Leadership and healthcare professionals’ role in hand hygiene compliance: Identifying risk factors at surgical clinics of the university clinical center NIS, Serbia

Background Hospital-associated infections (HAIs) caused by multidrug-resistant organisms represent a global threat to public health. Despite various strategies, compliance with effective hand hygiene (HH) remains inconsistent. This study examines risk factors influencing hand hygiene compliance (HHC) in surgical clinics of the University Clinical Center Nis, Serbia. Methods A cross-sectional, questionnaire-based study was conducted from August 16 to September 16, 2023, among healthcare professionals in surgical, urgent care, and anesthesia units at UCC Nis. The representative sample size was calculated using G*Power 3.1. Effect sizes were assessed with Hedges’ g, Glass’s Δ, η 2 , and R 2 for correlations. Regression analyses were performed to model HHC scores. Results Participants demonstrated relatively good HH knowledge. HHC scores varied most across organizational units, with large effect sizes for subscales (η 2 = 0.13-0.2) and intermediate effect for the total score. Total HHC did not significantly correlate with job satisfaction ( r = -0.023) or Leadership trait score ( r = 0.041), though some subscales showed low but significant correlations. Job satisfaction and Leadership traits were moderately correlated (R = -0.579, p < 0.001). Of seven regression models, only the model predicting “transmission of microorganisms to healthcare workers” achieved R 2 > 0.3 (intermediate effect). Conclusions HH knowledge and practices in surgical settings appear to depend more on the work environment, particularly leadership, than on individual characteristics. Sustained improvements in hand hygiene behavior require comprehensive, tailored educational programs and robust promotional campaigns, while strengthening managerial leadership skills emerges as a critical, evidence-based strategy. Job satisfaction showed only limited influence.