Hand hygiene knowledge, glove use misconceptions, and determinants among healthcare workers in Addis Ababa hospitals: a mixed-method cross-sectional study

Abstract

BACKGROUND: Hand hygiene is a cornerstone of infection prevention, yet compliance among healthcare workers remains low. Despite multiple national initiatives, adherence in Ethiopian hospitals continues to be sub-optimal. This challenge is partly due to knowledge gaps and misconceptions, particularly regarding the WHO "Five Moments" and the appropriate use of gloves. This study aimed to assess the knowledge and misconceptions of healthcare workers concerning hand hygiene practices and glove use in hospitals in Addis Ababa. METHODS: A mixed-methods cross-sectional study was conducted from December 2024 to January 2025 among 493 healthcare workers from public and private hospitals. Data were collected using the WHO Hand Hygiene Knowledge Questionnaire and in-depth interviews. Knowledge was assessed with a 33-item tool, categorized as good (> 75%), moderate (50-74%), or poor (< 50%). Quantitative data were analyzed using descriptive statistics, and Chi-squared Automatic Interaction Detection (CHAID) decision tree analysis, while qualitative data analyzed to contextualize and enrich the findings. RESULTS: While 86% of respondents were aware of the WHO 'Five Moments,' detailed understanding remained inconsistent, with a moderate mean knowledge score of 71%. Nearly half (48.2%) believed hand hygiene was unnecessary when gloves were worn. Institutional factors strongly influenced knowledge: visible instructions (χ² = 15.62, df = 1, p < 0.001), functional IPC committees (χ² = 34.55, df = 1, p < 0.001), hospital ownership (χ² = 5.15, df = 1, p = 0.023), and working unit type (χ² = 15.63, df = 1, p = 0.010) were significantly associated with better knowledge. Individual factors such as younger age and higher educational attainment also predicted better knowledge. Qualitative findings revealed limited protocol adherence, reliance on routine habits over guidelines, insufficient training, inadequate institutional support, and misconceptions about glove use, all of which undermined healthcare workers' knowledge and practice. CONCLUSION: Moderate hand hygiene knowledge and significant misconceptions about hand hygiene and appropriate glove use persist among healthcare workers in Addis Ababa, undermining infection prevention efforts. Targeted and continuous education, visible instructions, strengthening Infection Prevention and Control (IPC) committees, and improved institutional support are essential to foster effective hand hygiene practices and reduce healthcare-associated infections.