Knowledge and practices of hand hygiene among healthcare workers in three urban hospitals in Bobo-Dioulasso city, 2022 (Burkina Faso)

Knowledge and practices of hand hygiene among healthcare workers in three urban hospitals in Bobo-Dioulasso city, 2022 (Burkina Faso) | 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 Research Article Knowledge and practices of hand hygiene among healthcare workers in three urban hospitals in Bobo-Dioulasso city, 2022 (Burkina Faso) Arsène Hema, Arsène Some, Marthe Louise Traoré, Soufiane Sanou, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4430550/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Background The hands of healthcare workers are the major source of healthcare-associated infection transmission. Hand hygiene (HH) remains the most effective measure for preventing such infections. This study aimed to assess knowledge, technical mastery and compliance with HH among healthcare workers in three hospitals in Bobo Dioulasso city. Methods A multicenter cross-sectional study was conducted from May 5th to July 3rd, 2022, in 2 district hospitals (DO et Dafra) and the Sourô Sanou Teaching Hospital. Data collection involved the use of a questionnaire on knowledge (WHO, 2009), a WHO direct observation tool for HH compliance (WHO, 2009c) and an observation grid completed by trained investigators to assess HH technique and compliance. Data analysis was performed using Stata 13. We used multilevel linear and logistic regression to analyze the associations between HH knowledge scores, HH compliance, and participants’ characteristics. Results In total, 175 participants were included, and a total of 1701 observations were made. The participants included 24.6% physicians, 60.0% nurses, 12.0% midwives and 3.4% hospital hygiene technicians. The median age of the study participants was 39 years (IQR 27–46), and the median work experience was 10 years (IQR 5–15). The median HH knowledge score was 8 out of 15 points (IQR 7–9). Only 40.7% of participants adhered to the correct HH technique, and the compliance rate for HH following WHO indications was 40.3%. The predictors of good knowledge scores on HH were young age, female gender, workplace, seniority in the profession and participation in HH training. The predictors of HH compliance were age between 40 and 49 years (OR = 2.1; CI = 1.2–3.8), surgery ward of Do (OR = 3.3; CI = 2.0–5.5), and participation in HH training (OR = 1.4; CI = 1.1–1.9). Conclusions Healthcare workers’ knowledge, technical mastery and HH compliance were low. It is therefore necessary to strengthen compliance with HH through implementation training programs and increased awareness initiatives. hand hygiene knowledge practices healthcare workers Bobo-Dioulasso Figures Figure 1 Introduction Healthcare-associated infections (HAIs) constitute a major public health issue and represent a significant economic burden [ 1 ]. Indeed, HAIs can increase the length of hospital stays, increase health care costs, and increase the risk of complications and deaths but also promote the emergence and dissemination of antibiotic resistance [ 1 ]. However, since 1845, thanks to the Austro-Hungarian obstetrician Ignaz Semmelweis’s work, it is known that good hand hygiene (HH) reduces the risk of transmission of these infections [ 2 ]. Since infectious agents are mainly spread through the hands, hand hygiene has become the primary measure used to prevent and control infections in healthcare settings [ 1 ]. Studies have shown that good hand hygiene reduces the frequency of HAIs by 15–30% [ 3 – 5 ]. Therefore, since 2009, the World Health Organization (WHO) has developed specific guidelines for hand hygiene improvement in healthcare facilities. The concept of “my five moments for hand hygiene” merged with the multimodal hand hygiene improvement strategy. The WHO Guidelines on Hand Hygiene in Health Care have been developed with the ultimate objective of changing the behavior of individual HCWs to optimize compliance with hand hygiene at the recommended moments and to improve patient safety. Thus, at least five components drive the strategy: system change, in particular, the recourse to alcohol-based hand rubbing as the new standard of care, staff education using newly developed tools, monitoring and feedback of staff performance, reminders in the workplace, and promotion of an institutional safety climate [ 1 , 6 ]. The WHO also launched the global campaign “Clean Care is Safer”, which emphasizes the importance of hand hygiene in healthcare facilities [ 6 ]. Decades of promoting hospital hygiene have led to an overall improvement in relative HH compliance in hospitals in developed countries. However, there are large variations in HH compliance rates from one hospital to another and in the same hospital from one department to another, depending on the method of compliance assessment [ 7 – 11 ]. This variability suggests that individual features could play a role in determining behavior. Understanding these features and individual factors such as social cognitive determinants may provide additional insight into hand hygiene behavior [ 12 , 13 ]. However, low levels of adherence to HH are reported in developing countries, where healthcare facilities face shortages of material and human resources [ 14 – 16 ]. The lack of HH compliance in healthcare settings exposes staff, patients, patient companions, and the community to the risk of healthcare-acquired infections. A lack of knowledge of guidelines for hand hygiene, lack of recognition of hand hygiene opportunities during patient care, and lack of awareness of the risk of cross-transmission of pathogens were identified as the main barriers to good hand hygiene practices[ 6 ]. A lack or shortage of basic equipment, inadequate infrastructure, and poor hygiene and sanitation are also unfavorable factors for hand hygiene compliance. The recent COVID-19 pandemic has highlighted the importance of this simple hygiene practice in controlling contagion. Thus, during this pandemic in 2020, training and awareness raising for healthcare workers on standard and additional hygiene precautions were performed in healthcare facilities in Burkina Faso. Two years after these training sessions, this study aimed to assess the knowledge levels, technical proficiency, and hand hygiene compliance among healthcare workers from three hospitals in Bobo Dioulasso city. Methods Study design and location: This cross-sectional, multicenter study was conducted from May 5th to July 3rd, 2022, in 3 healthcare facilities located in Bobo-Dioulasso, Burkina Faso's second-largest city. The facilities included 2 district hospitals (DO et Dafra) and 1 teaching hospital (Sourô Sanou Teaching Hospital = CHUSS) in Bobo-Dioulasso. Locally produced hydroalcoholic solution was utilized for hand hygiene across all three facilities. In the district’s hospital, DO and Dafra, the study took place in the surgery ward. At the Sourô Sanou Teaching Hospital, it is located in the intensive care, gynecology and obstetrics postoperative care ward and neonatology wards. Surgery ward of Dafra district hospital The surgery ward of Do District Hospital received 888 postsurgical patients in 2022. This ward comprises 2 hospitalization rooms with a total capacity of 16 beds. During the survey, the service was staffed by 52 nurses, 2 hospital hygiene technicians, and 2 permanent physicians. Surgery ward of Do district hospital The surgery ward of Do District Hospital received 1706 postsurgical patients in 2022. This ward comprises six hospitalization rooms with a total capacity of twenty-four beds (24). At the time of the survey, the service was staffed by 59 nurses, 1 hospital hygiene technician, 5 permanent physicians, and approximately 5 medical trainees. Intensive Care Units of Sourô Sanou Teaching Hospital In 2022, 525 patients were admitted to the intensive care unit of Sourô Sanou Teaching Hospital. This unit has 14 inpatient beds. The service is staffed by 5 Physicians Anaesthetist resuscitators, approximately 10 physicians’ residents, 23 nurses and 3 hospital hygiene technicians Neonatology ward of Sourô Sanou Teaching Hospital In 2022, the neonatology ward of Sourô Sanou Teaching Hospital received 2,765 new-borns. It has a hospital room that includes 6 incubators and 34 cradles. The staff consists of 2 doctors specializing in pediatrics, 2 general practitioners, approximately 10 physician residents, 28 nurses and 3 hospital hygiene technicians. Gynecology and Obstetrics Postoperative Care Ward of Sourô Sanou Teaching Hospital In 2022, the gynecology and obstetrics postoperative care ward of Sourô Sanou Teaching Hospital received 1,946 women, including 1,433 cesareans. This unit has 30 inpatient beds. The staff consisted of 16 physicians, 4 nurses and 21 midwives. Study population The study participants were healthcare professionals. All clinical staff directly involved in patient care or environmental hygiene on a daily basis and employed at the study site were eligible for inclusion: physicians, nurses, midwives, and hygiene technicians (HTs). Sampling Sample size In the absence of a similar study on this subject in Burkina Faso, we based the calculation of the sample size on the hypothesis that the average knowledge score (µ) of health workers on hand hygiene was between 7.5 and 8/15, with a standard deviation (Ժ) of 2. With a risk of α = 5% and a power of β = 80%, a minimum of 128 participants were necessary for this study. The number of staff included per ward was weighted by the total number of people working in the ward. Thus, the minimum number of participants included in the wards were as follows: 21 participants in the gynecology and obstetrics postoperative care ward, 23 in the neonatology ward, 21 in intensive care units, 35 in the surgery ward of Do and 29 in the surgery ward of Dafra. For the hand hygiene compliance study, we analyzed a minimum of 5 opportunities per included participant. Sampling method In the three hospitals, health workers were included in the study because they worked in the targeted wards. Observations of health workers' hand hygiene practices were made discreetly by surveys without knowledge of the latter. Data collection Assessment of healthcare workers’ knowledge The collection of knowledge data was performed using the questionnaire on knowledge (WHO, 2009), a self-administered questionnaire for health workers. The survey included socioprofessional data (age, sex, profession, work experience, training on hand hygiene), 4 multiple-choice questions on the modes of transmission of infections in healthcare settings, 5 questions (true/false) on the methods of hand hygiene and 6 multiple-choice questions on the indications of hand hygiene methods. One point was awarded for each correct answer, and 0 points were awarded otherwise. The participants' level of knowledge was scored out of 15 points. Assessment of health workers’ practices The assessment of healthcare workers’ practices focused on the observation of the prerequisites, technique and hand hygiene compliance. Prerequisites and technique for hand hygiene Using a checklist, the investigators checked compliance with the prerequisites for hand hygiene (no jewelry, short nails, no polishing, no fake nails, short or rolled up sleeves) and compliance with the technique of hand hygiene, i.e., respecting it of the six stages of hand hygiene: Sufficient soap (or alcohol-based products) was applied to cover the entire hand surface, the palms of the hands were rubbed together, the back of the hand was placed between the fingers and the nails, backs of fingers to opposing palms with fingers interlocked, rotational rubbing of the left thumb clasped in the right palm and vice versa, and rotational rubbing, backward and forwarding with clasped fingers of the right hand in the left palm and vice versa, was applied. Hand hygiene compliance Individual healthcare workers who routinely cared for patients in each ward were directly observed anonymously by survey investigators. The investigators noted all potential opportunities for hand hygiene and assessed hand hygiene compliance using the WHO hand hygiene observation tool (WHO, 2009c). The survey investigators were nurses who were recruited from outside the surveyed health facilities and trained on the WHO hand hygiene instrument. The hand hygiene observation tool is based on the WHO five moments of hand hygiene, which defines opportunities for hand hygiene as follows: before patient contact, before the performance of an aseptic procedure, after contact with bodily fluids, after touching a patient and after leaving a patient’s surroundings. Variables Outcome variables The outcome variables were the HH knowledge score and hand hygiene compliance. The hand hygiene knowledge score was calculated by adding points obtained by a question indicating that one point was awarded for each correct answer and 0 points otherwise. The maximum score was 15. Hand hygiene compliance was determined according to five WHO standards for hand hygiene. Several hand hygiene opportunities were observed per health worker. For logistic regression, we coded 0 for no compliance and 1 for hand hygiene compliance. Predictor variables Gender: Male, Female Age in years was categorized by convenience in four classes: 20–29, 30–39, 40–49 and ≥ 50 years. Profession: participants’ occupations were categorized into four classes: nurses (nurses, nurse trainees), physicians (specialist doctors, general practitioners, physician residents and medical trainees), midwives, and hygiene technicians. Wards/Units: These are the wards/units from which the participants were recruited. There were three wards/units of Sourô Sanou Teaching Hospital (Gyn & Ob/CHUSS, Neonatology/CHUSS, Intensive Care Unit/CHUSS), one ward of the district hospital of Dafra (Surgical/Dafra) and one of the district hospitals of DO (Surgical/Do). Work experiences in years: health worker's experience in their profession. The data were categorized into classes 9 years and missing data. Training on hand hygiene in the last three years: Yes, or No Statistical analysis The data collected on survey sheets were entered into Epidata ® software and analyzed using Stata ® software version 13. The socioprofessional characteristics, knowledge of the participants on hand hygiene, hand hygiene prerequisites and technique compliance were described by professional category. The qualitative variables are presented as percentages, and the quantitative variables are presented as medians and interquartile ranges (IQRs). We determined the distribution of the knowledge score of healthcare workers as well as that of their observance of hand hygiene according to the five WHO moments of hand hygiene. We used multilevel linear regression to analyze the associations between knowledge scores and socioprofessional characteristics (age, gender, profession, department/unit, professional experience, training in hand hygiene). For the analysis of the associations between hand hygiene compliance and socioprofessional characteristics, we used multilevel logistic regression. The significance level p-value was 5% for all the statistical analyses. Ethical aspects This study was carried out as part of the "Surveillance and prevention strategies for healthcare-associated infections in Bobo-Dioulasso, Burkina Faso" study approved by the National Health Ethics Committee of Burkina Faso. An information sheet was given to each participant. After reading this information sheet, those who desired to participate in the study signed a free and informed consent form. The data collected were anonymized to ensure their confidentiality. Results Characteristics of the study participants Out of 233 potential healthcare workers in the five wards, we recruited 175, representing a participation rate of 75.1%. Most of the participants were recruited from surgical wards (45.7%). The participation rate varied from 49.3% in the surgery ward of Do District Hospital to 97% in the neonatology ward of Sourô Sanou University Hospital. The participants were physicians (n = 43, 24.6%), nurses (n = 105, 60.0%), midwives (n = 21, 12.0%) and hospital hygiene technicians (n = 6; 3.4%). Our 175 participants were composed of 109 men (63.0%). The median age of the study participants was 39 years (IQR: 27–46); most of them (31.4%) were between 40 and 49 years old. The median work experience was 10 years (IQR: 5–15), and health care workers with more than 9 years of work experience were the most numerous. Over half of the participants reported that they had been trained in hand hygiene in the last three years, and 76.6% of them used hydroalcoholic products for hand hygiene (Table 1 ). Table 1 Distribution of study participants’ characteristics by professional category Characteristic Professional category, n(%) Total Physician Nurse Midwife HTs Ages group (years), (n = 175) • 20–29 31 (72.1) 15 (14.3) 3 (14.3) 3 (50.0) 52 (29.7) • 30–39 4 (9.3) 27 (25.7) 10 (47.6) 1 (16.7) 42 (24.0) • 40–49 5 (11.6) 42 (40.0) 6 (28.6) 2 (33.3) 55 (31.4) • ≥ 50 3 (7.0) 21 (20.0) 2 (9.5) 0 (0.0) 26 (14.9) • Median (IQR) 29 (26–33) 43 (34–48) 39 (35–42) 32 (24–44) 39 (27–46) Gender (n = 175) • Male 32 (74.4) 70 (66.7) 7 (33.3) 2 (33.3) 109 (63.0) • Female 11 (25.6) 35 (33.3) 14 (66.7) 4 (66.7) 64 (37.0) Hospital (n = 175) • CMA DAFRA 0 (0.0) 45 (42.9) 0 (0.0) 0 (0.0) 45 (25.7) • CMA DO 10 (23.3) 25 (23.8) 0 (0.0) 0 (0.0) 35 (20.0) • CHUSS 33 (76.4) 35 (33.3) 21 (100.0) 6 (100.0) 95 (54.3) Ward/Unit (n = 175) • Surgery/Dafra 0 (0.0) 45 (42.9) 0 (0.0) 0 (0.0) 45 (25.7) • Surgery/Do 10(23.3) 25(23.8) 0 (0.0) 0 (0.0) 35 (20.0) • Gyn & Ob/CHUSS 16 (37.2) 4 (3.8) 10 (47.6) 0 (0.0) 30 (17.2) • Neonatology/CHUSS 12 (27.9) 8 (7.6) 11 (52.4) 3 (50.0) 34 (19.4) • Intensive care unit/CHUSS 5 (11.6) 23 (21.9) 0 (0.0) 3 (50.0) 31(17.7) Work experience(years),(n = 145) • 9 2 (8.0) 61 (64.9) 13 (62.0) 1 (20.0) 77 (53.1) • Median (IQR) 5 (4–5) 12 (8–19) 10 (5–12) 5 (5–8) 10 (5–15) Training on hand hygiene in the last three years,(n = 175) (yes) 30 (69.8) 51 (48.6) 10 (47.6) 4 (66.7) 95 (54.3) Common use of hydroalcoholic products,(n = 175) (yes) 29 (67.4) 83 (79.0) 16 (76.2) 6 (100.0) 134 (76.6) Total, n (%) 43(24.6) 105(60.0) 21(12.0) 6(3.4) 175 (100) HTs = hygiene technicians; Gyn & Ob = Gynecology & obstetrics Participants’ knowledge of hand hygiene The median knowledge score of the health workers was 8 of 15 points, with an IQR (7–9), as shown in Table 2 . There was no statistically significant difference between the knowledge scores of the different professional categories (p = 0.128). Among the healthcare professionals surveyed, 89.1% were able to cite the appropriate hand hygiene technique after emptying a bedpan, and 82.3% knew that ABHR is faster than hand washing. However, only 17.7% of participants, including 9.5% of nurses (p = 0.001), were able to recognize the hygiene actions that protect caregivers (Table 2 ). Knowledge of the common source of transmission of microorganisms in healthcare settings was much lower among physicians (18.6%, p = 0.001). Nurses (88.6%) and midwives (90.5%) better understood the hand hygiene technique required after removing gloves (p = 0.000) and the hand hygiene technique required after making a patient's bed (66.7%; p = 0.002). Table 2 Study of healthcare workers’ knowledge of hand hygiene by professional category Knowledge questions (maximum score = 15) Total n = 175 Physician n = 43 Nurse n = 105 Midwife n = 21 HT n = 6 p- value Median score (IQR) 8 (7–9) 8 (7–10) 8 (7–9) 8 (7–10) 9 (8–10) 0.128 Desired responses, n (%) What is the main mode of cross-transmission of germs between patients in a healthcare facility? 108(61.7) 29 (67.4) 67 (63.8) 9 (42.9) 3 (50.0) 0.230 What is the most common microbial source responsible for infection? 54 (30.9) 8 (18.6) 29 (27.6) 12 (57.1) 5 (83.3) 0.001 What hand hygiene actions prevent the transmission of germs to the patient? 39 (22.3) 11 (25.6) 21 (20.0) 4 (19.0) 3 (50.0) 0.320 What hand hygiene actions prevent the transmission of germs to the caregiver? 31 (17.7) 14 (32.6) 10 (9.5) 4 (19.0) 3 (50.0) 0.001 ABHR is faster than washing with soap and water? 144 (82.3) 38 (88.4) 83 (79.0) 17 (80.9) 6 (100.0) 0.450 ABHR causes greater skin dryness than hand washing? 140 (80.0) 36 (83.7) 79 (75.2) 20 (95.2) 5 (83.3) 0.158 ABHR is more effective than washing hands with soap and water? 58 (33.1) 15 (34.9) 33 (31.4) 7 (33.3) 3 (50.0) 0.786 it is recommended to wash your hands then to ABHR? 55 (31.4) 19 (44.2) 30 (28.6) 28 (28.6) 0 (0.0) 0.099 What is the minimum duration necessary for ABHR? 40 (22.9) 10 (23.3) 24 (22.9) 4 (19.0) 2 (33.3) 0.892 What technique should be applied before palpating a patient's abdomen? 128 (73.4) 34 (79.1) 76 (72.4) 14 (66.7) 4 (66.7) 0.690 What technique should be applied before making an injection? 69 (39.4) 18 (41.9) 37 (35.2) 13 (61.9) 1 (16.7) 0.089 What technique should be applied after emptying a bedpan? 156 (89.1) 36 (83.7) 94 (89.5) 20 (95.2) 6 (100.0) 0.522 What technique should be applied after removing the gloves? 139 (79.4) 24 (55.8) 93 (88.6) 19 (90.5) 3 (50.0) 0.000 What technique should be applied after making a patient's bed? 30 (17.1) 12 (27.9) 12 (11.4) 2 (9.5) 4 (66.7) 0.002 What technique should be applied after exposure to blood? 163 (93.1) 38 (88.4) 98 (93.3) 21 (100.0) 6 (100.0) 0.384 ABHR = alcohol-based hand rub. HT = hygiene technician Observance of the prerequisites for hand hygiene. The prerequisites for hand hygiene were met by 72.7% of the participants. These measures were used by 79.8% of nurses, 70.0% of doctors, 50% of THHs and 50% of midwives (p = 0.021). The least observed measure was the absence of jewelry (77.1%), and the most observed was short or rolled up sleeves (94.6%), as shown in Fig. 1 . Observance of hand hygiene technique. The hand washing/rubbing technique was used by 40.7% of the participants. It was 18.2% among midwives and 47.8% among nurses. None of the doctors or HTs used the correct hand washing technique (p = 0.038). Observance of hand hygiene according to the five WHO hand hygiene moments We observed 1,701 opportunities to wash hands, i.e., 450 opportunities in the surgery ward of Dafra, 350 in that of Do, 450 in the neonatology ward, 300 in the gynecology and obstetrics postoperative care ward and 310 in intensive care units. An average of 9.7 opportunities were observed per participant. Appropriate hand hygiene actions were observed for 705 opportunities, or an observance rate of 40.3%. No hand hygiene action was observed for 33.7% of the opportunities and wearing gloves without hand hygiene was observed for 24.0% of the opportunities. Hand hygiene after contact with patients (58.2%) was better than that before contact (27.6%) (Table 3 ). Adherence to hand hygiene was 46.7%, 33.5%, 24.8% and 31.7%, respectively, among nurses, physicians, midwives and HTs (p = 0.000). Table 3 Practice of hand hygiene according to the five WHO moment of hand hygiene Five moment of hand hygiene Zero action Hydroalcoholic hand rub Hand washing Glove Total Before patient contact 177 (28.1) 90 (14.3) 84 (13.3) 279 (44.3) 630 (100.0) Before the aseptic procedure 22 (19.0) 9 (7.8) 6 (5.2) 79 (68.0) 116 (100.0) After body fluid exposure risk 12 (13.5) 14 (15.7) 29 (32.6) 34 (38.2) 89 (100.0) After patient contact 232 (40.1) 127 (21.9) 210 (36.3) 10 (1.7) 579 (100.0) After contact with the patient’s environment 130 (45.3) 68 (23.7) 82 (28.6) 7 (2.4) 187 (100.0) Total 573 (33.7) 308 (18.1) 411 (24.2) 409 (24.0) 1701 (100.0) Predictors of knowledge of hand hygiene and hand hygiene compliance After multivariable analysis, the independent predictors of good knowledge scores on hand hygiene were young age, female sex, a workplace with a better score for Do and Dafra surgery wards compared to those of the CHUSS, professional seniority and participation in HH training in the last three years. However, the nursing profession was predictive of a decline in the knowledge score on hand hygiene compared to other professions (Table 4 ). Additionally, the predictors of hand hygiene compliance were age between 40 and 49 years (OR = 2.1; CI = 1.2–3.8), surgery ward of Do (OR = 3.3; CI = 2.0–5.5), and participation in hand hygiene training in the last three years (OR = 1.4; CI = 1.1–1.9) (Table 4 ). Table 4 Predictors of participants’ knowledge scores (multilevel linear regression) and hand hygiene compliance (multilevel logistic regression). Knowledge hand hygiene compliance Variables Coefficient Multivariable models [95% CI] p-value OR aj [95% CI] p-value * Ages group (years) 0.026 • 20–29 Ref Ref • 30–39 -1.4 [-1.8 - -1.0] 0.000 1.3 [0.8–2.2] • 40–49 -1.1 [-1.5 - -0.8] 0.000 2.1 [1.2–3.8] • ≥ 50 -1.3 [-1.7 - -0.8] 0.000 1.7 [0.9–3.2] Gender 0.606 • Female Ref Ref • Male -0.4 [-0.6 - -0.2] 0.000 1.1 [0.8–1.5] Profession 0.741 • Nurse Ref Ref • Physician 1.8 [1.4–2.1] 0.000 0.8 [0.5–1.4] • Midwife 2.3 [1.9–2.7] 0.000 0.9 [0.5–1.7] • HTs 2.9 [2.4–3.5] 0.000 0.6 [0.3–1.5] ward/Unit 0.000 • Surgical/Dafra Ref Ref • Surgical/Do 0.1 [-2.1–2.3] 0.934 3.3 [2.0–5.5] • Gyn & Ob/CHUSS -2.9 [-5.1 - -0.7] 0.009 0.4 [0.2–0.7] • Neonatology/CHUSS -2.5 [-4.7 - -0.3] 0.023 0.9 [0.5–1.6] • Intensive care unit/CHUSS -2.8 [-5.0 - -0.6] 0.012 1.4 [0.9–2.2] Work experience(years) 0.606 • 9 1.4 [1.0–1.7] 0.000 1.0 [0.6–1.7] • Missing -1.1 [-1.5 - -0.7] 0.000 1.3 [0.7–2.5] Training on hand hygiene in the last three years • No Ref Ref 0.019 • Yes 0.3 [0.1–0.5] 0.003 1.4 [1.1–1.9] * Global p value determined using a multilevel logistic regression model Discussion This study aimed to determine the level of knowledge, technical mastery and compliance with HH among health workers in three hospitals in three urban hospitals. Our study population was composed of participants in different professional categories in contact with patients and/or with different healthcare environments. Our results revealed a median knowledge score of 8/15 IQR(7–9), a proportion of caregivers using the correct HH technique of 40.7% and a hand hygiene compliance rate of 40.3%. The HH compliance rate after contact with the patient was better (58.2%) than that before contact (27.6%). Additionally, the predictors of good HH knowledge scores were young age, female gender, workplace, seniority in the profession and participation in HH training in the last three years. However, the nursing profession was predictive of a decline in the HH knowledge score. The predictors of hand hygiene compliance were age between 40–49 years (OR = 2.1; CI = 1.2–3.8), surgery ward of Do (OR = 3.3; CI = 2.0–5.5), and participation in HH training in the last three years (OR = 1.4; CI = 1.1–1.9). We observed a relatively low level of knowledge (8/15 or 53% correct answers). Similar low levels of knowledge to our results have been reported in The Tygerberg Children's Hospital (TCH), in South Africa [ 17 ], in the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC) in Nigeria [ 18 ], in the General Reference Hospitals (GRH) of the city of Kisangani in the Democratic Republic of Congo [ 14 ] and in the Yendi municipality in Ghana [ 19 ]. However, the knowledge level of our participants is well below those reported in the Lagos University Teaching Hospital [ 20 ], in the Local Government Area (LGA) of Sokoto state in Nigeria [ 21 ] and in the Quang Nam Central General Hospital in Vietnam [ 4 ]. Variability in the HH knowledge level among health workers from one study to another depending on the data collection tools used and the experience of the participants. A small proportion of health workers (40.7%) respected the different stages of HH. Our results corroborate those reported by Adegboye MB et al. in Nigeria [ 22 ], who reported that 32.5% of the respondents had knowledge of the movement of HH and practiced six steps of the hand washing technique. Only 28% of the physicians practiced the six steps of the hand washing technique. The steps of HH focus on specific areas, such as the spaces between the fingers, nails and wrists. This ensures that these often overlooked areas are properly cleaned, reducing the areas where germs could hide. They also ensure an adequate duration of hand treatment. Compliance with the different stages of HH is therefore essential to guarantee maximum effectiveness in eliminating germs and preventing infections. We observed a low hand hygiene compliance rate (40.3%) and that hand hygiene compliance after contact was better than that before contact. Our results were close to the 39% [95% CI 0.37; 0.41] reported by Longembe EB et al. in the DR Congo [ 14 ] and higher than the 28.8% reported by Labi A. et al. in Ghana [ 15 ] and the 25% reported by AlAnazi et al. in Kuwait [23]. However, some African authors have reported that hand hygiene compliance rates based on self-assessments are much greater than ours, with rates varying from 60–96.5%[ 17 , 20 , 21 , 24 ]. Variations in hand hygiene compliance rates across studies could be related to the method of data collection. Indeed, observational data collection techniques such as ours reflect the hidden and actual activities of human beings; however, self-administered questionnaires mostly reflect people’s knowledge, principles and obligation rather than their actual practices, which is liable for social desire bias [ 16 , 21 , 25 ]. Furthermore, as in our study, several authors reported [ 20 ] that compliance with hand hygiene after contact was better than that before contact. Thus, greater adherence to indications that protect healthcare workers rather than patients, such as fear of contracting a disease, is the main motivation of health workers for HH and hence better compliance after contact with patients [ 9 ]. HH compliance in our study was associated with age, training and service. Labi A. et al. in Ghana [ 15 ] showed a link between HH compliance and training plus inputs for HH availability. Ekwere TA et al. in Nigeria [ 20 ] showed that nurses had better hand washing practices than did doctors. Longembe EB et al. in the DR Congo [ 14 ] reported higher compliance rates among cleaning technicians and doctors than among nurses. We did not find a statistically significant association between socioprofessional status and the level of compliance. Training followed by frequent reminders and the availability of inputs for HH are guarantees of health workers' adherence to hand hygiene [ 9 , 26 , 27 ]. Variations in compliance rates from one site to another in our study could be explained by infrastructural, material, and educational disparities and workload [ 9 , 28 ]. However, recent studies have demonstrated that the effective implementation of hand hygiene improvement strategies is possible and sustainable, even in resource-poor settings, and has led to significant compliance and knowledge improvement among healthcare workers and to healthcare-associated infection reduction in some cases [ 9 ]. Our study has several methodological limitations. Indeed, the nonprobability sampling method and the relatively small sample size (n = 175) could make the inferences less relevant. Likewise, this study does not address infrastructural and material barriers to HH. Additionally, perceptions and safety culture are not considered. However, this study has the merit of including the different professional categories that play roles in infection prevention and control and using observation as a method of evaluating hand hygiene practices, which, although time-consuming, is more reliable than the commonly used self-assessment. This study provides valuable information on hand hygiene knowledge and practices in sensitive areas of Bobo Dioulasso city's largest healthcare establishments. Conclusions The levels of knowledge, technical mastery and hand hygiene compliance of health personnel were low. The training of healthcare workers was one of the main factors associated with improved knowledge and compliance with HH. These findings indicate the need for training programs and awareness campaigns on hand hygiene for healthcare staff in the health centers of Bobo Dioulasso city. Other factors, such as the environment, education, and culture, also influence human health-related behavior and must be considered in hand hygiene promotion strategies. The World Health Organization's multimodal strategy for improving hand hygiene serves as an ideal framework for developing and implementing context-specific hand hygiene promotion plans. Declarations Ethics approval and consent to participate The study was approved by the National Health Ethics Committee of Burkina Faso. An information sheet was given to each participant. After reading this information sheet, those who desired to participate in the study signed a free and informed consent form. The data collected were anonymized to ensure their confidentiality. Data availability The datasets, including deidentified provider quantitative and qualitative data, used and/or analyzed during the current study are available from the corresponding author upon reasonable request. Competing interests AH, AS, MLT, SS, VK, AP, CM and LS have no competing interests to declare. Funding No external funding was provided for this project. The costs of collecting data were borne by a group of researchers from Sourô Sanou Teaching Hospital and Centre Muraz. Authors’ contributions AH, AS, MLT, SS and KV designed the study; AH, AS, MLT, SS and VK drafted the manuscript. AH, AS and VK conducted the analyses. AH, AS, MLT, SS, VK, AP, CM and LS contributed to the interpretation of the findings and edited and reviewed the manuscript. All the authors have read and approved the final manuscript. Acknowledgments The authors thank the healthcare workers and all the investigators for their commitment and dedication during this study. References World Health Organization, WHO Patient Safety. WHO guidelines on hand hygiene in health care. 2009;(WHO/IER/PSP/2009/01):262. François Léger. « Semmelweis et l’Académie de médecine ». Available from: Site de la Bibliothèque de l’Académie nationale de médecine [en ligne]. Billet publié le 20 mai 2021. Disponible à l’adresse : http://bibliotheque.academie-medecine.fr/semmelweis/. Pittet D, Hugonnet S, Harbarth S, Mourouga P, Sauvan V, Touveneau S, et al. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. The Lancet. 2000 Oct;356(9238):1307–12. Huis A, van Achterberg T, de Bruin M, Grol R, Schoonhoven L, Hulscher M. A systematic review of hand hygiene improvement strategies: a behavioural approach. Implementation Science [Internet]. 2012 Sep 14 [cited 2023 May 19];7(1). Available from: http://implementationscience.biomedcentral.com/articles/10.1186/1748-5908-7-92 Allegranzi B, Pittet D. Role of hand hygiene in healthcare-associated infection prevention. Journal of Hospital Infection. 2009 Dec;73(4):305–15. World Health Organization. WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety Challenge Clean Care Is Safer Care [Internet]. PubMed. 2009 [cited 2024 Mar 19]. Available from: https://pubmed.ncbi.nlm.nih.gov/23805438/ Smith A, Carusone SC, Loeb M. Hand hygiene practices of health care workers in long-term care facilities. American Journal of Infection Control. 2008 Sep;36(7):492–4. Gluck PA, Nevo I, Lenchus JD, Sanko JS, Everett-Thomas R, Fitzpatrick M, et al. Factors Impacting Hand Hygiene Compliance Among New Interns: Findings From a Mandatory Patient Safety Course. Journal of Graduate Medical Education. 2010 Jun 1;2(2):228–31. Damani N, Mehtar S, Allegranzi B. Hand Hygiene in Resource‐Poor Settings. In: Pittet D, Boyce JM, Allegranzi B, editors. Hand Hygiene [Internet]. 1st ed. Wiley; 2017 [cited 2024 Mar 18]. p. 357–66. Available from: https://onlinelibrary.wiley.com/doi/10.1002/9781118846810.ch43 Healthcare-Associated Infection Prevention Network (Repias). Publication of Pulpe’friction 2021 results [Internet] [cited 2024 Mar 20]. Available from: https://www.preventioninfection.fr/actualites/publication-des-resultats-pulpefriction-2021/ Vaud university Teaching Hospital, Compliance of hand hygiene: 2020 activity report: [Internet]. 2024 [cited 2024 Mar 20]. Available from: https://rapportsannuels.chuv.ch/qualite/2020/4-2-lobservance-de-lhygiene-des-mains Kretzer EK, Larson EL. Behavioral interventions to improve infection control practices. American Journal of Infection Control. 1998 Jun;26(3):245–53. Whitby M, Pessoa-Silva CL, McLaws M-L, Allegranzi B, Sax H, Larson E, et al. Behavioural considerations for hand hygiene practices: the basic building blocks. Journal of Hospital Infection. 2007 Jan;65(1):1–8. Longembe EB, Kitronza PL. Observance de l’hygiène des mains dans les hôpitaux généraux de référence de la ville de Kisangani en République Démocratique du Congo. Pan African Medical Journal [Internet]. 2020 Feb 26 [cited 2024 Mar 18];35. Available from: http://www.panafrican-med-journal.com/content/article/35/57/full/ Labi A, Obeng-Nkrumah N, Nuertey BD, Issahaku S, Ndiaye NF, Baffoe P, et al. Hand hygiene practices and perceptions among healthcare workers in Ghana: A WASH intervention study. The Journal of Infection in Developing Countries. 2019 Dec 31;13(12):1076–85. Gedamu H, Wgiorgis T, Tesfa G, Tafere Y, Genet M. Hand washing practice among health care workers in Ethiopia: systemic review and meta-analysis, 2020. Heliyon. 2021 May;7(5):e06972. Dramowski A, Whitelaw A, Cotton MF. Healthcare-associated infections in children: knowledge, attitudes and practice of paediatric healthcare providers at Tygerberg Hospital, Cape Town. Paediatrics and International Child Health. 2016 Sep 6;36(3):225–31. Irek EO, Aliyu AA, Dahiru T, Obadare TO, Aboderin AO. Healthcare-associated infections and compliance of hand hygiene among healthcare workers in a tertiary health facility, southwest Nigeria. Journal of Infection Prevention. 2019 Jul 9;20(6):289–96. Mutaru A-M, Balegha AN, Kunsu R, Gbeti C. Knowledge and determinants of infection prevention and control compliance among nurses in Yendi municipality, Ghana. Săndulescu O, editor. PLOS ONE. 2022 Jul 20;17(7):e0270508. Ekwere TA, Okafor IP. Hand hygiene knowledge and practices among healthcare providers in a tertiary hospital, south west, Nigeria. International Journal of Infection Control [Internet]. 2013 Oct 17 [cited 2024 Mar 18];9(4). Available from: http://www.ijic.info/article/view/11917 Ango U, Awosan K, Adamu H, Salawu S, Sani M, Ibrahim A. Knowledge, Attitude and Practice of Hand Hygiene among Healthcare Providers in Semi-urban Communities of Sokoto State, Nigeria. International Journal of TROPICAL DISEASE & Health. 2017 Jan 10;26(2):1–9. Adegboye MB, Zakari S, Ahmed BA, Olufemi GH. Knowledge, awareness and practice of infection control by health care workers in the intensive care units of a tertiary hospital in Nigeria. African Health Sciences. 2018 Apr 4;18(1):72. Al-Anazi S, Al-Dhefeery N, Al-Hjaili R, Al-Duwaihees A, Al-Mutairi A, Al-Saeedi R, et al. Compliance with hand hygiene practices among nursing staff in secondary healthcare hospitals in Kuwait. BMC Health Services Research [Internet]. 2022 Nov 8 [cited 2024 Apr 18];22(1). Available from: https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-022-08706-8 Mandana Bambenongama N, Losimba Likwela J. Connaissances, attitudes et pratiques des professionnels de santé face aux précautions standards en milieu hospitalier. Santé Publique. 2013 Oct 1;Vol. 25(5):663–73. Desta M, Ayenew T, Sitotaw N, Tegegne N, Dires M, Getie M. Knowledge, practice and associated factors of infection prevention among healthcare workers in Debre Markos referral hospital, Northwest Ethiopia. BMC Health Services Research [Internet]. 2018 Jun 18 [cited 2024 Mar 18];18(1). Available from: https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-018-3277-5 Allegranzi B, Sax H, Bengaly L, Riebet H, Minta DK, Chraiti M-N, et al. Successful Implementation of the World Health Organization Hand Hygiene Improvement Strategy in a Referral Hospital in Mali, Africa. Infection Control & Hospital Epidemiology. 2015 Jan 2;31(2):133–41. Kibira J, Kihungi L, Ndinda M, Wesangula E, Mwangi C, Muthoni F, et al. Improving hand hygiene practices in two regional hospitals in Kenya using a continuous quality improvement (CQI) approach. Antimicrobial Resistance & Infection Control [Internet]. 2022 Apr 4 [cited 2024 Apr 18];11(1). Available from: https://aricjournal.biomedcentral.com/articles/10.1186/s13756-022-01093-z Tenna A, Stenehjem EA, Margoles L, Kacha E, Blumberg HM, Kempker RR. Infection Control Knowledge, Attitudes, and Practices among Healthcare Workers in Addis Ababa, Ethiopia. Infection Control & Hospital Epidemiology. 2015 Jan 2;34(12):1289–96. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 21 May, 2024 Submission checks completed at journal 19 May, 2024 Editor assigned by journal 19 May, 2024 First submitted to journal 16 May, 2024 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. 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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-4430550","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":304938615,"identity":"9d50aa14-7030-4400-9037-4f26fef604c7","order_by":0,"name":"Arsène Hema","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA10lEQVRIiWNgGAWjYBACAwST+QADYwOEJlYLWwJEC5AmVguPAXFazNm7Ez/83FMnZ87e803i5w4bOQY23gd4tVj2nN0s2fPssDGQsU2y90yaMQMbuwFeLQY3cjdI8Bw4kLjhRu42Cd62w4kN8m0E/HL/7eaffw7U1W+4/+aZ5F+QFjY2Alpu8G6T5jnAnGBwg4dNmpcoLWdyt1nLHDhsuAHoDWvZtjRjNoJajp/dfPPNgTp5g+OHH95822Yjx09ICzJgkQCRJGgAppQPpKgeBaNgFIyCkQMAFr5I1exwhaYAAAAASUVORK5CYII=","orcid":"","institution":"1. Quality Department of Sourô Sanou Teaching Hospital, Bobo-Dioulasso","correspondingAuthor":true,"prefix":"","firstName":"Arsène","middleName":"","lastName":"Hema","suffix":""},{"id":304938616,"identity":"218426c2-7596-460c-b417-09d98ef7e75c","order_by":1,"name":"Arsène Some","email":"","orcid":"","institution":"2.Centre Muraz, National Institute of Public Health, Bobo-Dioulasso","correspondingAuthor":false,"prefix":"","firstName":"Arsène","middleName":"","lastName":"Some","suffix":""},{"id":304938617,"identity":"ffc907e3-06a1-4af8-840d-d2fe34550a5d","order_by":2,"name":"Marthe Louise Traoré","email":"","orcid":"","institution":"3.Emergency preparedness and response program, World Health Organization, Ouagadougou","correspondingAuthor":false,"prefix":"","firstName":"Marthe","middleName":"Louise","lastName":"Traoré","suffix":""},{"id":304938618,"identity":"91bcc873-8986-4062-9242-e5eca58a7914","order_by":3,"name":"Soufiane Sanou","email":"","orcid":"","institution":"2.Centre Muraz, National Institute of Public Health, Bobo-Dioulasso","correspondingAuthor":false,"prefix":"","firstName":"Soufiane","middleName":"","lastName":"Sanou","suffix":""},{"id":304938619,"identity":"80f112c0-4ab8-4e08-ae65-a328041f82af","order_by":4,"name":"Victorien Kafando","email":"","orcid":"","institution":"1. Quality Department of Sourô Sanou Teaching Hospital, Bobo-Dioulasso","correspondingAuthor":false,"prefix":"","firstName":"Victorien","middleName":"","lastName":"Kafando","suffix":""},{"id":304938620,"identity":"d8e734d9-c3cf-44ad-b868-dbf5947030b1","order_by":5,"name":"Armel Poda","email":"","orcid":"","institution":"4.Infectious Diseases Department of Sourô Sanou Teaching Hospital, Bobo-Dioulasso","correspondingAuthor":false,"prefix":"","firstName":"Armel","middleName":"","lastName":"Poda","suffix":""},{"id":304938621,"identity":"92937e36-0f0c-4187-9f68-0807aa132765","order_by":6,"name":"Clément Meda","email":"","orcid":"","institution":"5.Information, Research and Epidemiology Department of Sourô Sanou Teaching Hospital, Bobo- Dioulasso","correspondingAuthor":false,"prefix":"","firstName":"Clément","middleName":"","lastName":"Meda","suffix":""},{"id":304938622,"identity":"833dad2b-b593-4fd1-a911-3726a73b941e","order_by":7,"name":"Léon Savadogo","email":"","orcid":"","institution":"6.National Institute of Health Sciences, Nazi Boni University, Bobo-Dioulasso","correspondingAuthor":false,"prefix":"","firstName":"Léon","middleName":"","lastName":"Savadogo","suffix":""}],"badges":[],"createdAt":"2024-05-16 10:47:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4430550/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4430550/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":57728031,"identity":"e40418e3-5ff6-44f0-8e96-246d08bc1241","added_by":"auto","created_at":"2024-06-04 21:41:35","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":52920,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"Figure1Compliancewiththeprerequisitesforhandhygienebyprofessionalcategory.png","url":"https://assets-eu.researchsquare.com/files/rs-4430550/v1/93e0ad249848657c8c1bbe35.png"},{"id":57728836,"identity":"f3bdb915-4d02-4daa-a2cb-58ae4178f92f","added_by":"auto","created_at":"2024-06-04 21:49:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1146650,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4430550/v1/06c4d0bd-6f10-4f57-b64a-e546d524f2cd.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Knowledge and practices of hand hygiene among healthcare workers in three urban hospitals in Bobo-Dioulasso city, 2022 (Burkina Faso)","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHealthcare-associated infections (HAIs) constitute a major public health issue and represent a significant economic burden [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Indeed, HAIs can increase the length of hospital stays, increase health care costs, and increase the risk of complications and deaths but also promote the emergence and dissemination of antibiotic resistance [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. However, since 1845, thanks to the Austro-Hungarian obstetrician Ignaz Semmelweis\u0026rsquo;s work, it is known that good hand hygiene (HH) reduces the risk of transmission of these infections [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSince infectious agents are mainly spread through the hands, hand hygiene has become the primary measure used to prevent and control infections in healthcare settings [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eStudies have shown that good hand hygiene reduces the frequency of HAIs by 15\u0026ndash;30% [\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Therefore, since 2009, the World Health Organization (WHO) has developed specific guidelines for hand hygiene improvement in healthcare facilities. The concept of \u0026ldquo;my five moments for hand hygiene\u0026rdquo; merged with the multimodal hand hygiene improvement strategy. The WHO Guidelines on Hand Hygiene in Health Care have been developed with the ultimate objective of changing the behavior of individual HCWs to optimize compliance with hand hygiene at the recommended moments and to improve patient safety. Thus, at least five components drive the strategy: system change, in particular, the recourse to alcohol-based hand rubbing as the new standard of care, staff education using newly developed tools, monitoring and feedback of staff performance, reminders in the workplace, and promotion of an institutional safety climate [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe WHO also launched the global campaign \u0026ldquo;Clean Care is Safer\u0026rdquo;, which emphasizes the importance of hand hygiene in healthcare facilities [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDecades of promoting hospital hygiene have led to an overall improvement in relative HH compliance in hospitals in developed countries. However, there are large variations in HH compliance rates from one hospital to another and in the same hospital from one department to another, depending on the method of compliance assessment [\u003cspan additionalcitationids=\"CR8 CR9 CR10\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. This variability suggests that individual features could play a role in determining behavior. Understanding these features and individual factors such as social cognitive determinants may provide additional insight into hand hygiene behavior [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, low levels of adherence to HH are reported in developing countries, where healthcare facilities face shortages of material and human resources [\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The lack of HH compliance in healthcare settings exposes staff, patients, patient companions, and the community to the risk of healthcare-acquired infections. A lack of knowledge of guidelines for hand hygiene, lack of recognition of hand hygiene opportunities during patient care, and lack of awareness of the risk of cross-transmission of pathogens were identified as the main barriers to good hand hygiene practices[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. A lack or shortage of basic equipment, inadequate infrastructure, and poor hygiene and sanitation are also unfavorable factors for hand hygiene compliance.\u003c/p\u003e \u003cp\u003eThe recent COVID-19 pandemic has highlighted the importance of this simple hygiene practice in controlling contagion. Thus, during this pandemic in 2020, training and awareness raising for healthcare workers on standard and additional hygiene precautions were performed in healthcare facilities in Burkina Faso.\u003c/p\u003e \u003cp\u003eTwo years after these training sessions, this study aimed to assess the knowledge levels, technical proficiency, and hand hygiene compliance among healthcare workers from three hospitals in Bobo Dioulasso city.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and location:\u003c/h2\u003e \u003cp\u003eThis cross-sectional, multicenter study was conducted from May 5th to July 3rd, 2022, in 3 healthcare facilities located in Bobo-Dioulasso, Burkina Faso's second-largest city. The facilities included 2 district hospitals (DO et Dafra) and 1 teaching hospital (Sour\u0026ocirc; Sanou Teaching Hospital\u0026thinsp;=\u0026thinsp;CHUSS) in Bobo-Dioulasso. Locally produced hydroalcoholic solution was utilized for hand hygiene across all three facilities. In the district\u0026rsquo;s hospital, DO and Dafra, the study took place in the surgery ward. At the Sour\u0026ocirc; Sanou Teaching Hospital, it is located in the intensive care, gynecology and obstetrics postoperative care ward and neonatology wards.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eSurgery ward of Dafra district hospital\u003c/h2\u003e \u003cp\u003eThe surgery ward of Do District Hospital received 888 postsurgical patients in 2022. This ward comprises 2 hospitalization rooms with a total capacity of 16 beds. During the survey, the service was staffed by 52 nurses, 2 hospital hygiene technicians, and 2 permanent physicians.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eSurgery ward of Do district hospital\u003c/h2\u003e \u003cp\u003eThe surgery ward of Do District Hospital received 1706 postsurgical patients in 2022. This ward comprises six hospitalization rooms with a total capacity of twenty-four beds (24). At the time of the survey, the service was staffed by 59 nurses, 1 hospital hygiene technician, 5 permanent physicians, and approximately 5 medical trainees.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eIntensive Care Units of Sour\u0026ocirc; Sanou Teaching Hospital\u003c/h2\u003e \u003cp\u003eIn 2022, 525 patients were admitted to the intensive care unit of Sour\u0026ocirc; Sanou Teaching Hospital. This unit has 14 inpatient beds. The service is staffed by 5 Physicians Anaesthetist resuscitators, approximately 10 physicians\u0026rsquo; residents, 23 nurses and 3 hospital hygiene technicians\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eNeonatology ward of Sour\u0026ocirc; Sanou Teaching Hospital\u003c/h2\u003e \u003cp\u003eIn 2022, the neonatology ward of Sour\u0026ocirc; Sanou Teaching Hospital received 2,765 new-borns. It has a hospital room that includes 6 incubators and 34 cradles. The staff consists of 2 doctors specializing in pediatrics, 2 general practitioners, approximately 10 physician residents, 28 nurses and 3 hospital hygiene technicians.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003eGynecology and Obstetrics Postoperative Care Ward of Sour\u0026ocirc; Sanou Teaching Hospital\u003c/h2\u003e \u003cp\u003e In 2022, the gynecology and obstetrics postoperative care ward of Sour\u0026ocirc; Sanou Teaching Hospital received 1,946 women, including 1,433 cesareans. This unit has 30 inpatient beds. The staff consisted of 16 physicians, 4 nurses and 21 midwives.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003eStudy population\u003c/h2\u003e \u003cp\u003eThe study participants were healthcare professionals. All clinical staff directly involved in patient care or environmental hygiene on a daily basis and employed at the study site were eligible for inclusion: physicians, nurses, midwives, and hygiene technicians (HTs).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003eSampling\u003c/h2\u003e \u003cdiv id=\"Sec11\" class=\"Section4\"\u003e \u003ch2\u003eSample size\u003c/h2\u003e \u003cp\u003eIn the absence of a similar study on this subject in Burkina Faso, we based the calculation of the sample size on the hypothesis that the average knowledge score (\u0026micro;) of health workers on hand hygiene was between 7.5 and 8/15, with a standard deviation (Ժ) of 2. With a risk of α\u0026thinsp;=\u0026thinsp;5% and a power of β\u0026thinsp;=\u0026thinsp;80%, a minimum of 128 participants were necessary for this study. The number of staff included per ward was weighted by the total number of people working in the ward. Thus, the minimum number of participants included in the wards were as follows: 21 participants in the gynecology and obstetrics postoperative care ward, 23 in the neonatology ward, 21 in intensive care units, 35 in the surgery ward of Do and 29 in the surgery ward of Dafra. For the hand hygiene compliance study, we analyzed a minimum of 5 opportunities per included participant.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eSampling method\u003c/h2\u003e \u003cp\u003eIn the three hospitals, health workers were included in the study because they worked in the targeted wards. Observations of health workers' hand hygiene practices were made discreetly by surveys without knowledge of the latter.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cp\u003e \u003cb\u003eAssessment of healthcare\u003c/b\u003e \u003cb\u003eworkers\u0026rsquo; knowledge\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe collection of knowledge data was performed using the questionnaire on knowledge (WHO, 2009), a self-administered questionnaire for health workers. The survey included socioprofessional data (age, sex, profession, work experience, training on hand hygiene), 4 multiple-choice questions on the modes of transmission of infections in healthcare settings, 5 questions (true/false) on the methods of hand hygiene and 6 multiple-choice questions on the indications of hand hygiene methods. One point was awarded for each correct answer, and 0 points were awarded otherwise. The participants' level of knowledge was scored out of 15 points.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eAssessment of health workers\u0026rsquo; practices\u003c/h2\u003e \u003cp\u003eThe assessment of healthcare workers\u0026rsquo; practices focused on the observation of the prerequisites, technique and hand hygiene compliance.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003ePrerequisites and technique for hand hygiene\u003c/h2\u003e \u003cp\u003eUsing a checklist, the investigators checked compliance with the prerequisites for hand hygiene (no jewelry, short nails, no polishing, no fake nails, short or rolled up sleeves) and compliance with the technique of hand hygiene, i.e., respecting it of the six stages of hand hygiene:\u003c/p\u003e \u003cp\u003eSufficient soap (or alcohol-based products) was applied to cover the entire hand surface, the palms of the hands were rubbed together, the back of the hand was placed between the fingers and the nails, backs of fingers to opposing palms with fingers interlocked, rotational rubbing of the left thumb clasped in the right palm and vice versa, and rotational rubbing, backward and forwarding with clasped fingers of the right hand in the left palm and vice versa, was applied.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eHand hygiene compliance\u003c/h2\u003e \u003cp\u003eIndividual healthcare workers who routinely cared for patients in each ward were directly observed anonymously by survey investigators. The investigators noted all potential opportunities for hand hygiene and assessed hand hygiene compliance using the WHO hand hygiene observation tool (WHO, 2009c). The survey investigators were nurses who were recruited from outside the surveyed health facilities and trained on the WHO hand hygiene instrument. The hand hygiene observation tool is based on the WHO five moments of hand hygiene, which defines opportunities for hand hygiene as follows: before patient contact, before the performance of an aseptic procedure, after contact with bodily fluids, after touching a patient and after leaving a patient\u0026rsquo;s surroundings.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eVariables\u003c/h2\u003e \u003cdiv id=\"Sec18\" class=\"Section3\"\u003e \u003ch2\u003eOutcome variables\u003c/h2\u003e \u003cp\u003eThe outcome variables were the HH knowledge score and hand hygiene compliance. The hand hygiene knowledge score was calculated by adding points obtained by a question indicating that one point was awarded for each correct answer and 0 points otherwise. The maximum score was 15. Hand hygiene compliance was determined according to five WHO standards for hand hygiene. Several hand hygiene opportunities were observed per health worker. For logistic regression, we coded 0 for no compliance and 1 for hand hygiene compliance.\u003c/p\u003e \u003cp\u003e \u003cb\u003ePredictor variables\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eGender: Male, Female\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eAge in years was categorized by convenience in four classes: 20\u0026ndash;29, 30\u0026ndash;39, 40\u0026ndash;49 and \u0026ge;\u0026thinsp;50 years.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eProfession: participants\u0026rsquo; occupations were categorized into four classes: nurses (nurses, nurse trainees), physicians (specialist doctors, general practitioners, physician residents and medical trainees), midwives, and hygiene technicians.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eWards/Units: These are the wards/units from which the participants were recruited. There were three wards/units of Sour\u0026ocirc; Sanou Teaching Hospital (Gyn \u0026amp; Ob/CHUSS, Neonatology/CHUSS, Intensive Care Unit/CHUSS), one ward of the district hospital of Dafra (Surgical/Dafra) and one of the district hospitals of DO (Surgical/Do).\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eWork experiences in years: health worker's experience in their profession. The data were categorized into classes\u0026thinsp;\u0026lt;\u0026thinsp;5, 5\u0026ndash;9, \u0026gt;\u0026thinsp;9 years and missing data.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eTraining on hand hygiene in the last three years: Yes, or No\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThe data collected on survey sheets were entered into Epidata\u003csup\u003e\u0026reg;\u003c/sup\u003e software and analyzed using Stata\u003csup\u003e\u0026reg;\u003c/sup\u003e software version 13. The socioprofessional characteristics, knowledge of the participants on hand hygiene, hand hygiene prerequisites and technique compliance were described by professional category. The qualitative variables are presented as percentages, and the quantitative variables are presented as medians and interquartile ranges (IQRs). We determined the distribution of the knowledge score of healthcare workers as well as that of their observance of hand hygiene according to the five WHO moments of hand hygiene. We used multilevel linear regression to analyze the associations between knowledge scores and socioprofessional characteristics (age, gender, profession, department/unit, professional experience, training in hand hygiene). For the analysis of the associations between hand hygiene compliance and socioprofessional characteristics, we used multilevel logistic regression. The significance level p-value was 5% for all the statistical analyses.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eEthical aspects\u003c/h2\u003e \u003cp\u003e This study was carried out as part of the \"Surveillance and prevention strategies for healthcare-associated infections in Bobo-Dioulasso, Burkina Faso\" study approved by the National Health Ethics Committee of Burkina Faso. An information sheet was given to each participant. After reading this information sheet, those who desired to participate in the study signed a free and informed consent form. The data collected were anonymized to ensure their confidentiality.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eCharacteristics of the study participants\u003c/h2\u003e \u003cp\u003e Out of 233 potential healthcare workers in the five wards, we recruited 175, representing a participation rate of 75.1%. Most of the participants were recruited from surgical wards (45.7%). The participation rate varied from 49.3% in the surgery ward of Do District Hospital to 97% in the neonatology ward of Sour\u0026ocirc; Sanou University Hospital. The participants were physicians (n\u0026thinsp;=\u0026thinsp;43, 24.6%), nurses (n\u0026thinsp;=\u0026thinsp;105, 60.0%), midwives (n\u0026thinsp;=\u0026thinsp;21, 12.0%) and hospital hygiene technicians (n\u0026thinsp;=\u0026thinsp;6; 3.4%). Our 175 participants were composed of 109 men (63.0%). The median age of the study participants was 39 years (IQR: 27\u0026ndash;46); most of them (31.4%) were between 40 and 49 years old. The median work experience was 10 years (IQR: 5\u0026ndash;15), and health care workers with more than 9 years of work experience were the most numerous. Over half of the participants reported that they had been trained in hand hygiene in the last three years, and 76.6% of them used hydroalcoholic products for hand hygiene (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of study participants\u0026rsquo; characteristics by professional category\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eProfessional category, n(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePhysician\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNurse\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMidwife\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHTs\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAges group (years), (n\u0026thinsp;=\u0026thinsp;175)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; 20\u0026ndash;29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31 (72.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e52 (29.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; 30\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (9.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (25.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (47.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e42 (24.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; 40\u0026ndash;49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (11.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42 (40.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (28.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e55 (31.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; \u0026ge;\u0026thinsp;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (7.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (9.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e26 (14.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29 (26\u0026ndash;33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43 (34\u0026ndash;48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39 (35\u0026ndash;42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e32 (24\u0026ndash;44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e39 (27\u0026ndash;46)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender (n\u0026thinsp;=\u0026thinsp;175)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Male\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32 (74.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e109 (63.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Female\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (25.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e64 (37.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHospital (n\u0026thinsp;=\u0026thinsp;175)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; CMA DAFRA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45 (42.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e45 (25.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; CMA DO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (23.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (23.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e35 (20.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; CHUSS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33 (76.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95 (54.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWard/Unit (n\u0026thinsp;=\u0026thinsp;175)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Surgery/Dafra\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45 (42.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e45 (25.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Surgery/Do\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10(23.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25(23.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e35 (20.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Gyn \u0026amp; Ob/CHUSS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (37.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (47.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e30 (17.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Neonatology/CHUSS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (27.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (7.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (52.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34 (19.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Intensive care unit/CHUSS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (11.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (21.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e31(17.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWork experience(years),(n\u0026thinsp;=\u0026thinsp;145)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; \u0026lt;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (32.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (14.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (19.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e27 (18.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; 5\u0026ndash;9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (60.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (20.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (19.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (60.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e41 (28.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; \u0026gt;\u0026thinsp;9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (8.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61 (64.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (62.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e77 (53.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (4\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (8\u0026ndash;19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (5\u0026ndash;12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (5\u0026ndash;8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10 (5\u0026ndash;15)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTraining on hand hygiene in the last three years,(n\u0026thinsp;=\u0026thinsp;175) (yes)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (69.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51 (48.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (47.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95 (54.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCommon use of hydroalcoholic products,(n\u0026thinsp;=\u0026thinsp;175) (yes)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29 (67.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83 (79.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (76.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e134 (76.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e43(24.6)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e105(60.0)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e21(12.0)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e6(3.4)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e175 (100)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003cp\u003eHTs\u0026thinsp;=\u0026thinsp;hygiene technicians; Gyn \u0026amp; Ob\u0026thinsp;=\u0026thinsp;Gynecology \u0026amp; obstetrics\u003c/p\u003e \u003cdiv id=\"Sec24\" class=\"Section4\"\u003e \u003ch2\u003eParticipants\u0026rsquo; knowledge of hand hygiene\u003c/h2\u003e \u003cp\u003eThe median knowledge score of the health workers was 8 of 15 points, with an IQR (7\u0026ndash;9), as shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. There was no statistically significant difference between the knowledge scores of the different professional categories (p\u0026thinsp;=\u0026thinsp;0.128). Among the healthcare professionals surveyed, 89.1% were able to cite the appropriate hand hygiene technique after emptying a bedpan, and 82.3% knew that ABHR is faster than hand washing. However, only 17.7% of participants, including 9.5% of nurses (p\u0026thinsp;=\u0026thinsp;0.001), were able to recognize the hygiene actions that protect caregivers (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Knowledge of the common source of transmission of microorganisms in healthcare settings was much lower among physicians (18.6%, p\u0026thinsp;=\u0026thinsp;0.001). Nurses (88.6%) and midwives (90.5%) better understood the hand hygiene technique required after removing gloves (p\u0026thinsp;=\u0026thinsp;0.000) and the hand hygiene technique required after making a patient's bed (66.7%; p\u0026thinsp;=\u0026thinsp;0.002).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStudy of healthcare workers\u0026rsquo; knowledge of hand hygiene by professional category\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge questions (maximum score\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal n\u0026thinsp;=\u0026thinsp;175\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003ePhysician n\u0026thinsp;=\u0026thinsp;43\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNurse n\u0026thinsp;=\u0026thinsp;105\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMidwife n\u0026thinsp;=\u0026thinsp;21\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHT\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;6\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ep- value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian score (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (7\u0026ndash;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e8 (7\u0026ndash;10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8 (7\u0026ndash;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8 (7\u0026ndash;10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9 (8\u0026ndash;10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.128\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c8\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eDesired responses, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhat is the main mode of cross-transmission of germs between patients in a healthcare facility?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e108(61.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29 (67.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e67 (63.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9 (42.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.230\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhat is the most common microbial source responsible for infection?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54 (30.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (18.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e29 (27.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12 (57.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5 (83.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhat hand hygiene actions prevent the transmission of germs to the patient?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39 (22.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (25.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e21 (20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4 (19.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.320\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhat hand hygiene actions prevent the transmission of germs to the caregiver?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31 (17.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (32.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e10 (9.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4 (19.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eABHR is faster than washing with soap and water?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e144 (82.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (88.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e83 (79.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17 (80.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.450\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eABHR causes greater skin dryness than hand washing?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e140 (80.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (83.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e79 (75.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20 (95.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5 (83.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.158\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eABHR is more effective than washing hands with soap and water?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58 (33.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (34.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e33 (31.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.786\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eit is recommended to wash your hands then to ABHR?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55 (31.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (44.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e30 (28.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e28 (28.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.099\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhat is the minimum duration necessary for ABHR?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40 (22.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (23.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e24 (22.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4 (19.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.892\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhat technique should be applied before palpating a patient's abdomen?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e128 (73.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34 (79.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e76 (72.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.690\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhat technique should be applied before making an injection?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69 (39.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (41.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e37 (35.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13 (61.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.089\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhat technique should be applied after emptying a bedpan?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e156 (89.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (83.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e94 (89.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20 (95.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.522\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhat technique should be applied after removing the gloves?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e139 (79.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (55.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e93 (88.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19 (90.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhat technique should be applied after making a patient's bed?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (17.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (27.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e12 (11.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (9.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhat technique should be applied after exposure to blood?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e163 (93.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (88.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e98 (93.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e21 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.384\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003cp\u003e\u003cem\u003eABHR\u0026thinsp;=\u0026thinsp;alcohol-based hand rub. HT\u0026thinsp;=\u0026thinsp;hygiene technician\u003c/em\u003e\u003c/p\u003e \u003cp\u003e \u003cb\u003eObservance of the prerequisites for hand hygiene.\u003c/b\u003e \u003c/p\u003e \u003cp\u003e The prerequisites for hand hygiene were met by 72.7% of the participants. These measures were used by 79.8% of nurses, 70.0% of doctors, 50% of THHs and 50% of midwives (p\u0026thinsp;=\u0026thinsp;0.021). The least observed measure was the absence of jewelry (77.1%), and the most observed was short or rolled up sleeves (94.6%), as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eObservance of hand hygiene technique.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe hand washing/rubbing technique was used by 40.7% of the participants. It was 18.2% among midwives and 47.8% among nurses. None of the doctors or HTs used the correct hand washing technique (p\u0026thinsp;=\u0026thinsp;0.038).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section3\"\u003e \u003ch2\u003eObservance of hand hygiene according to the five WHO hand hygiene moments\u003c/h2\u003e \u003cp\u003eWe observed 1,701 opportunities to wash hands, i.e., 450 opportunities in the \u003cem\u003esurgery ward of\u003c/em\u003e Dafra, 350 in that of Do, 450 in the neonatology ward, 300 in the gynecology and obstetrics postoperative care ward and 310 in intensive care units. An average of 9.7 opportunities were observed per participant. Appropriate hand hygiene actions were observed for 705 opportunities, or an observance rate of 40.3%. No hand hygiene action was observed for 33.7% of the opportunities and wearing gloves without hand hygiene was observed for 24.0% of the opportunities. Hand hygiene after contact with patients (58.2%) was better than that before contact (27.6%) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Adherence to hand hygiene was 46.7%, 33.5%, 24.8% and 31.7%, respectively, among nurses, physicians, midwives and HTs (p\u0026thinsp;=\u0026thinsp;0.000).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePractice of hand hygiene according to the five WHO moment of hand hygiene\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFive moment of hand hygiene\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eZero action\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHydroalcoholic hand rub\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHand washing\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eGlove\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBefore patient contact\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e177 (28.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90 (14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e84 (13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e279 (44.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e630 (100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBefore the aseptic procedure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22 (19.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (7.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (5.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e79 (68.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e116 (100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAfter body fluid exposure risk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (13.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (15.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29 (32.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e34 (38.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e89 (100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAfter patient contact\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e232 (40.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e127 (21.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e210 (36.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10 (1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e579 (100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAfter contact with the patient\u0026rsquo;s environment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e130 (45.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68 (23.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e82 (28.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7 (2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e187 (100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e573 (33.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e308 (18.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e411 (24.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e409 (24.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1701 (100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section3\"\u003e \u003ch2\u003ePredictors of knowledge of hand hygiene and hand hygiene compliance\u003c/h2\u003e \u003cp\u003eAfter multivariable analysis, the independent predictors of good knowledge scores on hand hygiene were young age, female sex, a workplace with a better score for Do and Dafra surgery wards compared to those of the CHUSS, professional seniority and participation in HH training in the last three years. However, the nursing profession was predictive of a decline in the knowledge score on hand hygiene compared to other professions (Table \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Additionally, the predictors of hand hygiene compliance were age between 40 and 49 years (OR\u0026thinsp;=\u0026thinsp;2.1; CI\u0026thinsp;=\u0026thinsp;1.2\u0026ndash;3.8), surgery ward of Do (OR\u0026thinsp;=\u0026thinsp;3.3; CI\u0026thinsp;=\u0026thinsp;2.0\u0026ndash;5.5), and participation in hand hygiene training in the last three years (OR\u0026thinsp;=\u0026thinsp;1.4; CI\u0026thinsp;=\u0026thinsp;1.1\u0026ndash;1.9) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePredictors of participants\u0026rsquo; knowledge scores \u003cem\u003e(multilevel linear regression)\u003c/em\u003e and hand hygiene compliance \u003cem\u003e(multilevel logistic regression).\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eKnowledge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003ehand hygiene compliance\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVariables\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCoefficient Multivariable models\u003c/p\u003e \u003cp\u003e[95% CI]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOR aj\u003c/p\u003e \u003cp\u003e[95% CI]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAges group (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; 20\u0026ndash;29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; 30\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.4 [-1.8 - -1.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.3 [0.8\u0026ndash;2.2]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; 40\u0026ndash;49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.1 [-1.5 - -0.8]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.1 [1.2\u0026ndash;3.8]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; \u0026ge;\u0026thinsp;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.3 [-1.7 - -0.8]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.7 [0.9\u0026ndash;3.2]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.606\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Female\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Male\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.4 [-0.6 - -0.2]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.1 [0.8\u0026ndash;1.5]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eProfession\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.741\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Physician\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.8 [1.4\u0026ndash;2.1]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.8 [0.5\u0026ndash;1.4]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Midwife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.3 [1.9\u0026ndash;2.7]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.9 [0.5\u0026ndash;1.7]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; HTs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.9 [2.4\u0026ndash;3.5]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.6 [0.3\u0026ndash;1.5]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eward/Unit\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Surgical/Dafra\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Surgical/Do\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.1 [-2.1\u0026ndash;2.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.934\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.3 [2.0\u0026ndash;5.5]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Gyn \u0026amp; Ob/CHUSS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-2.9 [-5.1 - -0.7]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.4 [0.2\u0026ndash;0.7]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Neonatology/CHUSS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-2.5 [-4.7 - -0.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.9 [0.5\u0026ndash;1.6]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Intensive care unit/CHUSS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-2.8 [-5.0 - -0.6]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.4 [0.9\u0026ndash;2.2]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWork experience(years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.606\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; \u0026lt;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; 5\u0026ndash;9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.0 [0.7\u0026ndash;1.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.2 [0.7\u0026ndash;2.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; \u0026gt;\u0026thinsp;9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.4 [1.0\u0026ndash;1.7]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.0 [0.6\u0026ndash;1.7]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Missing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.1 [-1.5 - -0.7]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.3 [0.7\u0026ndash;2.5]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTraining on hand hygiene in the last three years\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; No\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.019\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Yes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.3 [0.1\u0026ndash;0.5]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.4 [1.1\u0026ndash;1.9]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003cp\u003e* Global p value determined using a multilevel logistic regression model\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to determine the level of knowledge, technical mastery and compliance with HH among health workers in three hospitals in three urban hospitals. Our study population was composed of participants in different professional categories in contact with patients and/or with different healthcare environments. Our results revealed a median knowledge score of 8/15 IQR(7\u0026ndash;9), a proportion of caregivers using the correct HH technique of 40.7% and a hand hygiene compliance rate of 40.3%. The HH compliance rate after contact with the patient was better (58.2%) than that before contact (27.6%). Additionally, the predictors of good HH knowledge scores were young age, female gender, workplace, seniority in the profession and participation in HH training in the last three years. However, the nursing profession was predictive of a decline in the HH knowledge score. The predictors of hand hygiene compliance were age between 40\u0026ndash;49 years (OR\u0026thinsp;=\u0026thinsp;2.1; CI\u0026thinsp;=\u0026thinsp;1.2\u0026ndash;3.8), surgery ward of Do (OR\u0026thinsp;=\u0026thinsp;3.3; CI\u0026thinsp;=\u0026thinsp;2.0\u0026ndash;5.5), and participation in HH training in the last three years (OR\u0026thinsp;=\u0026thinsp;1.4; CI\u0026thinsp;=\u0026thinsp;1.1\u0026ndash;1.9).\u003c/p\u003e \u003cp\u003eWe observed a relatively low level of knowledge (8/15 or 53% correct answers). Similar low levels of knowledge to our results have been reported in The Tygerberg Children's Hospital (TCH), in South Africa [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], in the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC) in Nigeria [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], in the General Reference Hospitals (GRH) of the city of Kisangani in the Democratic Republic of Congo [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] and in the Yendi municipality in Ghana [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. However, the knowledge level of our participants is well below those reported in the Lagos University Teaching Hospital [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], in the Local Government Area (LGA) of Sokoto state in Nigeria [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] and in the Quang Nam Central General Hospital in Vietnam [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Variability in the HH knowledge level among health workers from one study to another depending on the data collection tools used and the experience of the participants.\u003c/p\u003e \u003cp\u003eA small proportion of health workers (40.7%) respected the different stages of HH. Our results corroborate those reported by Adegboye MB et al. in Nigeria [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], who reported that 32.5% of the respondents had knowledge of the movement of HH and practiced six steps of the hand washing technique. Only 28% of the physicians practiced the six steps of the hand washing technique. The steps of HH focus on specific areas, such as the spaces between the fingers, nails and wrists. This ensures that these often overlooked areas are properly cleaned, reducing the areas where germs could hide. They also ensure an adequate duration of hand treatment. Compliance with the different stages of HH is therefore essential to guarantee maximum effectiveness in eliminating germs and preventing infections.\u003c/p\u003e \u003cp\u003eWe observed a low hand hygiene compliance rate (40.3%) and that hand hygiene compliance after contact was better than that before contact. Our results were close to the 39% [95% CI 0.37; 0.41] reported by Longembe EB et al. in the DR Congo [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] and higher than the 28.8% reported by Labi A. et al. in Ghana [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] and the 25% reported by AlAnazi et al. in Kuwait [23]. However, some African authors have reported that hand hygiene compliance rates based on self-assessments are much greater than ours, with rates varying from 60\u0026ndash;96.5%[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eVariations in hand hygiene compliance rates across studies could be related to the method of data collection. Indeed, observational data collection techniques such as ours reflect the hidden and actual activities of human beings; however, self-administered questionnaires mostly reflect people\u0026rsquo;s knowledge, principles and obligation rather than their actual practices, which is liable for social desire bias [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFurthermore, as in our study, several authors reported [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] that compliance with hand hygiene after contact was better than that before contact. Thus, greater adherence to indications that protect healthcare workers rather than patients, such as fear of contracting a disease, is the main motivation of health workers for HH and hence better compliance after contact with patients [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHH compliance in our study was associated with age, training and service. Labi A. et al. in Ghana [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] showed a link between HH compliance and training plus inputs for HH availability. Ekwere TA et al. in Nigeria [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] showed that nurses had better hand washing practices than did doctors. Longembe EB et al. in the DR Congo [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] reported higher compliance rates among cleaning technicians and doctors than among nurses. We did not find a statistically significant association between socioprofessional status and the level of compliance. Training followed by frequent reminders and the availability of inputs for HH are guarantees of health workers' adherence to hand hygiene [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Variations in compliance rates from one site to another in our study could be explained by infrastructural, material, and educational disparities and workload [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. However, recent studies have demonstrated that the effective implementation of hand hygiene improvement strategies is possible and sustainable, even in resource-poor settings, and has led to significant compliance and knowledge improvement among healthcare workers and to healthcare-associated infection reduction in some cases [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur study has several methodological limitations. Indeed, the nonprobability sampling method and the relatively small sample size (n\u0026thinsp;=\u0026thinsp;175) could make the inferences less relevant. Likewise, this study does not address infrastructural and material barriers to HH. Additionally, perceptions and safety culture are not considered. However, this study has the merit of including the different professional categories that play roles in infection prevention and control and using observation as a method of evaluating hand hygiene practices, which, although time-consuming, is more reliable than the commonly used self-assessment. This study provides valuable information on hand hygiene knowledge and practices in sensitive areas of Bobo Dioulasso city's largest healthcare establishments.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe levels of knowledge, technical mastery and hand hygiene compliance of health personnel were low. The training of healthcare workers was one of the main factors associated with improved knowledge and compliance with HH. These findings indicate the need for training programs and awareness campaigns on hand hygiene for healthcare staff in the health centers of Bobo Dioulasso city. Other factors, such as the environment, education, and culture, also influence human health-related behavior and must be considered in hand hygiene promotion strategies. The World Health Organization's multimodal strategy for improving hand hygiene serves as an ideal framework for developing and implementing context-specific hand hygiene promotion plans.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the National Health Ethics Committee of Burkina Faso. An information sheet was given to each participant. After reading this information sheet, those who desired to participate in the study signed a free and informed consent form. The data collected were anonymized to ensure their confidentiality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets, including deidentified provider quantitative and qualitative data, used and/or analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAH, AS, MLT, SS, VK, AP, CM and LS have no competing interests to declare.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo external funding was provided for this project. The costs of collecting data were borne by a group of researchers from Sour\u0026ocirc; Sanou Teaching Hospital and Centre Muraz.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAH, AS, MLT, SS and KV designed the study; AH, AS, MLT, SS and VK drafted the manuscript. AH, AS and VK conducted the analyses. AH, AS, MLT, SS, VK, AP, CM and LS contributed to the interpretation of the findings and edited and reviewed the manuscript. All the authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank the healthcare workers and all the investigators for their commitment and dedication during this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization, WHO Patient Safety. 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Available from: http://www.panafrican-med-journal.com/content/article/35/57/full/\u003c/li\u003e\n\u003cli\u003eLabi A, Obeng-Nkrumah N, Nuertey BD, Issahaku S, Ndiaye NF, Baffoe P, et al. Hand hygiene practices and perceptions among healthcare workers in Ghana: A WASH intervention study. The Journal of Infection in Developing Countries. 2019 Dec 31;13(12):1076\u0026ndash;85. \u003c/li\u003e\n\u003cli\u003eGedamu H, Wgiorgis T, Tesfa G, Tafere Y, Genet M. Hand washing practice among health care workers in Ethiopia: systemic review and meta-analysis, 2020. Heliyon. 2021 May;7(5):e06972. \u003c/li\u003e\n\u003cli\u003eDramowski A, Whitelaw A, Cotton MF. Healthcare-associated infections in children: knowledge, attitudes and practice of paediatric healthcare providers at Tygerberg Hospital, Cape Town. Paediatrics and International Child Health. 2016 Sep 6;36(3):225\u0026ndash;31. \u003c/li\u003e\n\u003cli\u003eIrek EO, Aliyu AA, Dahiru T, Obadare TO, Aboderin AO. Healthcare-associated infections and compliance of hand hygiene among healthcare workers in a tertiary health facility, southwest Nigeria. Journal of Infection Prevention. 2019 Jul 9;20(6):289\u0026ndash;96. \u003c/li\u003e\n\u003cli\u003eMutaru A-M, Balegha AN, Kunsu R, Gbeti C. Knowledge and determinants of infection prevention and control compliance among nurses in Yendi municipality, Ghana. Săndulescu O, editor. PLOS ONE. 2022 Jul 20;17(7):e0270508. \u003c/li\u003e\n\u003cli\u003eEkwere TA, Okafor IP. Hand hygiene knowledge and practices among healthcare providers in a tertiary hospital, south west, Nigeria. International Journal of Infection Control [Internet]. 2013 Oct 17 [cited 2024 Mar 18];9(4). Available from: http://www.ijic.info/article/view/11917\u003c/li\u003e\n\u003cli\u003eAngo U, Awosan K, Adamu H, Salawu S, Sani M, Ibrahim A. Knowledge, Attitude and Practice of Hand Hygiene among Healthcare Providers in Semi-urban Communities of Sokoto State, Nigeria. International Journal of TROPICAL DISEASE \u0026amp; Health. 2017 Jan 10;26(2):1\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eAdegboye MB, Zakari S, Ahmed BA, Olufemi GH. Knowledge, awareness and practice of infection control by health care workers in the intensive care units of a tertiary hospital in Nigeria. African Health Sciences. 2018 Apr 4;18(1):72. \u003c/li\u003e\n\u003cli\u003eAl-Anazi S, Al-Dhefeery N, Al-Hjaili R, Al-Duwaihees A, Al-Mutairi A, Al-Saeedi R, et al. Compliance with hand hygiene practices among nursing staff in secondary healthcare hospitals in Kuwait. BMC Health Services Research [Internet]. 2022 Nov 8 [cited 2024 Apr 18];22(1). Available from: https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-022-08706-8\u003c/li\u003e\n\u003cli\u003eMandana Bambenongama N, Losimba Likwela J. Connaissances, attitudes et pratiques des professionnels de sant\u0026eacute; face aux pr\u0026eacute;cautions standards en milieu hospitalier. Sant\u0026eacute; Publique. 2013 Oct 1;Vol. 25(5):663\u0026ndash;73. \u003c/li\u003e\n\u003cli\u003eDesta M, Ayenew T, Sitotaw N, Tegegne N, Dires M, Getie M. Knowledge, practice and associated factors of infection prevention among healthcare workers in Debre Markos referral hospital, Northwest Ethiopia. BMC Health Services Research [Internet]. 2018 Jun 18 [cited 2024 Mar 18];18(1). Available from: https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-018-3277-5\u003c/li\u003e\n\u003cli\u003eAllegranzi B, Sax H, Bengaly L, Riebet H, Minta DK, Chraiti M-N, et al. Successful Implementation of the World Health Organization Hand Hygiene Improvement Strategy in a Referral Hospital in Mali, Africa. Infection Control \u0026amp; Hospital Epidemiology. 2015 Jan 2;31(2):133\u0026ndash;41. \u003c/li\u003e\n\u003cli\u003eKibira J, Kihungi L, Ndinda M, Wesangula E, Mwangi C, Muthoni F, et al. Improving hand hygiene practices in two regional hospitals in Kenya using a continuous quality improvement (CQI) approach. Antimicrobial Resistance \u0026amp; Infection Control [Internet]. 2022 Apr 4 [cited 2024 Apr 18];11(1). Available from: https://aricjournal.biomedcentral.com/articles/10.1186/s13756-022-01093-z\u003c/li\u003e\n\u003cli\u003eTenna A, Stenehjem EA, Margoles L, Kacha E, Blumberg HM, Kempker RR. Infection Control Knowledge, Attitudes, and Practices among Healthcare Workers in Addis Ababa, Ethiopia. Infection Control \u0026amp; Hospital Epidemiology. 2015 Jan 2;34(12):1289\u0026ndash;96. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"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":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"hand hygiene, knowledge, practices, healthcare workers, Bobo-Dioulasso","lastPublishedDoi":"10.21203/rs.3.rs-4430550/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4430550/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe hands of healthcare workers are the major source of healthcare-associated infection transmission. Hand hygiene (HH) remains the most effective measure for preventing such infections. This study aimed to assess knowledge, technical mastery and compliance with HH among healthcare workers in three hospitals in Bobo Dioulasso city.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA multicenter cross-sectional study was conducted from May 5th to July 3rd, 2022, in 2 district hospitals (DO et Dafra) and the Sour\u0026ocirc; Sanou Teaching Hospital. Data collection involved the use of a questionnaire on knowledge (WHO, 2009), a WHO direct observation tool for HH compliance (WHO, 2009c) and an observation grid completed by trained investigators to assess HH technique and compliance. Data analysis was performed using Stata 13. We used multilevel linear and logistic regression to analyze the associations between HH knowledge scores, HH compliance, and participants\u0026rsquo; characteristics.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eIn total, 175 participants were included, and a total of 1701 observations were made. The participants included 24.6% physicians, 60.0% nurses, 12.0% midwives and 3.4% hospital hygiene technicians. The median age of the study participants was 39 years (IQR 27\u0026ndash;46), and the median work experience was 10 years (IQR 5\u0026ndash;15). The median HH knowledge score was 8 out of 15 points (IQR 7\u0026ndash;9). Only 40.7% of participants adhered to the correct HH technique, and the compliance rate for HH following WHO indications was 40.3%. The predictors of good knowledge scores on HH were young age, female gender, workplace, seniority in the profession and participation in HH training. The predictors of HH compliance were age between 40 and 49 years (OR\u0026thinsp;=\u0026thinsp;2.1; CI\u0026thinsp;=\u0026thinsp;1.2\u0026ndash;3.8), surgery ward of Do (OR\u0026thinsp;=\u0026thinsp;3.3; CI\u0026thinsp;=\u0026thinsp;2.0\u0026ndash;5.5), and participation in HH training (OR\u0026thinsp;=\u0026thinsp;1.4; CI\u0026thinsp;=\u0026thinsp;1.1\u0026ndash;1.9).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eHealthcare workers\u0026rsquo; knowledge, technical mastery and HH compliance were low. It is therefore necessary to strengthen compliance with HH through implementation training programs and increased awareness initiatives.\u003c/p\u003e","manuscriptTitle":"Knowledge and practices of hand hygiene among healthcare workers in three urban hospitals in Bobo-Dioulasso city, 2022 (Burkina Faso)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-04 21:41:30","doi":"10.21203/rs.3.rs-4430550/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-05-21T09:26:44+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-20T01:03:17+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-05-20T01:03:17+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2024-05-16T10:46:03+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"364aac9c-3034-431c-a00a-b041db24d56d","owner":[],"postedDate":"June 4th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-13T15:24:44+00:00","versionOfRecord":[],"versionCreatedAt":"2024-06-04 21:41:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4430550","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4430550","identity":"rs-4430550","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}