Baseline Hand Hygiene Knowledge, Attitudes and Self-Reported Practices Among Medical Staff in a Mexican Tertiary-Care Hospital

Abstract

Hand hygiene is the cornerstone of infection prevention, yet adherence and conceptual understanding among physicians are often suboptimal. As part of a quality-improvement initiative, we conducted a baseline survey to assess hand hygiene knowledge, attitudes and self-reported practices among medical staff. We performed a cross-sectional survey of physicians (residents and specialists) using a structured, self-administered questionnaire on hand hygiene indications, technique, glove use, post-exposure management and local policies. Responses were collected from 285 participants at a tertiary-care teaching hospital and affiliated centers. Descriptive statistics were used to summarize demographics, knowledge items and self-efficacy; results are reported as frequencies, percentages and central tendency measures. Of 285 respondents, 259 (90.9%) were residents and 26 (9.1%) specialists; 77% were from a national referral center. Most rated the importance of hand hygiene as high/very high (99.3%), and 94.0% reported being familiar with local protocols. Self-rated hand hygiene knowledge and compliance had a median score of 9 (interquartile range 8–10) on a 10-point scale; 74% scored ≥9. Regarding knowledge, 72.6% correctly identified that bacteria, viruses and fungi can all be transmitted via hands, and 97.5% indicated an effective handwash should last ≥20 seconds. Almost all participants (99.6%) reported being able to identify key moments for hand hygiene. The majority used both soap and alcohol-based hand rub (64.2%). However, glove-related concepts showed gaps: while 39.6% answered that gloves are never a substitute for hand hygiene, 32.3% believed gloves are appropriate “in all cases” instead of hand hygiene. Most respondents correctly described glove removal “from inside to outside” (78.6%) and comprehensive actions after fluid exposure (“all of the above,” 86.3%). Perceived ability to address non-adherent colleagues was high (77.5% effective/very effective), and 97.9% felt safe or very safe maintaining hand hygiene during procedures. Participants most frequently identified needs in “education and awareness” (63.2%), followed by “technique” (21.1%) and “glove use” (13.0%). Medical staff reported very high awareness, familiarity with protocols and self-confidence regarding hand hygiene, with generally good conceptual knowledge of indications and technique. Nevertheless, important gaps persist, particularly around the role of gloves and specific educational/behavioral components. These baseline findings will inform targeted educational interventions and ongoing monitoring within a broader hand hygiene quality-improvement program.