Assessment of knowledge and determinants of hand hygiene compliance among health workers at Garowe General Hospital- Somalia

Background: Healthcare-associated infections (HCAIs) remain a critical challenge, particularly in low-resource settings like Somalia, where hand hygiene compliance is often inadequate. This study focuses on improving hand hygiene practices at Garowe General Hospital. Aim: This study evaluated health workers’ knowledge of hand hygiene and identified the determinants influencing compliance at Garowe General Hospital, Somalia. Method: A cross-sectional quantitative study combined direct observations and questionnaire. A sample of 379 was calculated using Kish Leslie’s formula at a 95% confidence interval and 5% error margin. 300 health workers responded (79.2%) and were analyzed. Hand hygiene compliance was observed across key clinical moments based on WHO guidelines, while knowledge and compliance determinants were assessed using structured questionnaires. Associations were tested using chi-square, and predictors were examined using binary logistic regression. Results: Awareness of hand hygiene protocols was significantly linked to better compliance (χ² = 5.432, p = 0.020). Key factors facilitating compliance included the availability of handwashing facilities (χ² = 9.231, p = 0.026) and manageable workloads (χ² = 6.782, p = 0.034). Conversely, barriers such as insufficient training, high patient loads, and lack of resources were associated with lower compliance (χ² = 4.821, p = 0.042). Observations revealed critical gaps, especially during high-pressure periods, despite good theoretical knowledge. Compliance was notably higher among health workers who received regular training and refresher courses. Conclusion/Recommendation: Improved hand hygiene compliance requires a multifaceted approach, addressing both individual knowledge and systemic barriers. Health workers’ awareness, workload management, and institutional support are critical in promoting adherence to hand hygiene protocols. Enhanced training and accessible hygiene resources should be prioritized.