Prevalence and Determinants of Hand Hygiene Knowledge, Compliance, and Practices Among Indian Healthcare Workers: A...

This systematic review and meta-analysis aimed to synthesize studies on hand hygiene practices and their determinants among healthcare workers (HCWs) in India, providing guidance for effective public health policy.

Following PRISMA guidelines, a comprehensive search of PubMed and Scopus identified primary research studies on hand hygiene knowledge, compliance, and related practices in Indian healthcare settings published from 2009 to 2023. Out of 276 records identified, 252 were screened after removing duplicates and ineligible records. Seventy-nine full-text articles were assessed for eligibility, of which 34 were excluded for being narrative, qualitative, or otherwise non-eligible. Finally, 45 studies were included in the review and quantitative synthesis.

The pooled prevalence of observed compliance with hand hygiene protocols among Indian Healthcare Workers (HCWs) was 44% (95% CI: 35%-54%), with extreme variation across studies (range: 3%-90%). Self-reported hand hygiene adequacy was similar at 45% (95% CI: 29%-62%; I2 = 99%), though adherence varied significantly across the WHO's five moments (range: 24%-68%). The pooled prevalence of adequate knowledge was 39% (95% CI: 28%-50%). Behavioural interventions demonstrated moderate to high efficacy in improving both knowledge and practice. Key reported barriers to compliance included improper protocol implementation (71.1%), inadequate training (57.8%), attitudinal issues (33.3%), resource shortages (24.4%), and high workloads (15.6%).

Healthcare providers in India exhibit suboptimal hand hygiene compliance with a majority (56%) observed to be non-compliant during opportunities for hand hygiene. A multifaceted approach, including comprehensive training, resource availability, regular audits, and strong leadership, is crucial to enhance hand hygiene adherence, reduce healthcare-associated infections, and improve patient safety.