Barriers to hand hygiene practice among healthcare workers in health centres of Kirkos and Akaki Kality sub-cities, Addis Ababa, Ethiopia: a qualitative study.

Background: Hand hygiene is an easy step to reduce healthcare-acquired infections, and improve patient safety. Major progress in facility accessibility was made during the coronavirus disease 2019 (COVID-19) pandemic, and this led to greater adherence to hand hygiene practices. However, handwashing practices have now returned to the pre-COVID-19 era. Most of the studies that have investigated hand hygiene adherence are quantitative. As such, this study aimed to explore barriers to hand hygiene practice in the health centres of Kirkos and Akaki Kality sub-cities in Addis Ababa, Ethiopia. Methods: Twenty-four healthcare professionals employed at the aforementioned health centres were interviewed using the key informant interview method. Data were analysed using a qualitative content analysis technique. Results: Based on the findings, there were three main categories of barriers to hand hygiene practice: barriers related to individuals (including three sub-categories: lack of knowledge and skill, improper attitude, and poor attention and negligence of healthcare workers); leadership barriers (including two sub-categories: lack of dedicated staff and low attention of leaders); and institutional barriers (including three sub-categories: inappropriate infrastructure and lack of resources, shortage of water, and high work load and staff turnover). Conclusion: There were several reasons why hand hygiene guidance was not followed. Hand hygiene barriers can be minimized by displaying colour-coded notice boards, making washing facilities easily accessible, monitoring the availability of soap, offering training, and providing accurate evidence about the need to enhance hand hygiene.