Hand hygiene practices assessment among health care workers at an university hospital in Tunisia during the COVID-19 pandemic: An observation audit

Introduction: The ongoing Covid-19 pandemic provides the opportunity to demonstrate the potential benefit of the good hand hygiene practices (HHP) in controlling health care-associated transmission of Covid-19. Objectives: The present study aims at evaluating hand hygiene practices of health care workers (HCWs) during the first wave of Covid-19 pandemic at the university hospital Tahar Sfar Mahdia (Tunisia). Methods: We carried out an observation audit among HCWs staff at the university hospital Tahar Sfar Mahdia in Tunisia during the first wave of Covid-19 pandemic (April-May 2020) using four pretested and reliable audit sheets. The first one concerned the simple washing hand, the second and third sheet were used to evaluate respectively the hygienic washing and the hydro alcoholic friction and the fourth sheet to assess the compliance and conformity rates. We excluded the outpatients departments. Results: A total of 214 observations were enrolled of which 143 HCWs were observed. Approximately a quarter 24.6% were medical professionals and 53.2% were nursing personnel with a female predominance (sex-ratio = 0.33).Nearly two thirds of the observations 61.5% concerned high-risk departments and 56.6% were collected during the morning shift. The Half of HCWs observed 50.3% met the requirements of efficacy for hand hygiene. The majority 91.3% did not respect the technique of simple washing hand against 75% the technique of hydro alcoholic friction. The hand hygiene compliance rate before observation was 19% compared to 20.3% after. The overall conformity rate was 6.5%. Being male (p < 0.001), working at a high risk department (p < 0.01) and working during the morning shift (p = 0.003) were found to have significant relationship with good HHP. Conclusion: HCWs must modify their behaviors to face the risk propensity of the Covid-19 pandemic. However, to improve the poor compliance a culture of rigorous HHP should be established.