Assessment of Hand Hygiene Compliance Among Healthcare Workers in a Secondary Hospital in Ekiti State

Hand hygiene is the single most effective intervention for preventing healthcare-associated infections, yet compliance among healthcare workers in Nigerian secondary hospitals remains consistently below international benchmarks. This study assessed hand hygiene compliance and its determinants among healthcare workers at a secondary hospital in Ado-Ekiti, Ekiti State, South West Nigeria. A cross-sectional observational study was conducted over a four-week period among 120 healthcare workers including doctors, nurses, and laboratory scientists from medical, surgical, and paediatric wards. Compliance was assessed using direct observation of hand hygiene opportunities applying the WHO five moments framework. A structured self-administered questionnaire collected knowledge scores, attitudes, and perceived barriers. Direct observation of 600 hand hygiene opportunities was conducted by trained observers blinded to participant identity. Results showed an overall observed compliance rate of 38.5 percent, significantly lower than self-reported compliance of 82.3 percent. Compliance was highest before aseptic procedures (54.2 percent) and lowest after contact with patient surroundings (21.7 percent). Doctors had lower compliance rates than nurses (29.4 percent versus 42.6 percent; p < 0.01). Alcohol-based hand rub availability was inadequate in 65 percent of observation areas. Barriers included product non-availability (71.7 percent), forgetfulness (58.3 percent), and perceived low risk from patients (43.3 percent). The study recommends product availability improvement, WHO multimodal hand hygiene strategy implementation, and senior physician leadership modelling of compliance as priority infection control interventions. Keywords: hand hygiene, healthcare-associated infections, healthcare workers, Ekiti State, South West Nigeria