From perceived compliance to practice: hand hygiene knowledge, self-reported behaviour and operational barriers among...

Hand hygiene is a core component of infection prevention, but self-reported behaviour may not reflect compliance at clinical opportunities. This study assessed hand hygiene knowledge, attitudes and self-reported practices among nursing staff and examined factors associated with consistent self-reported practice, focussing on operational barriers and perceived versus observed compliance.

A cross-sectional study was conducted among nursing staff in a tertiary-care teaching hospital in Central India. Data were collected using a questionnaire adapted from the World Health Organization (WHO) Hand Hygiene Knowledge Questionnaire and relevant literature. Knowledge, attitudes, self-reported practices and perceived barriers were assessed. Multivariable logistic regression examined factors independently associated with reporting that hand hygiene was performed "always" during the work shift.

Among 262 participants with valid responses for the primary practice outcome, 235 (89.7%) reported always performing hand hygiene during the work shift. Awareness of the WHO Five Moments was 99.2%, and 85.8% reported hand hygiene training within the preceding three years. Before and after patient contact, 98.1% and 96.9%, respectively, reported performing hand hygiene. Insufficient time was the most frequently reported barrier (70.3%). Monitoring with feedback was associated with consistent self-reported practice in bivariate analysis (P = 0.003) and remained independently associated in multivariable analysis (aOR 3.79, 95% CI 1.50-9.56; P = 0.005).

Very high self-reported adherence coexisted with operational barriers and misconceptions. Reliable point-of-care supplies, workflow-sensitive interventions and monitoring with feedback may be more actionable than refresher training alone. Self-reported practice should not be interpreted as observed compliance.