Evaluation of hand hygiene implementation in hospitals in the post-war Tigray region of Ethiopia, using the WHO Hand Hygiene Self-Assessment Framework.

Background: Healthcare-associated infections are a major cause of morbidity and mortality among health personnel worldwide. The World Health Organization's (WHO) multi-modal hand hygiene tool has shown inadequate hand hygiene levels in various sub-Saharan countries. We have applied it here to describe the hand hygiene level in public health facilities in Tigray, Ethiopia. Methods: A cross-sectional study was conducted from June to July 2024 in all accessible public health facilities. An interview-based WHO hand hygiene self-assessment framework (HHSAF) tool was used for data collection. Descriptive analyses and independent t-test were used to analyse data. Results: A total of 33 facilities (two referral, 10 general, and 21 primary hospitals) from six accessible zones of Tigray participated in the survey. The mean age of the respondents was 35 years (SD: 8) with a mean service duration of nine years (SD: 7). Most respondents were infection prevention and control (IPC) focal persons (66.7%), followed by chief executive officers (9.1%). The overall HHSAF score was 126 (range: 15-318), indicating a basic hand hygiene level. Seventeen facilities (51.5%) had inadequate hand hygiene levels, 13 (39.4%) had basic hand hygiene level, three (9.1%) had an intermediate hand hygiene level, and none had an advanced hand hygiene level. Conclusions: Hand hygiene levels were unsatisfactory in post-war Tigray and were limited across all zones and types of facility, posing an increased risk of infection for healthcare personnel. Improvements in hand hygiene practices and IPC capacity building are essential to prevent healthcare-associated infections. Longitudinal research on hand hygiene level monitoring is recommended.