Assessment of Nurses, Compliance with Hand Hygiene Guidelines in Public Hospitals: A Cross-Sectional Study from Mardan Medical Complex, Pakistan

Abstract

Background: Hand hygiene is the cornerstone of infection prevention and control (IPC) in healthcare settings and plays a critical role in reducing healthcare-associated infections (HAIs). Despite well-established international and national guidelines, compliance among nurses remains inconsistent, particularly in resource-constrained public sector hospitals of low- and middle-income countries. This study aimed to assess nurses' knowledge, attitudes, and self-reported compliance with hand hygiene guidelines, and to identify the barriers to compliance and its demographic correlates in a public tertiary care hospital. Methods: A hospital-based, descriptive cross-sectional study was conducted at Mardan Medical Complex, Mardan, Pakistan, over a four-month period from 1 January 2026 to 30 April 2026. A total of 210 registered nurses were recruited using a non-probability convenient sampling technique. Data were collected through a structured, pre-tested, self-administered questionnaire developed on the basis of the World Health Organization's "My Five Moments for Hand Hygiene" framework, covering demographic characteristics, knowledge, attitudes, and self-reported compliance practices. Data were entered and analyzed using SPSS version 26. Descriptive statistics (frequencies, percentages, means, and standard deviations) were used to summarize the findings, and the chi-square test was used to determine associations between demographic variables and hand hygiene compliance, with p < 0.05 considered statistically significant. Results: Among the 210 participants, the majority (81.4%) were female, and the mean age was 30.6 ± 7.4 years. The mean knowledge score was 15.7 ± 2.4 out of 20 (78.3%), indicating good overall knowledge of hand hygiene guidelines. The mean self-reported compliance score was 66.2 ± 13.3%, indicating moderate overall compliance; 12.4% of nurses demonstrated poor compliance (< 50%), 61.4% moderate compliance (50–75%), and 26.2% good compliance (> 75%). Higher compliance was observed among nurses with greater clinical experience and those who had received recent infection prevention and control training. Heavy workload (78%), inadequate availability of hand hygiene supplies (64%), and time constraints (59%) were identified as the most common barriers to compliance. A statistically significant association was found between attendance at infection control training and hand hygiene compliance (χ² = 33.90, p < 0.001), as well as between years of clinical experience and compliance (χ² = 13.82, p = 0.001). Conclusion: Nurses at Mardan Medical Complex demonstrated good theoretical knowledge but only moderate practical compliance with hand hygiene guidelines, reflecting a persistent knowledge–practice gap. Regular in-service training programs, continuous compliance monitoring, adequate provision of hand hygiene resources, and institutional/administrative support are recommended to improve adherence and reduce the risk of healthcare-associated infections in public sector hospitals.

Keywords: Hand hygiene; Nurses; Compliance; Infection prevention and control; Healthcare-associated infections; Cross-sectional study; Public hospitals; Pakistan.