Longitudinal evaluation of a multimodal hand hygiene intervention in improving healthcare worker compliance: a three-year quasi-experimental study at a cardiac specialty hospital in Karachi, Pakistan

Q: What are the key findings of this study?

A WHO-based multimodal intervention significantly improved hand hygiene compliance among healthcare workers from 68.0% at baseline to 85.5% over three years.

Q: What is the clinical evidence from this study?

Population: Healthcare-associated infections (hand hygiene compliance) (n=9460). Intervention: WHO multimodal hand hygiene improvement strategy vs. Baseline (pre-intervention) practices. Primary outcome: Hand hygiene compliance rate (17.5% absolute increase, p=<0.001).

Q: What question did this study set out to answer?

To evaluate the effectiveness of a WHO-based multimodal hand hygiene improvement strategy in enhancing compliance among healthcare workers at a cardiac specialty hospital over three years.

Shaheen Asif; Moiz Ahmed Khan; Victor Basheer; Margaret Palous; Nassim Sheraz

doi:10.1186/s13756-025-01689-1

January 17, 2026Antimicrobial Resistance and Infection ControlOpen Access

Longitudinal evaluation of a multimodal hand hygiene intervention in improving healthcare worker compliance: a three-year quasi-experimental study at a cardiac specialty hospital in Karachi, Pakistan

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Key result

Multimodal WHO intervention increases healthcare worker hand hygiene compliance by ~18 percentage points over three years.

17.5% absolute increase
P<0.001
n=9,460

Key Points

To evaluate the effectiveness of a WHO-based multimodal hand hygiene improvement strategy in enhancing compliance among healthcare workers at a cardiac specialty hospital over three years.
Quasi-experimental quality improvement study conducted from 2022 to 2024 at Tabba Heart Institute in Karachi, Pakistan.
Implemented the five-component WHO multimodal strategy comprising system change, training and education, monitoring and feedback, workplace reminders, and an institutional safety climate.
Evaluated hand hygiene compliance across healthcare worker categories using observational audits and segmented regression in an interrupted time series analysis.
Hand hygiene compliance increased from a baseline of 68.0% (3082/4532 opportunities) in 2022 to 71.0% (2532/3584) in 2023, reaching 85.5% (1150/1344) in 2024, achieving a 17.5% overall increase.
Interrupted time series analysis showed an immediate post-intervention improvement of +8.7% (p < 0.001) and sustained monthly gains of +1.2% per month (p = 0.003), with compliance reaching 87.5% (95% CI 85.1–89.9) by June 2024.
Nurses maintained the highest compliance rates, exceeding 80% by the final period, while compliance before aseptic procedures showed the greatest relative improvement across observed moments.

PICO

P

Population

Healthcare workers in direct patient care at a cardiac specialty hospital in Pakistan, assessed across 9,460 hand hygiene opportunities over a 3-year period.

I

Intervention / Comparator

WHO multimodal hand hygiene improvement strategy vs Baseline (pre-intervention) practices

O

Primary Outcome

Hand hygiene compliance rate — 17.5% absolute increase, p=<0.001

Main Result

Effect estimate: 17.5% absolute increase

Absolute Event Rate: 85.5% vs 68%

p-value: p=<0.001

Limitations

Quasi-experimental design limits ability to definitively attribute improvements solely to the intervention
Potential observation bias (Hawthorne effect) during manual observations
Conducted at a single cardiac care institution, which may limit generalizability
Smaller sample size of observations in the final 2024 evaluation phase
Study did not measure direct clinical outcomes such as healthcare-associated infection rates

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Implication

Quasi-experimental study evaluates improved hand hygiene compliance in healthcare workers, suggesting effectiveness in resource-limited settings.

Abstract

The WHO multimodal HH strategy effectively and sustainably improved HH compliance at our institution, achieving a 17.5% increase over three years. This demonstrates the feasibility and impact of systematic quality improvement interventions in resource-limited healthcare settings.

Discussion

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Cite This Study

Asif et al. (2026) studied Healthcare-associated infections (hand hygiene compliance) (n=9,460). WHO multimodal hand hygiene improvement strategy vs. Baseline (pre-intervention) practices was evaluated on Hand hygiene compliance rate (17.5% absolute increase, p=<0.001). A WHO-based multimodal intervention significantly improved hand hygiene compliance among healthcare workers from 68.0% at baseline to 85.5% over three years.

synapsesocial.com/papers/696f1a629e64f732b51ee9e0 https://doi.org/10.1186/s13756-025-01689-1

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Longitudinal evaluation of a multimodal hand hygiene intervention in improving healthcare worker compliance: a three-year quasi-experimental study at a cardiac specialty hospital in Karachi, Pakistan

Key Points

PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Longitudinal evaluation of a multimodal hand hygiene intervention in improving healthcare worker compliance: a three-year quasi-experimental study at a cardiac specialty hospital in Karachi, Pakistan

Key Points

PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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