<b>ASSESSMENT OF HAND HYGIENE COMPLIANCE AND ASSOCIATED FACTORS AMONG HEALTHCARE WORKERS AT MEDICARE HOSPITAL MULTAN</b>

Background: Hand hygiene is universally recognized as the most cost-effective measure for preventing healthcare-associated infections (HAIs), which pose significant threats to patient safety worldwide. In Pakistan, limited data exists on hand hygiene compliance among healthcare workers, particularly in secondary care settings like Medicare Hospital Multan. Understanding compliance levels and associated factors is essential for designing effective interventions to reduce HAI rates and improve patient safety. Objective: This study aimed to assess hand hygiene compliance and identify associated factors among healthcare workers at Medicare Hospital Multan. Methods: A hospital-based cross-sectional study was conducted among 200 healthcare workers (doctors, nurses, paramedics, and support staff) using a convenience sampling technique. Data were collected from January to March 2024 using: (1) a structured self-administered questionnaire assessing demographics, knowledge, and perceived barriers; (2) direct observation of hand hygiene practices using the WHO "Five Moments for Hand Hygiene" tool (942 hand hygiene opportunities observed); and (3) an infrastructural assessment checklist. Data were analyzed using SPSS version 26. Descriptive statistics were computed as frequencies, percentages, means, and standard deviations. Associations were tested using chi-square tests and binary logistic regression, with statistical significance set at p<0.05. Results: Overall observed hand hygiene compliance was 47.2% (444/942 opportunities). Compliance varied significantly across the Five Moments: highest after body fluid exposure risk (68.3%) and lowest before touching a patient (34.2%). Nurses demonstrated higher compliance (54.8%) compared to doctors (41.3%) and support staff (32.7%). Only 42.5% of participants demonstrated adequate knowledge of hand hygiene indications, with a mean knowledge score of 64.8% (SD=14.2). Significant factors associated with compliance included professional cadre (p=0.003), previous training (p<0.001), knowledge level (p=0.002), and availability of alcohol-based hand rub at point of care (p=0.008). Logistic regression identified training (AOR=3.42, 95% CI: 1.89-6.18, p<0.001), adequate knowledge (AOR=2.94, 95% CI: 1.42-6.08, p=0.004), and hand rub availability at point of care (AOR=2.76, 95% CI: 1.54-4.95, p=0.001) as independent predictors of compliance. Major barriers included high workload (67.5%), forgetfulness (54.0%), skin irritation (41.5%), and inconveniently located sinks (38.0%). Conclusion: Hand hygiene compliance at Medicare Hospital Multan is suboptimal, with significant gaps in knowledge and practice, particularly for moments before patient contact. The "self-protection bias" observed indicates the need for interventions that emphasize patient safety alongside personal protection. Multimodal interventions including continuous education, improved access to alcohol-based hand rub at point of care, regular audits with feedback, and addressing workload concerns are urgently needed to improve compliance and reduce HAI risk in this setting.