Proper hand hygiene (HH) is crucial to prevent healthcare-associated infections, including coronavirus disease 2019 (COVID-19), which disproportionately affects patients in low-and middle-income countries. As part of COVID-19 response, we evaluated key factors associated with HH practices in healthcare facilities (HCF) across five countries. From December 2020 to June 2021, we observed HH practices among healthcare personnel in 88 HCFs; observations occurred before and after patient contact. HH adherence (HHA) was defined as the use of alcohol-based hand rub (ABHR) or handwashing with soap and water. HH materials (soap and water, ABHR, or gloves) in patient care areas during observation were recorded in Belize, Uganda, and Kenya, and whether HHA occurred during invasive or noninvasive procedures. Descriptive methods and regression models were conducted. Overall, 3,940 HH observations were completed; average HHA was 32% (23-52% by country). Adjusted odds ratios (aORs) of HHA among nurses (aOR = 0.58; 95% CI = 0.44-0.77) and laboratory technicians (aOR = 0.41; 95% CI = 0.25-0.67) were lower than those among physicians, higher after versus before patient contact (aOR = 2.84; 95% CI = 2.44-3.28), higher with invasive procedures versus noninvasive (aOR = 1.45; 95% CI = 1.18-1.78), and higher when both ABHR and water and soap were available (aOR = 2.04, 95% CI = 1.73-3.53) or only ABHR was available (aOR = 1.86, 95% CI = 1.12-3.06) versus only water and soap were available. Our assessment highlights the need for behavioral and infrastructural interventions to improve HH practices in five resource-limited countries across two regions globally.

正确的手卫生（HH）对于预防包括2019冠状病毒病（COVID-19）在内的医疗相关感染至关重要，特别是在低收入和中等收入国家的患者中。作为对COVID-19应对措施的一部分，我们评估了五个国家医疗卫生机构（HCF）内与手卫生实践相关的关键因素。从2020年12月至2021年6月期间，在88家医疗保健设施中观察医护人员的手卫生行为；这些观察发生在接触患者前后。手卫生依从性（HHA）定义为使用含酒精的手部消毒剂（ABHR）或用肥皂和水洗手。在伯利兹、乌干达和肯尼亚，记录了患者护理区域内的手卫生材料（如肥皂和水、ABHR 或手套），并观察在侵入性和非侵入性程序期间是否进行了HHA。采用描述性方法和回归模型进行分析。总共完成了3,940次手卫生观察；平均的手卫生依从率为32%（按国家划分范围为23%-52%）。调整后的优势比（aORs）表明，护士（aOR = 0.58; 95% CI = 0.44-0.77）和实验室技术员（aOR = 0.41; 95% CI = 0.25-0.67）的手卫生依从性低于医生。手卫生依从性在接触患者后比接触前更高（aOR = 2.84；95% CI = 2.44-3.28），在侵入性程序期间比非侵入性程序期间更高（aOR = 1.45；95% CI = 1.18-1.78）。当同时提供ABHR和肥皂及水时，手卫生依从性高于仅提供肥皂和水的情况（aOR = 2.04, 95% CI = 1.73-3.53）或仅提供ABHR的情况高于仅提供肥皂和水的情况（aOR = 1.86, 95% CI = 1.12-3.06）。我们的评估表明，有必要在五个资源有限的国家进行行为干预和基础设施改进以提高手卫生实践水平。