Abstract
<jats:p>Background Hand hygiene is the most effective and cost-efficient measure for preventing healthcare-associated infections (HAIs). However, adherence among healthcare workers remains suboptimal, particularly in low-resource settings. Purpose/Aim This study assessed the level of adherence to hand hygiene practices and the factors associated with adherence among healthcare workers at Lubaga Hospital, Kampala City. Methods An analytical cross-sectional study was conducted among 216 healthcare workers selected using stratified random sampling. Data were collected through direct observation using the WHO “Five Moments for Hand Hygiene” checklist and a structured, self-administered questionnaire. Data were analyzed using SPSS version 20. Descriptive statistics were used to summarize the data, while inferential analysis included Pearson’s Chi-square tests and Modified Poisson regression to estimate crude and adjusted prevalence ratios (cPR and aPR) with 95% confidence intervals at a significance level of p ≤0.05. Results Overall adherence to hand hygiene practices was 69.9%, while 30.1% of participants were non-adherent. At the individual level, gender, cadre, and attitude toward hand hygiene were significantly associated with adherence. Male healthcare workers were less likely to adhere compared to females (aPR = 0.490, 95% CI: 0.226–0.969), while nurses and midwives were more than twice as likely to adhere compared to other cadres (aPR = 2.213, 95% CI: 1.113–4.398). Participants with a positive attitude toward hand hygiene were also significantly more likely to adhere (aPR = 1.462, 95% CI: 1.227–3.226). Resource-related factors, including the availability of alcohol-based hand rub and timely replenishment of supplies, were not significantly associated with adherence. Organizational factors such as recent training in hand hygiene and infection prevention (aPR = 1.771, 95% CI: 1.673–2.989), presence of reminders (aPR = 1.747, 95% CI: 1.538–5.949), feedback on performance (aPR = 0.339, 95% CI: 0.156–0.738), and teamwork (aPR = 3.006, 95% CI: 1.424–6.348) were significantly associated with improved adherence. Conclusion Adherence to hand hygiene practices among healthcare workers was moderate but remains suboptimal. Behavioral and organizational factors, particularly training, feedback, teamwork, and attitude, play a more significant role in influencing and adherence than resource availability alone.</jats:p>