Abstract:
Background: Effective hand hygiene is a cost-efficient strategy for preventing infections and
delivering substantial health benefits. Healthcare facilities with poor hand hygiene become
hotspots for microbial infections, leading to increased illness and potential fatalities among
patients. This mixed-method study was attentive to examine rural lower-level health centers.
Objective: The study sought to investigate adherence to hand hygiene standards and associated
factors among healthcare professionals in public healthcare facilities within the agro-pastoral
woredas of the West Hararghe Zone, Eastern Ethiopia, from August 25 to September 15, 2024.
Methods: A cross-sectional mixed-method study design was employed, including all 156
healthcare professionals comprehensively. For the qualitative component, 12 participants were
purposively selected until saturation was reached. Data were collected using self-administered
questionnaires and semi-structured interviews. Quantitative data were processed with Epinfo-7.2
and analyzed in STATA 17. Logistic regression used to assess associations between explanatory
variables and outcomes. Statistical significance was defined at p<0.05, with odds ratios indicating
the direction and strength of associations. Qualitative data were analyzed thematically.
Results: 141 healthcare professionals participated, yielding a response rate of 90.4%. The study
revealed that overall adherence to hand hygiene standards was approximately 18% (95% CI:
12.2%, 24.9%). Key predictors of adherence included the presence of workplace reminders (3
times more adherence; AOR=3.0, 95% CI=1.09, 8.01), subjective norms (5.9 times; AOR=5.9,
95% CI=1.06, 33.85), perceived behavioral control (0.14 times; AOR: 0.14, 95% CI: 0.02, 0.95),
and system changes (10.5 times; AOR=10.5, 95% CI: 2.2, 49). Knowledge of hand hygiene
standard 2.9 times (AOR=2.9, 95% CI=1.06, 8.11), while leadership having a joint yearly hand
hygiene target/plan led to a 7.8 times increase in adherence (AOR=7.8, 95% CI=2.15, 22.05).
Conclusion: The study found that only one in five healthcare professionals adhered to hand
hygiene standards, posing significant infection risks for both patients and healthcare
professional. Qualitative interviews indicated that hand hygiene strategies were not effectively
adopted. There appeared role-confusion perception effect from the demands of serving multiple
departments while providing services in an overcrowded room at lower-level health centers,
which overwhelmed healthcare professionals to have poor hand hygiene adherence. Hence, it
emphasized focused interventions to tackle systemic obstacles and behavioral factors.
