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Effect of Hospital Hand Hygiene Audits on Hand Hygiene Compliance among Healthcare Workers in Nigeria

Abstract

Hand hygiene is a fundamental component of infection prevention and control and plays an important role in reducing the transmission of healthcare-associated infections among patients and healthcare workers. Despite the importance of appropriate hand hygiene, compliance among healthcare workers may remain inadequate due to high workload, limited access to hand hygiene facilities, insufficient supplies, poor knowledge, forgetfulness, and weak monitoring systems. Hospital hand hygiene audits provide a structured mechanism for observing, documenting, and providing feedback on healthcare workers' adherence to recommended hand hygiene practices. Regular audits may identify gaps in compliance and encourage healthcare workers to improve their practices. Against this background, this study investigates the effect of hospital hand hygiene audits on hand hygiene compliance among healthcare workers in Nigeria. The study will be anchored on the Donabedian Model of Healthcare Quality, Social Cognitive Theory, and the Theory of Planned Behavior. The Donabedian Model explains how healthcare structures, processes, and outcomes interact to influence quality of care, with hand hygiene facilities and auditing representing important components of the structure and care process. Social Cognitive Theory emphasizes knowledge, self-efficacy, observational learning, feedback, and workplace environmental influences in shaping healthcare workers' hand hygiene behaviour. The Theory of Planned Behavior explains how healthcare workers' attitudes, subjective norms, perceived behavioural control, and behavioural intentions may influence compliance with recommended hand hygiene practices. Collectively, these theoretical perspectives provide a suitable framework for explaining how hospital hand hygiene audits may influence hand hygiene compliance among healthcare workers in Nigeria. The study will adopt a quantitative quasi-experimental research design. The study population will comprise healthcare workers, including doctors, nurses, midwives, laboratory personnel, pharmacists, healthcare assistants, and other clinical staff involved in direct patient care in selected public and private hospitals across Nigeria. A multistage sampling technique will be used to select states, local government areas, hospitals, departments, units, and eligible healthcare workers. Hospital hand hygiene audits will be measured using indicators such as frequency of audits, audit coverage, use of standardized observation tools, direct observation of hand hygiene opportunities, documentation of findings, provision of feedback, identification of compliance gaps, frequency of feedback sessions, corrective actions, and follow-up audits. Hand hygiene compliance will be assessed using indicators such as compliance with hand hygiene at recommended moments of patient care, appropriate use of alcohol-based hand rub, handwashing with soap and water when indicated, correct hand hygiene technique, duration of hand hygiene, compliance before patient contact, compliance before aseptic procedures, compliance after exposure to body fluids, compliance after patient contact, and compliance after contact with the patient's surroundings. Data will be collected using structured questionnaires, standardized hand hygiene observation checklists, audit records, infection prevention and control records, facility assessments, and direct observations of healthcare workers' practices. Hand hygiene compliance will be assessed before and after implementation of the audit intervention. Descriptive statistics will be used to summarize healthcare workers' demographic and professional characteristics, audit exposure, and hand hygiene compliance patterns. Inferential statistical techniques, including paired sample tests, independent sample tests, chi-square tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the effect of hospital hand hygiene audits on hand hygiene compliance. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that hospital hand hygiene audits have a significant positive effect on hand hygiene compliance among healthcare workers in Nigeria. Healthcare workers exposed to regular, standardized, and constructive hand hygiene audits are expected to demonstrate higher compliance with recommended hand hygiene practices than healthcare workers without similar audit exposure. Regular observation and feedback may increase awareness of hand hygiene responsibilities, identify specific compliance gaps, strengthen accountability, and encourage consistent adherence to infection prevention procedures. Repeated audits may also promote a culture of patient safety and infection prevention within hospitals. However, inadequate hand hygiene facilities, shortages of alcohol-based hand rub and soap, insufficient water supply, heavy workloads, staffing shortages, lack of management support, and poor implementation of corrective actions may reduce the effectiveness of audits. The study therefore expects regular, objective, feedback-oriented, and well-supported hand hygiene auditing to contribute significantly to improved hand hygiene compliance among healthcare workers in Nigeria. The study is expected to contribute to the literature on hospital hand hygiene audits, hand hygiene compliance, healthcare-associated infection prevention, healthcare workers, infection prevention and control, patient safety, hospital quality improvement, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, state ministries of health, hospital management boards, healthcare facilities, infection prevention and control committees, healthcare workers, quality improvement teams, development partners, and policymakers regarding strategies for strengthening hand hygiene practices. The study will also provide evidence-based recommendations for institutionalizing regular hand hygiene audits, strengthening feedback mechanisms, improving access to hand hygiene infrastructure and supplies, training healthcare workers, conducting follow-up audits, and integrating hand hygiene monitoring into hospital quality improvement and infection prevention programmes across Nigeria.

Keywords: Hospital hand hygiene audits, hand hygiene compliance, healthcare workers, healthcare-associated infections, infection prevention and control, patient safety, handwashing, quality improvement, hospital hygiene, Nigeria, public health.