Adherence to WHO Hand Hygiene Protocols in the Surgical Department, Police Hospital, Nile River- Sudan

Adherence to WHO Hand Hygiene Protocols in the Surgical Department, Police Hospital, Nile River- Sudan | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Short Report Adherence to WHO Hand Hygiene Protocols in the Surgical Department, Police Hospital, Nile River- Sudan Nada Abdalla, Omniat Ahmed, Saad Adam Abdallah Abakar³, Arwa Eltayeb This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7496087/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : Hand hygiene is a simple yet essential practice to prevent healthcare-associated infections (HAIs). However, adherence among healthcare workers is often poor. This study assessed compliance with the WHO “Five Moments for Hand Hygiene” among doctors in the surgical department of Police Hospital, Nile River State, Sudan. Methods: We conducted a prospective observational audit in two cycles (December 2024 and March 2025). Doctors’ adherence to hand hygiene moments was observed directly using a WHO-based checklist. Compliance rates were compared between cycles. Results: Across 147 opportunities in Cycle 1, compliance was 48.9%. In Cycle 2, compliance rose to 93.4% (138 opportunities). The largest improvement occurred in “After body fluid exposure” (27.3% → 91.2%) and “Before aseptic procedures” (76.1% → 100%). Notably, adherence “After touching a patient” decreased from 100% to 66.7%. Conclusion: Educational interventions and supply improvements significantly boosted hand hygiene compliance. Ongoing training, monitoring, and reinforcement will be essential to maintain these gains. Hand hygiene WHO Five Moments compliance infection prevention Sudan audit Figures Figure 1 Introduction Hand hygiene stands as a fundamental pillar in the prevention and control of infections within healthcare environments, playing a pivotal role in diminishing the transmission of healthcare-associated infections (HAIs) [1]. Hand hygiene is the most effective and feasible infection prevention and control measure within healthcare facilities. Hand hygiene can be achieved through different methods depending on various factors like the activity/procedure being performed or to be performed, the level of dirtiness of hand and time. Despite the ease and simplicity of the technique, the adherence rate among health professionals remains suboptimal, leaving health professionals and patients vulnerable to healthcare-acquired infections [2,3]. Contaminated hands of health professionals are responsible for the transmission of most infections including drug-resistance microorganisms through direct and indirect contact [4]. Studies suggested that improving hand hygiene adherence alone can reduce up to 50% of the transmission of pathogens within the healthcare settings. A significant reduction of Healthcare Acquire Infections can be achieved with an approximately 60% hand hygiene adherence rate among healthcare workers within the facility. However, almost 61% of health professionals don’t comply with the hand hygiene guidelines [5,6]. Hand hygiene adherence rates significantly differ across World Health Organization (WHO) five critical moments for the hand hygiene [7, 8]. In recognition of the critical importance of this seemingly simple yet highly effective practice, the World Health Organization (WHO) introduced the "Five Moments for Hand Hygiene" in 2009 as a globally applicable framework. This strategy provides clear guidance to healthcare workers on the specific instances during patient care when hand hygiene is absolutely essential [1]. These five crucial moments are: 1) before touching a patient, 2) before a clean or aseptic procedure, 3) after body fluid exposure risk, 4) after touching a patient, and 5) after touching patient surroundings [1]. The critical importance of hand hygiene in preventing healthcare-associated (nosocomial) infections [9,10] was the primary reason for selecting this audit topic. Non-compliance with hand hygiene is recognized as the leading cause of these infections, a major contributor to the dissemination of multi-resistant organisms, and a significant driver of infection outbreaks. Previous studies have used various approaches to improve hand hygiene compliance in health care settings, such as self-assessment questionnaires and observation by trained individuals.[11,12] Educational programs that incorporate monitoring and feedback can positively influence hand hygiene compliance.[12,13] Various methods, such as posters, videos, and role-playing, have been adopted.[14] However, further research is needed to evaluate the individual effects of each component of these training program. There is a lack of research that has directly and objectively measured the impact of these programs on hand hygiene techniques and the quality of performance . There is also a research gap in the understanding of the efficacy of different hand hygiene techniques[15]. ‌ Aim:- This audit aims to evaluate the compliance with hand hygiene compliance in the surgical department, this audit explores hand hygiene behavior of doctors in the surgical department, identifying non compliance and ways to improve compliance the information gathered will be develop and implement an initiative to promote patient safety and limit the risk of healthcare-associated infections. Objectives:- 1. Achieve and maintain > or = 90% compliance on all five moments of hand hygiene according to the WHO for doctors. 2. Evaluate compliance with a current WHO standard. ‌3. Determine what influences hand hygiene compliance 4. Categorizing reasons for non-compliance on the WHO hand hygiene with example and photographs Standards or best practice adherence [1]:- Before Touching a Patient Before touching a patient, you should wash your hands in order to protect them from harmful microorganisms that could be present on your hands: 90% Before Clean/Aseptic Procedure Before performing an aseptic task (for example, inserting a catheter, drawing up an injection, or dressing a wound), you must wash your hands to prevent you carrying harmful microorganisms to vulnerable sites: 95% After Body Fluid Exposure Risk Immediately after any activity that involves risk of exposure to body fluids, even if gloves were worn, you must wash your hands to protect yourself and somebody else: 98% After Touching a Patient After touching a patient you must wash your hands to remove microorganisms acquired during care: 90% After touching patient surroundings Clean your hands after coming into contact with any items or surfaces in close proximity to a patient (such as bed rails, medical equipment, or furniture) to minimize the potential for the transfer of microorganisms: 85% ‌Methodology Prospective study approach. Sampling technique:- Direct observation was used as the method of data collection in this study, and direct observation of hand hygiene represented consecutive observations of hand hygiene. Observers filled out a structured checklist based on the WHO “Five Moments for Hand Hygiene” framework for assessing HAND hygiene used by doctors in the surgical department Data Collection tool:- A structured checklist based on the WHO “Five Moments for Hand Hygiene” was developed to assess compliance, and was done together with a Google Spreadsheet which allowed for immediate data tracking, organizing, and analysing during the direct observations. Sample size:- Due to not having a determined population size, convenience sampling was used to collect data. This cross sectional study consisted of observing a total of 80 moments during cycle 1, and 71 moments during cycle 2 by doctors directly working in the surgical department at Police Hospital, River Nile State, Sudan. Data collection was divided into two separate time periods: cycle 1 lasted from 12 th December to 24 th December, and cycle 2 lasted from 16 th March to 24 th March. Inclusion criteria:- Doctors who currently are working in the surgical department who are in the process of providing patient care, and undergoing surgical operations. Exclusion criteria:- Non-medical staff, administrators, and doctors who are providing care but do not have direct contact with patients. Also doctors not working in the surgical department. Results Results of the First Cycle:- Moment Target % Target Numbers Exclusions Result % Result numbers Before touching a patient 90% 34 No direct physical interaction occurred 17.6% 6 Before aseptic procedures 95% 67 Non invasive procedures that doesn’t require sterile conditions such as (monitor vital signs) 76.1% 51 After body fluids exposure risk 98% 33 Situations where no body fluid exposure 27.3% 9 After touching a patient 90% 10 No direct contact with the patient 30% 3 After touching patient surroundings 85% 3 Touching items not related to the patient 100% 3 Total Observed Opportunities 147 Overall % Compliance 48.9% Results of the Second Cycle:- Moment Target % Target numbers Exclusions Result % Result numbers Before touching a patient 90% 33 No direct physical interaction occurred 84.8% 28 Before aseptic procedures 95% 67 Non invasive procedures that doesn’t require sterile conditions such as ( monitor vital signs) 100% 67 After body fluid exposure risk 98% 34 Situations where no body fluid exposure 91.2% 31 After touching a patient 90% 3 No direct contact with the patient 66.7% 2 After touching patient surroundings 85% 1 Touching items not related to the patient 100% 1 Total Observed Opportunities 138 Overall % Compliance 93.4% These tables demonstrate a detailed analysis of two audit cycles, highlighting an excellent improvement in compliance and identifying areas of improvement that need a continuous focus. Overall, there were significant and positive findings for improving hand hygiene practices. There is a considerable increase in hand hygiene compliance from the first cycle to the second cycle. The overall compliance rate was more than double – rising from 48.9% to an astonishing 93.4%. This improvement demonstrates that the interventions used between the two cycles were extremely effective in facilitating positive doctors’ behaviour change. Assessment of Major Improvements The second audit cycle made huge gains in some key areas where compliance was previously low and transformed those into areas of compliance strength. Before Aseptic Procedures: This is a critical moment because it is related to patient safety; compliance reached a perfect score of 100% in the second cycle – an increase from 76.1% in the first cycle. This illustrates that doctors are following the highest standards of hygiene during the preparation for sterile procedures. After Body Fluid Exposure Risk: There were great improvements to this moment. Compliance for this moment increased from 27.3% in the first cycle to 91.2% in the second cycle. This demonstrates that doctors believe this is a significant safety measure, and the importance of this moment was demonstrated and communicated successfully to the doctors. After Touching Patient Surroundings: doctors had 100% compliance for both cycles for this measure. This demonstrates that there are uniform high standards for this hygiene moment. Overall, while most metrics demonstrate great progress, there’s a specific measure that showed a decline and needs to be corrected to support ongoing success. After Touching a Patient: Compliance for this specific measure dropped from 100% in cycle 1 to 66.7% in cycle 2. This a concerning observation, as this is a slip in predictable behaviour for a key moment in hand hygiene. A systematic review conducted among health professionals in Sub-Saharan Africa revealed that a lack of adequate knowledge among healthcare providers prevents them from complying with hand hygiene guidelines [16]. Studies suggested that the knowledge gap could be filled with continuous professional development programs to acquaint health professionals with the required knowledge [17]. The American Centres for Disease Control and Prevention (CDC) and WHO recommended that to address the knowledge gap, training or professional development training effectively should incorporate theoretical and practical sessions and be delivered continuously between 6 and 12 months [18,19] Limitations There are many barriers affecting the adherence rate to WHO hand hygiene protocol including physical barriers (unavailability of hand hygiene resources) such as water, soap, Alcohol based hand rub. Poor quality resources and physical discomfort such as skin irritation and allergies, organizational barriers are broad, including lack of comprehensive and consistent training programs on hand hygiene regarding established protocols, improper supervision, and poor monitoring and evaluation programs. Behavioural barriers include poor understanding of importance of hand hygiene for reducing healthcare associated infections (no need for hand hygiene if gloves are used), forgetfulness due to routine nature of hand hygiene. All these factors affect hand hygiene compliance. Recommendations that were implemented:- A coordinated approach to improve hand hygiene protocols required a co-ordinated team effort within the following areas: Targeted Education and Training: Scheduled, regular updates with practical steps, role-specific training led by effective communication and visual reminders. Supply Chain Management: Resilient supply chain, appropriate context-specific solutions and reserves. Strategic Infrastructure Development: Improve clean water access, sanitation, mobile hand hygiene facilities, appropriate technologies such as solar-powered purification, and appropriate waste disposal. Monitoring & Evaluation: Regular adherence audits with timely feedback and appropriate data analysis to target interventions. Conclusion Hand hygiene adherence among doctors in the surgical department improved from 48.9% in Cycle 1 to 93.4% in Cycle 2 following targeted interventions. These findings confirm that structured education and supply-chain support can drive significant improvements. To sustain progress, continuous monitoring, refresher training, and institutional backing are essential. Areas of Adherence In the second cycle, the highest levels of compliance were observed in cases of contact with patients, their surroundings, or exposure to bodily substances. The compliance rate was reportedly lowest in cases of prior contact with patients or followed by an aseptic procedure. This was consistent with the first cycle where compliance was highest after contact with bodily substances and lowest before contact with a patient or prior to an aseptic procedure. This data reveals an ongoing need for emphasis and training focus on hand hygiene in advance of contact with patients. Interns were a significant proportion of the observed healthcare workers. The interns comprised more than half of the observed health care workers in the first cycle and a vast majority in the second cycle. This provides an important opportunity for trainers to build targeted training for interns. The data suggests that this training was very effective, with all observed hand hygiene by interns in the second cycle rated adequate. Action Plan: - Healthcare workers received practical training sessions for effective hand washing, and correct usage of alcohol-based hand sanitizers. We were in touch with the quality improvement office for dependable supply-chain provision of hand hygiene items including soap, water and alcohol-based hand-sanitizers. The organization continued to liaise with the quality improvement office to get clean water supply and improve sanitation access in areas without water supply. Declarations Sharing Learning :- An audit report was delivered to the quality improvement office members at Police Hospital River Nile State, Sudan. We also delivered the audit at a national journal club of the Sudanese Consortium for Surgical Development on Saturday, April 19. Authors’ contributions: NAH analysed the data and prepared the manuscript. OAH analysed the data and led data collection and prepared the manuscript. SAA analysed the data and led data collection AIY designed the study. All authors approved the final version. Acknowledgement We gratefully acknowledge the collaborative, support and expert guidance provided by our mentors in TheSudanese Consortium for Surgical development, the Quality Improvement and infection control office, theadministration and clinical staff of Police Hospital, also Dr. Hanan Abdelrhman Abdella Hamed, which wereessential to the successful completion of this clinical audit. References World Health Organization. (2009). WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety Challenge Clean Care is Safer Care. World Health Organization. 2 .Glowicz JB, Landon E, Sickbert-Bennett EE, Aiello AE, deKay K, Hoffmann KK, et al. SHEA/IDSA/APIC practice recommendation: strategies to prevent healthcare-associated infections through hand hygiene: 2022 update. Infect Control Hosp Epidemiol. 2023;44(3):355–76. [DOI] [PMC free article] [PubMed] [Google Scholar ] Boyce JM, Pittet D. 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Hand Hygiene Education Components Among First-Year Nursing Students: A Cluster Randomized Clinical Trial. JAMA Netw Open. 2024;7(6):e2413835. doi:10.1001/jamanetworkopen.2024.13835 Ataiyero Y, Dyson J, Graham M. Barriers to hand hygiene practices among health care workers in sub-Saharan African countries: A narrative review. Am J Infect Control. 2019;47(5):565–73. [DOI] [PubMed] [Google Scholar] Tartari E, Fankhauser C, Masson-Roy S, Márquez-Villarreal H, Fernández Moreno I, Rodriguez Navas ML, et al. Train-the-Trainers in hand hygiene: a standardized approach to guide education in infection prevention and control. Antimicrob Resist Infect Control. 2019;8(1):206. [DOI] [PMC free article] [PubMed] [Google Scholar] Boyce JM, Pittet D. Guideline for hand hygiene in Health-Care settings: recommendations of the healthcare infection control practices advisory committee and the HICPAC/SHEA/APIC/IDSA hand hygiene task force. Infect Control Hosp Epidemiol. 2002;23(S12):S3–40. [DOI] [PubMed] [Google Scholar] World Health Organization, WHO Patient Safety. WHO guidelines on hand hygiene in health care. 2009;(WHO/IER/PSP/2009/01):262. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7496087","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Short Report","associatedPublications":[],"authors":[{"id":508832172,"identity":"e7c13bdf-896a-40e3-b9e3-762193d0128a","order_by":0,"name":"Nada Abdalla","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9ElEQVRIiWNgGAWjYBACgwMMBkBKQo6fvfkAkGHBwMBDQIsFRIuFsWTPsQQGhgQJwlpsIFoqEjfcyDEgUsvxwxsf89RIJG44c+bjY94fQBfyHGD88DEHtxazM2nFxjzHJIxnHu/dbMyTIGEs2dvALDlzGx4tB3LMpHnYJGT7zpzdJg3UkrjhPAMbMy8eLcbn3wC1/JNgbLiR84w4LYY3gLbwtkkoTriRwwbRcraBkJZnxYZz+yRAgWxsOCcNxDjYjNcvBueTNz54860OFJUPH7yxsQGGWPLBDx/xaAEBJrSYYGzArx6k5AdBJaNgFIyCUTCiAQBjJFRzObLd0QAAAABJRU5ErkJggg==","orcid":"","institution":"Lab of Quality improvement in Surgery, Research Department, Sudanese Consortium for Surgical Development","correspondingAuthor":true,"prefix":"","firstName":"Nada","middleName":"","lastName":"Abdalla","suffix":""},{"id":508832174,"identity":"7691af05-ca98-4e12-a496-d7dfeb50aa51","order_by":1,"name":"Omniat Ahmed","email":"","orcid":"","institution":"Lab of Quality improvement in Surgery, Research Department, Sudanese Consortium for Surgical Development","correspondingAuthor":false,"prefix":"","firstName":"Omniat","middleName":"","lastName":"Ahmed","suffix":""},{"id":508832177,"identity":"165ef3ea-1f17-4d47-aec5-ab6d3bca277d","order_by":2,"name":"Saad Adam Abdallah Abakar³","email":"","orcid":"","institution":"Lab of Quality improvement in Surgery, Research Department, Sudanese Consortium for Surgical Development","correspondingAuthor":false,"prefix":"","firstName":"Saad","middleName":"Adam Abdallah","lastName":"Abakar³","suffix":""},{"id":508832179,"identity":"fb02c539-add1-4268-8814-0af9552c5b6f","order_by":3,"name":"Arwa Eltayeb","email":"","orcid":"","institution":"Lab of Quality improvement in Surgery, Research Department, Sudanese Consortium for Surgical Development","correspondingAuthor":false,"prefix":"","firstName":"Arwa","middleName":"","lastName":"Eltayeb","suffix":""}],"badges":[],"createdAt":"2025-08-30 15:08:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7496087/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7496087/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":90545021,"identity":"eeefbf67-a049-4057-ae14-e5c590c38005","added_by":"auto","created_at":"2025-09-04 00:25:15","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":222173,"visible":true,"origin":"","legend":"\u003cp\u003eThis figure show comparison of hand hygiene compliance between Cycle 1 (December 2024) and Cycle 2 (March 2025) across the WHO “Five Moments for Hand Hygiene.”\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7496087/v1/1ef997599d3d9176dea0ae16.png"},{"id":90545498,"identity":"2513bba3-ae3b-4f0c-b5a7-d688dc64b1a1","added_by":"auto","created_at":"2025-09-04 00:41:17","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":914407,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7496087/v1/041cef9b-7b3c-43ff-ba17-ab98ce296947.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eAdherence to WHO Hand Hygiene Protocols in the Surgical Department, Police Hospital, Nile River- Sudan\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHand hygiene stands as a fundamental pillar in the prevention and control of infections within healthcare environments, playing a pivotal role in diminishing the transmission of healthcare-associated infections (HAIs) [1]. Hand hygiene is the most effective and feasible infection prevention and control measure within healthcare facilities. Hand hygiene can be achieved through different methods depending on various factors like the activity/procedure being performed or to be performed, the level of dirtiness of hand and time. Despite the ease and simplicity of the technique, the adherence rate among health professionals remains suboptimal, leaving health professionals and patients vulnerable to healthcare-acquired infections [2,3]. Contaminated hands of health professionals are responsible for the transmission of most infections including drug-resistance microorganisms through direct and indirect contact [4]. Studies suggested that improving hand hygiene adherence alone can reduce up to 50% of the transmission of pathogens within the healthcare settings. A significant reduction of Healthcare Acquire Infections can be achieved with an approximately 60% hand hygiene adherence rate among healthcare workers within the facility. However, almost 61% of health professionals don\u0026rsquo;t comply with the hand hygiene guidelines [5,6]. Hand hygiene adherence rates significantly differ across World Health Organization (WHO) five critical moments for the hand hygiene [7, 8]. In recognition of the critical importance of this seemingly simple yet highly effective practice, the World Health Organization (WHO) introduced the \u0026quot;Five Moments for Hand Hygiene\u0026quot; in 2009 as a globally applicable framework. This strategy provides clear guidance to healthcare workers on the specific instances during patient care when hand hygiene is absolutely essential [1]. These five crucial moments are: 1) before touching a patient, 2) before a clean or aseptic procedure, 3) after body fluid exposure risk, 4) after touching a patient, and 5) after touching patient surroundings [1]. The critical importance of hand hygiene in preventing healthcare-associated (nosocomial) infections [9,10] was the primary reason for selecting this audit topic. Non-compliance with hand hygiene is recognized as the leading cause of these infections, a major contributor to the dissemination of multi-resistant organisms, and a significant driver of infection outbreaks. Previous studies have used various approaches to improve hand hygiene compliance in health care settings, such as self-assessment questionnaires and observation by trained individuals.[11,12] Educational programs that incorporate monitoring and feedback can positively influence hand hygiene compliance.[12,13] Various methods, such as posters, videos, and role-playing, have been adopted.[14] However, further research is needed to evaluate the individual effects of each component of these training program. There is a lack of research that has directly and objectively measured the impact of these programs on hand hygiene techniques and the quality of performance . There is also a research gap in the understanding of the efficacy of different hand hygiene techniques[15]. \u0026zwnj;\u003c/p\u003e\n\u003ch2\u003eAim:-\u003c/h2\u003e\n\u003cp\u003eThis audit aims to evaluate the compliance with hand hygiene compliance in the surgical department, this audit explores hand hygiene behavior of doctors in the surgical department, identifying non compliance and ways to improve compliance the information gathered will be develop and implement an initiative to promote patient safety and limit the risk of healthcare-associated infections.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eObjectives:-\u003c/h2\u003e\n\u003cp\u003e1. Achieve and maintain \u0026gt; or = 90% compliance on all five moments of hand hygiene according to the WHO for doctors.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2. Evaluate compliance with a current WHO standard.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026zwnj;3. Determine what influences hand hygiene compliance\u003c/p\u003e\n\u003cp\u003e4. Categorizing reasons for non-compliance on the WHO hand hygiene with example and photographs\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eStandards or best practice adherence [1]:-\u003c/h2\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003ch3\u003eBefore Touching a Patient\u003c/h3\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eBefore touching a patient, you should wash your hands in order to protect them from harmful microorganisms that could be present on your hands: 90%\u0026nbsp;\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003ch3\u003eBefore Clean/Aseptic Procedure\u003c/h3\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eBefore performing an aseptic task (for example, inserting a catheter, drawing up an injection, or dressing a wound), you must wash your hands to prevent you carrying harmful microorganisms to vulnerable sites: 95%\u0026nbsp;\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003ch3\u003eAfter Body Fluid Exposure Risk\u003c/h3\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eImmediately after any activity that involves risk of exposure to body fluids, even if gloves were worn, you must wash your hands to protect yourself and somebody else: 98%\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003ch3\u003eAfter Touching a Patient\u003c/h3\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eAfter touching a patient you must wash your hands to remove microorganisms acquired during care: 90%\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003ch3\u003eAfter touching patient surroundings\u003c/h3\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eClean your hands after coming into contact with any items or surfaces in close proximity to a patient (such as bed rails, medical equipment, or furniture) to minimize the potential for the transfer of microorganisms: 85%\u003c/p\u003e"},{"header":"‌Methodology","content":"\u003cp\u003eProspective study approach.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eSampling technique:-\u003c/h2\u003e\n\u003cp\u003eDirect observation was used as the method of data collection in this study, and direct observation of hand hygiene represented consecutive observations of hand hygiene. Observers filled out a structured checklist based on the WHO \u0026ldquo;Five Moments for Hand Hygiene\u0026rdquo; framework for assessing HAND hygiene used by doctors in the surgical department\u003c/p\u003e\n\u003ch2\u003eData Collection tool:-\u003c/h2\u003e\n\u003cp\u003eA structured checklist based on the WHO \u0026ldquo;Five Moments for Hand Hygiene\u0026rdquo; was developed to assess compliance, and was done together with a Google Spreadsheet which allowed for immediate data tracking, organizing, and analysing during the direct observations.\u003c/p\u003e\n\u003ch2\u003eSample size:-\u003c/h2\u003e\n\u003cp\u003eDue to not having a determined population size, convenience sampling was used to collect data. This cross sectional study consisted of observing a total of 80 moments during cycle 1, and 71 moments during cycle 2 by doctors directly working in the surgical department at Police Hospital, River Nile State, Sudan. Data collection was divided into two separate time periods: cycle 1 lasted from 12\u003csup\u003eth\u003c/sup\u003e December to 24\u003csup\u003eth\u003c/sup\u003e December, and cycle 2 lasted from 16\u003csup\u003eth\u003c/sup\u003e March to 24\u003csup\u003eth\u003c/sup\u003e March.\u003c/p\u003e\n\u003ch2\u003eInclusion criteria:-\u003c/h2\u003e\n\u003cp\u003eDoctors who currently are working in the surgical department who are in the process of providing patient care, and undergoing surgical operations.\u003c/p\u003e\n\u003ch2\u003eExclusion criteria:-\u003c/h2\u003e\n\u003cp\u003eNon-medical staff, administrators, and doctors who are providing care but do not have direct contact with patients. Also doctors not working in the surgical department.\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003ch2\u003eResults of the First Cycle:-\u003c/h2\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"585\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMoment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTarget %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTarget\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eNumbers\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExclusions\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResult %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResult numbers\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eBefore touching a patient\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e90%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eNo direct physical interaction occurred\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e17.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eBefore aseptic procedures\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e95%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eNon invasive procedures that doesn\u0026rsquo;t require sterile conditions such as (monitor vital signs)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e76.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eAfter body fluids exposure risk\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e98%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eSituations where no body fluid exposure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e27.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eAfter touching a patient\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e90%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eNo direct contact with the patient\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e30%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eAfter touching patient surroundings\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e85%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eTouching items not related to the patient\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eTotal Observed Opportunities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e147\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eOverall % Compliance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e48.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch2\u003eResults of the Second Cycle:-\u003c/h2\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"567\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMoment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTarget %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTarget numbers\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExclusions\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResult\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan dir=\"RTL\"\u003e%\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResult numbers\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eBefore touching a patient\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e90%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eNo direct physical interaction occurred\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e84.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eBefore aseptic procedures\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e95%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eNon invasive procedures that doesn\u0026rsquo;t require sterile conditions such as ( monitor vital signs)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eAfter body fluid exposure risk\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e98%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eSituations where no body fluid exposure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e91.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eAfter touching a patient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e90%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eNo direct contact with the patient\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e66.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eAfter touching patient surroundings\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e85%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eTouching items not related to the patient\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eTotal Observed Opportunities\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e138\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eOverall % Compliance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e93.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThese tables demonstrate a detailed analysis of two audit cycles, highlighting an excellent improvement in compliance and identifying areas of improvement that need a continuous focus. Overall, there were significant and positive findings for improving hand hygiene practices.\u003c/p\u003e\n\u003cp\u003eThere is a considerable increase in hand hygiene compliance from the first cycle to the second cycle. The overall compliance rate was more than double \u0026ndash; rising from 48.9% to an astonishing 93.4%. This improvement demonstrates that the interventions used between the two cycles were extremely effective in facilitating positive doctors\u0026rsquo; behaviour change.\u003c/p\u003e\n\u003ch3\u003eAssessment of Major Improvements\u0026nbsp;\u003c/h3\u003e\n\u003cp\u003eThe second audit cycle made huge gains in some key areas where compliance was previously low and transformed those into areas of compliance strength.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBefore Aseptic Procedures: This is a critical moment because it is related to patient safety; compliance reached a perfect score of 100% in the second cycle \u0026ndash; an increase from 76.1% in the first cycle. This illustrates that doctors are following the highest standards of hygiene during the preparation for sterile procedures.\u003c/p\u003e\n\u003cp\u003eAfter Body Fluid Exposure Risk: There were great improvements to this moment. Compliance for this moment increased from 27.3% in the first cycle to 91.2% in the second cycle. This demonstrates that doctors believe this is a significant safety measure, and the importance of this moment was demonstrated and communicated successfully to the doctors.\u003c/p\u003e\n\u003cp\u003eAfter Touching Patient Surroundings: \u0026nbsp;doctors had 100% compliance for both cycles for this measure. This demonstrates that there are uniform high standards for this hygiene moment.\u003c/p\u003e\n\u003cp\u003eOverall, while most metrics demonstrate great progress, there\u0026rsquo;s a specific measure that showed a decline and needs to be corrected to support ongoing success.\u003c/p\u003e\n\u003cp\u003eAfter Touching a Patient: Compliance for this specific measure dropped from 100% in cycle 1 to 66.7% in cycle 2. This a concerning observation, as this is a slip in predictable behaviour for a key moment in hand hygiene.\u003c/p\u003e\n\u003cp\u003eA systematic review conducted among health professionals in Sub-Saharan Africa revealed that a lack of adequate knowledge among healthcare providers prevents them from complying with hand hygiene guidelines [16]. Studies suggested that the knowledge gap could be filled with continuous professional development programs to acquaint health professionals with the required knowledge [17].\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The American Centres for Disease Control and Prevention (CDC) and WHO recommended that to address the knowledge gap, training or professional development training effectively should incorporate theoretical and practical sessions and be delivered continuously between 6 and 12 months [18,19]\u003c/p\u003e"},{"header":"Limitations","content":"\u003cp\u003eThere are many barriers affecting the adherence rate to WHO hand hygiene protocol including physical barriers (unavailability of hand hygiene resources) such as water, soap, Alcohol based hand rub. Poor quality resources and physical discomfort such as skin irritation and allergies, organizational barriers are broad, including lack of comprehensive and consistent training programs on hand hygiene regarding established protocols, improper supervision, and poor monitoring and evaluation programs.\u003c/p\u003e\n\u003cp\u003eBehavioural barriers include poor understanding of importance of hand hygiene for reducing healthcare associated infections (no need for hand hygiene if gloves are used), forgetfulness due to routine nature of hand \u0026nbsp; \u0026nbsp; hygiene. All these factors affect hand hygiene compliance. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRecommendations that were implemented:-\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;A coordinated approach to improve hand hygiene protocols required a co-ordinated team effort within the following areas:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eTargeted Education and Training: Scheduled, regular updates with practical steps, role-specific training led by effective communication and visual reminders.\u003c/li\u003e\n \u003cli\u003eSupply Chain Management: Resilient supply chain, appropriate context-specific solutions and reserves.\u003c/li\u003e\n \u003cli\u003eStrategic Infrastructure Development:\u0026nbsp;Improve clean water access, sanitation, mobile hand hygiene facilities, appropriate technologies such as solar-powered purification, and appropriate waste disposal.\u003c/li\u003e\n \u003cli\u003eMonitoring \u0026amp; Evaluation: Regular adherence audits with timely feedback and appropriate data analysis to target interventions.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Conclusion","content":"\u003cp\u003eHand hygiene adherence among doctors in the surgical department improved from 48.9% in Cycle 1 to 93.4% in Cycle 2 following targeted interventions. These findings confirm that structured education and supply-chain support can drive significant improvements. To sustain progress, continuous monitoring, refresher training, and institutional backing are essential.\u003c/p\u003e\n\u003ch3\u003eAreas of Adherence\u003c/h3\u003e\n\u003cp\u003eIn the second cycle, the highest levels of compliance were observed in cases of contact with patients, their surroundings, or exposure to bodily substances. The compliance rate was reportedly lowest in cases of prior contact with patients or followed by an aseptic procedure.\u003c/p\u003e\n\u003cp\u003eThis was consistent with the first cycle where compliance was highest after contact with bodily substances and lowest before contact with a patient or prior to an aseptic procedure. This data reveals an ongoing need for emphasis and training focus on hand hygiene in advance of contact with patients.\u003c/p\u003e\n\u003cp\u003eInterns were a significant proportion of the observed healthcare workers. The interns comprised more than half of the observed health care workers in the first cycle and a vast majority in the second cycle. This provides an important opportunity for trainers to build targeted training for interns. The data suggests that this training was very effective, with all observed hand hygiene by interns in the second cycle rated adequate. \u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eAction Plan: -\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eHealthcare workers received practical training sessions for effective hand washing, and correct usage of alcohol-based hand sanitizers. We were in touch with the quality improvement office for dependable supply-chain provision of hand hygiene items including soap, water and alcohol-based hand-sanitizers. The organization continued to liaise with the quality improvement office to get clean water supply and improve sanitation access in areas without water supply.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eSharing Learning :-\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAn audit report was delivered to the quality improvement office members at Police Hospital River Nile State, Sudan. We also delivered the audit at a national journal club of the Sudanese Consortium for Surgical Development on Saturday, April 19.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions:\u003c/strong\u003e\u003cstrong\u003e\u003cspan dir=\"RTL\"\u003e \u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNAH analysed the data and prepared the manuscript.\u003c/strong\u003e\u003cstrong\u003e\u003cspan dir=\"RTL\"\u003e \u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOAH analysed the data and led data collection and prepared the manuscript.\u003c/strong\u003e\u003cstrong\u003e\u003cspan dir=\"RTL\"\u003e \u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSAA analysed the data and led data collection\u003c/strong\u003e\u003cstrong\u003e\u003cspan dir=\"RTL\"\u003e \u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAIY designed the study.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAll authors approved the final version.\u003c/strong\u003e\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe gratefully acknowledge the collaborative, support and expert guidance provided by our mentors in TheSudanese Consortium for Surgical development, the Quality Improvement and infection control office, theadministration and clinical staff of Police Hospital, also Dr. Hanan Abdelrhman Abdella Hamed, which wereessential to the successful completion of this clinical audit.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization. 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WHO guidelines on hand hygiene in health care. 2009;(WHO/IER/PSP/2009/01):262.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Hand hygiene, WHO Five Moments, compliance, infection prevention, Sudan, audit","lastPublishedDoi":"10.21203/rs.3.rs-7496087/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7496087/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Hand hygiene is a simple yet essential practice to prevent healthcare-associated infections (HAIs). However, adherence among healthcare workers is often poor. This study assessed compliance with the WHO “Five Moments for Hand Hygiene” among doctors in the surgical department of Police Hospital, Nile River State, Sudan.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e We conducted a prospective observational audit in two cycles (December 2024 and March 2025). Doctors’ adherence to hand hygiene moments was observed directly using a WHO-based checklist. Compliance rates were compared between cycles.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eAcross 147 opportunities in Cycle 1, compliance was 48.9%. In Cycle 2, compliance rose to 93.4% (138 opportunities). The largest improvement occurred in “After body fluid exposure” (27.3% → 91.2%) and “Before aseptic procedures” (76.1% → 100%). Notably, adherence “After touching a patient” decreased from 100% to 66.7%.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eEducational interventions and supply improvements significantly boosted hand hygiene compliance. Ongoing training, monitoring, and reinforcement will be essential to maintain these gains.\u003c/p\u003e","manuscriptTitle":"Adherence to WHO Hand Hygiene Protocols in the Surgical Department, Police Hospital, Nile River- Sudan","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-04 00:17:10","doi":"10.21203/rs.3.rs-7496087/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c06ac231-f243-4d9e-8e11-e6e222690ca0","owner":[],"postedDate":"September 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-04T00:17:12+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-04 00:17:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7496087","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7496087","identity":"rs-7496087","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}