Hand hygiene compliance and glove use in Greece: a multi-centre, observational study in eight public hospitals

Hand hygiene is the single most effective action to prevent pathogen transmission and healthcare-associated infections. Systematically measuring hand hygiene compliance (HHC) is a fundamental requirement of any infection prevention and control programme.

To establish baseline HHC prevalence rates and evaluate associated glove use across all eight public hospitals in Crete, Greece, where such data are currently lacking.

Accredited auditors conducted overt, direct observation in 2025 to collect data using the World Health Organization's 'Five Moments' framework and the 'Australian National Hand Hygiene Initiative Manual'. Fully anonymized data were entered into the Hand Hygiene Compliance Application with permission from Hand Hygiene Australia. A mixed-effects logistic regression model with a nested cluster random effect at the hospital-ward-session level was used to estimate HHC proportions and their 95% confidence intervals (CIs).

Data were collected from 40 wards through 718 sessions, totalling 289 audit hours. A total of 13,359 Moments were recorded, with 4020 being compliant (mean HHC 30%, 95% CI 28-32%). Among healthcare workers, registered nurses demonstrated HHC of 39% (95% CI 36-42%), whereas specialized physicians recorded 26% (95% CI 21-31%). The highest compliance percentage was observed after body fluid exposure risk (53%, 95% CI 48-57%), while the lowest was recorded before touching a patient (11%, 95% CI 9-13%). Alcohol-based hand rub was the preferred technique (66%), yet hand hygiene was omitted in 68% of all Moments where glove use was recorded.

Findings revealed suboptimal HHC, suggesting a potential association with glove use, thus allowing significant room for improvement in both practices.