From Knowledge to Practice: The Effect of Multimodal Strategies on Hand Hygiene Improvement in Tunisia

Hand hygiene reduces healthcare-associated infections. The World Health Organization (WHO) recommends the multimodal hand hygiene strategy to improve hand hygiene. To compare hand hygiene knowledge and compliance of healthcare practitioners (HCPs) before and after the implementation of the WHO multimodal strategy, a before-and-after cross-sectional study was conducted in two Tunisian University Hospitals (2019-2023). Hand hygiene knowledge and compliance were assessed using the WHO questionnaire and observation tool. In 2019, 42 of 246 HCPs (17%) correctly answered ≥80% of 25 questions on hand hygiene knowledge. By 2023, this increased to 47 HCPs (19%). Knowledge on hand hygiene significantly improved for 10 out of 25 questions (12-38% increases) but declined for eight questions (5-40% decreases). Seven questions showed no significant changes in knowledge. Overall hand hygiene compliance increased from 21% in 2019 to 40% in 2023 (p < 0.001). Improvements were observed across the hospital departments (p < 0.001) and staff categories (p < 0.001). In 2023, the lowest hand hygiene compliance was for/before touching a patient (29%), and before clean/aseptic procedures (37%). Hand hygiene compliance was improved, but progress fell short of the WHO's desired 80% target. Sustained efforts and complementary interventions are needed to accelerate progress and achieve the desired outcomes.