Hand hygiene knowledge and practices among health care workers in Uganda: Evidence from Mukono and Kagadi districts

Background: Hand hygiene (HH) is one of the most effective measures to prevent healthcare-associated infections (HAIs) and limit the transmission of antimicrobial-resistant pathogens in healthcare facilities (HCFs). Effective HH programs depend not only on the availability of essential resources but also on healthcare workers' (HCWs) knowledge, attitudes, and adherence to recommended HH practices. Despite the critical role of these factors in improving infection prevention and control (IPC), evidence on HH knowledge and practices among HCWs remains limited. In Uganda, such evidence from lower-level district health facilities is particularly scarce. This study assessed HH knowledge and practices, along with associated factors, among HCWs at selected health facilities in the Mukono and Kagadi districts of Uganda. Methods: A cross-sectional study was conducted among 586 HCWs at selected health facilities in the Mukono and Kagadi districts from May to June 2025. Data were collected using a structured questionnaire administered via KoboCollect, covering participants' socio-demographic and professional characteristics, HH knowledge, self-reported HH practices, and facility-related factors. Descriptive statistics summarized the data, and modified Poisson regression with generalized estimating equations (GEE), accounting for clustering of HCWs within facilities, was used to estimate prevalence ratios for factors associated with HH knowledge and practices. Results: Overall, 82.1% of HCWs had adequate HH knowledge, and 43.0% had good HH practice. Nearly all respondents correctly identified the recommended handwashing duration (98.8%), the minimum effective alcohol concentration for alcohol-based hand rub (ABHR) (98.8%), proper HH as the most effective method for preventing HAIs (97.6%), and 89.9% correctly listed all five WHO Moments for HH. HCWs in Mukono were more likely to have adequate HH knowledge than those in Kagadi (aPR = 1.36; 95% CI: 1.15-1.60). HCWs with 6-10 years of experience had higher knowledge of HH than those with less than two years of experience (aPR=1.16, 95% CI: 1.02-1.33). Good HH practice was significantly more common among clinical officers (aPR=1.36, 95% CI: 1.06-1.75) and other cadres (aPR=1.65, 95% CI: 1.14-2.39) than nurses and nursing assistants. Conclusion: HCWs demonstrated high HH knowledge but suboptimal HH practice, suggesting a gap between knowledge and self-reported practice. Interventions should move beyond knowledge dissemination to strengthen compliance through multimodal, cadre-specific strategies, particularly for nurses and nursing assistants.