Compliance, Barriers, and Enhancers of WHO “Five Moments for Hand Hygiene” Among Healthcare Workers in Tanzania

Abstract

Background and Objective:

Nosocomial infections from inconsistent hand hygiene (HH) significantly increase morbidity, mortality, and healthcare costs globally. To address this, the World Health Organization (WHO) introduced the “Five Moments for Hand Hygiene” in 2009, emphasizing critical points for HH to prevent healthcare-associated infections. Despite its importance, compliance among healthcare workers (HCWs), particularly in resource-limited settings like Tanzania, remains challenging. This study assessed awareness and compliance with the “Five Moments” in Misungwi District Council.

Methods:

This was a cross-sectional study design to assess HH compliance among HCWs in Misungwi District. A mixed-methods approach combined quantitative observations of compliance and qualitative surveys exploring barriers and enhancers. A multistage random sampling technique selected 154 participants from Comprehensive Emergency Obstetric Care (CEmOC) facilities. Data collection involved questionnaires and checklists. The Statistical Package for the Social Sciences was used to analyze sociodemographic and compliance data.

Results:

The study revealed that a total of 154 participated, whereby the response rate was 33%, and most participants were female. The mean and mode age for participants were 39.05 and 34.5 years, respectively, but the age of 30–39 had the highest frequency. Furthermore, the study result showed that 95 (61.7%) had working experience between 5 and 10 years. HH awareness was low, with 53.9% answering fewer than three questions correctly. Compliance averaged 37.87%, with the highest adherence after touching body fluids (93.6%) and the lowest before touching patients (14.8%). Key barriers included lack of awareness (88.7%) and irregular water supply (84.8%), while guidelines (82.5%) and a suitable environment (77.5%) were key enhancers.

Conclusion and Implications for Translation:

Based on the Five Moments HH awareness, compliance is low in Misungwi District CEmOC facilities, requiring targeted education, adequate resources, and barrier mitigation. Promoting a culture of HH can enhance compliance, reduce infections, and improve patient safety. A collaborative approach involving healthcare leaders, staff, and stakeholders is essential for sustainable improvements.