COMPLIANCE TO HAND HYGIENE AMONG HEALTHCARE WORKERS IN MATERNITY WARDS IN COMPREHENSIVE EMERGENCY, OBSTETRIC AND NEW-BORN CARE HEALTH FACILITIES IN LIRA CITY AND LIRA DISTRICT, UGANDA

Abstract

This study examined compliance to hand hygiene among healthcare workers in maternity wards in Lango subregion, Uganda, where maternal and neonatal mortality remains high, with sepsis being one of the major contributors. Sepsis is often caused by infections spread via healthcare workers’ hands. Despite hand hygiene being a simple, cost-effective preventive measure, adherence remains low globally, especially in low-income settings. This mixed-methods cross-sectional study was conducted in CEmONC facilities in Lira City and Lira District. Quantitative data were collected by observations of compliance with the WHO's five moments of hand hygiene, and a checklist to assess availability of hand hygiene resources. Qualitative insights were gathered from interviews of health workers on drivers of compliance. Hand hygiene compliance was suboptimal at 54%, and varied significantly by facility level (p<0.001), facility ownership (p=0.005) and indication (p<0.001). While 83% of the facilities had at least one functioning handwashing facility, only 67% had alcohol-based hand rub (ABHR), with postnatal rooms particularly under-resourced. Key drivers of compliance included both health system factors: availability of supplies, workload and staffing and individual/organizational factors: knowledge and awareness, perceived risk and procedure type, reminders at workplace, monitoring and institutional support, being watched, attitude and beliefs, and hypersensitivity to soap or ABHR. Recommendations include: ensuring consistent supply of hand hygiene materials, particularly in postnatal wards, providing regular training and mentorship, enhancing monitoring and accountability, improving visibility of hygiene protocols, addressing staffing shortages, and conducting further research on adherence to proper hand hygiene techniques.