare quality, infection control, healthcare facilities, public health.