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Published on: June 7, 2017
Status of hand hygiene implementation using multi-modal strategy in public hospitals of Ethiopia: a multi-centre
Feyissa Regassa Senbato1, Zelalem Bonger2, Kibrewossen Aklilu Kifle3
1Infection Prevention and Control Department, Tikur Anbessa Specialized Hospital, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; The Ohio State University Global One Health, Addis Ababa, Ethiopia; Aklillu Lemma Institute of Health Research, Addis Ababa University, Addis Ababa, Ethiopia.
Background:
Healthcare-associated infections (HAIs) are a major patient safety concern, particularly in low-resource settings. The multi-modal strategy (MMS) is a core component of infection prevention and control (IPC) aimed at hand hygiene (HH) practice. The Hand Hygiene Self-Assessment Framework (HHSAF) is a standardized tool to evaluate institutional HH implementation via MMS. This study assessed institutional HH implementation of MMS components using the HHSAF across Ethiopian hospitals.
Methods:
A cross-sectional study was conducted from 1st January to 30th August 2025 in 20 public hospitals. Data were collected using the World Health Organization (WHO) HHSAF and validated through on-site assessments by senior IPC officers. Hospitals were classified as inadequate (0-125), basic (126-250), intermediate (251-375), or advanced (376-500) according to WHO criteria. Domain-specific and overall HHSAF scores were summarized using medians and interquartile ranges (IQRs) in SPSS v.25.
Findings:
The median HHSAF score across hospitals was 203.75 (IQR: 153.75-233.75), indicating that 14 hospitals were classified at the basic level of implementation. Tertiary hospitals scored higher (210; IQR: 152-225) than secondary hospitals (178; IQR: 155-197.5) (Mann-Whitney U = 47.5, P = 0.85). The median HH compliance rate was 42.5% (IQR: 30-49.5), with 15 of 20 (75%) of hospitals having a compliance rate below 50%. Institutional safety climate was positively correlated with the combined four-domain HHSAF score (r = 0.77, P < 0.001).
Conclusion:
HH implementation using MMS in Ethiopian hospitals showed significant variability and an unsatisfactory level. Strengthening leadership engagement is associated with higher HHSAF scores. Addressing critical system-change gaps, particularly in infrastructure and resource availability, is essential for sustained improvement.
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