Hand Hygiene Compliance of Healthcare Workers at a Public Hospital in South Africa: An Observational Study

Abstract

Introduction: Hand hygiene (HH) is crucial for preventing healthcare-associated infections (HAIs) in healthcare facilities. Aim: This observational study investigated the HH compliance of healthcare workers in the maternity departments of a public hospital in Gauteng. Methods: The study employed a quantitative, covert, observational design conducted at a public academic hospital in Gauteng Province, South Africa, with a focus on the maternity department. Convenience sampling was used to select HCWs directly involved in care and HH practices in September 2025. The WHO Hand Hygiene Observation Tool was utilised to record HH compliance. Each HH opportunity was noted as compliant or non-compliant. Results: A total of 783 HH moments were observed across selected wards. Overall compliance was critically low at 6.9%. By profession, nurses had 6.4% compliance, medical doctors 5.6%, and students 31.8%. Compliance varied by moment type: "After exposure to bodily fluids" showed the highest compliance at 20.9%, followed by "After touching patient" at 16.7%. The lowest compliance was observed for "After touching patient surroundings" at 1.7%. Conclusion: The results revealed low compliance with HH among nurses, doctors, and students. The data emphasise the urgent need for targeted interventions to improve hand hygiene compliance across all professional categories, thereby enhancing patient safety and reducing the risk of healthcare-associated infections throughout the maternal care continuum. These findings underscore the urgent need for expanded research and targeted interventions to improve HCW HH practices.