Hand hygiene knowledge, attitudes, and practices among healthcare workers in the Western Pacific Region: A scoping review

BACKGROUND: Healthcare-associated infections remain a major global challenge, and hand hygiene is a key measure to prevent transmission. Healthcare worker compliance remains variable across settings, and evidence of knowledge, attitudes, and practices across the Western Pacific Region has not been comprehensively synthesised. METHODS: A scoping review was conducted using the Arksey and O'Malley framework and reported in accordance with PRISMA-ScR. Primary studies of any design examining healthcare workers' hand hygiene knowledge, attitudes, and/or practices in the Western Pacific Region were included. Data were extracted and synthesised descriptively, and determinants influencing practice were mapped to the Theoretical Domains Framework to identify determinants of hand hygiene behaviour. Study quality was appraised using the Mixed Methods Appraisal Tool. RESULTS: Ninety-eight studies met the inclusion criteria; most were conducted in high-income countries, and none were from Pacific Island Countries and Territories. Quantitative descriptive designs predominated (n = 55), followed by quantitative non-randomised studies (n = 26); mixed-methods (n = 8), qualitative (n = 7), and randomised controlled trials (n = 2) were uncommon. HCWs generally reported high knowledge and positive attitudes in self-report surveys, but these were not consistently reflected in observed practice. Compliance was commonly higher after patient contact than before contact, and adherence to all WHO "5 Moments" was uncommon. Key barriers included workload pressures, limited resources, organisational culture, and training gaps, particularly in lower-resourced settings. TDF mapping emphasised the influence of social influences, environmental context and resources, and reinforcement beyond knowledge alone. CONCLUSION: Hand hygiene in the Western Pacific Region is shaped by behavioural and contextual determinants, with important evidence gaps in lower-resourced and Pacific settings.