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Dhangadhi, July 2025 — A simple act like cleaning your hands can save lives. Yet in healthcare settings, this critical step is often overlooked. Recognising its importance, a five-day hand hygiene compliance survey was carried out at Seti Provincial Hospital, Nepal, from 11–15 June 2025. The aim was to assess how consistently healthcare workers (HCWs) practice proper hand hygiene and to identify areas for improvement.

Why Hand Hygiene Matters

Hand hygiene is the most effective to safeguard against healthcare-associated infections (HAIs), which are illnesses that patients acquire while receiving medical care in a healthcare facility. HAIs typically develop 48 hours or more after a patient is admitted to a hospital or other healthcare setting. These infections can result from exposure to pathogens transmitted through direct contact, contaminated surfaces, or medical equipment. Proper and consistent hand hygiene among healthcare workers, patients, and visitors is crucial, as hands are the most common vehicle for pathogen transmission. By breaking the chain of infection, good hand hygiene significantly reduces the risk of HAIs, improves patient safety, and promotes better healthcare outcomes.

Survey Overview

• Duration: 5 days
• Surveyors: Two nursing staff (Kamala Bist and Rupa Acharya)
• Tool Used: WHO Hand Hygiene Self-Assessment Framework (HHSAF)
• Sampling: Non-probability purposive sampling of 40 HCWs from different departments
• Departments Covered:
  • 50% nurses in the inpatient department
  • 25% medical doctors in OPD, OT and IPD
  • 25% paramedics, including laboratory personnel

HCWs were observed during routine care across all shifts (morning, evening, night) and throughout the week to determine adherence to WHO’s “Five Moments for Hand Hygiene”.

Key Findings

Role	Opportunities	Hand Rub (HR)	Hand Wash (HW)	Gloves Used	Missed opportunities	Compliance (%)	Target (%)
Doctors	25	9	0	0	16	50%	50%
Nurses	26	7	6	6	7	26%	100%
Paramedics	11	2	0	0	9	22%	50%

Compliance varied markedly between staff groups:

• Doctors had the highest compliance rate (50%) — meeting the set target but still missing half of the required moments. Of 25 observed opportunities, doctors used hand rub nine times and missed 16 opportunities. No handwashing or glove use was recorded.
• Nurses complied only 26% of the time well below the ideal of 100%. Of 26 opportunities, nurses performed hand hygiene (hand rub or hand wash) 13 times, with seven missed occasions. Gloves were used in six cases.
• Paramedics recorded the lowest compliance rate (22%), with no observed handwashing or glove use. Of 11 opportunities, only two involved hand hygiene (both with hand rub), leaving nine missed moments.

 Missed Moments, Missed Protection

Despite having access to facilities, many critical hand hygiene moments were ignored. Gloves were used only by nurses, and no doctors or paramedics were found engaged in handwashing even when necessary. These findings highlight both behavioral shortcomings and the need for improved awareness and infrastructure.

 Recommendations

A multi-faceted approach is required to close these gaps:

• Education and Training: Reinforce WHO’s “Five Moments” and correct glove-use techniques.
• Accessibility: Ensure alcohol-based hand rub dispensers are available at every point of care.
• Reminders: Use posters, prompts and visual cues to keep hygiene in focus.
• Feedback and Monitoring: Conduct regular audits, share data, and provide timely feedback to improve accountability.
• Leadership and Culture: Set departmental targets and recognise teams that show improvement.

 A Foundation for Change

This survey represents an important step towards safer health care practices at Seti Provincial Hospital. While it reveals significant shortcomings, it also provides a clear path forward. These findings are vital for developing evidence-based interventions to enhance hand hygiene compliance and reduce HAIs.

With targeted measures, even modest improvements in hand hygiene could significantly reduce infection rates. The commitment of the survey team and the cooperation of the hospital staff were instrumental in the success of this initiative