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

BACKGROUND Healthcare-associated infections pose a major challenge in developing countries, with hand hygiene (HH) compliance being the most critical preventive measure. Despite WHO recommendations, HH compliance in Pakistani healthcare settings remains suboptimal. This study aimed to evaluate the effectiveness of a WHO-based multimodal HH improvement intervention in enhancing compliance among healthcare workers at Tabba Heart Institute, Karachi, from 2022 to 2024. METHODS A quasi-experimental before-and-after study was conducted in three phases: baseline assessment (Jan–Dec 2022), intervention implementation (Jan–Dec 2023), and post-intervention evaluation (Jan–Jun 2024). The multimodal intervention included system changes, educational training, monitoring with feedback, workplace reminders, and institutional safety climate enhancement. Trained observers used the WHO HH observation tool to record 9,460 HH opportunities across physicians, nurses, and allied healthcare staff. RESULTS HH compliance improved significantly from 68.0% in 2022 to 71.0% in 2023, with sustained improvement reaching 85.5% in 2024. Compliant HH actions increased from 3,082/4,532 opportunities in 2022 to 1,150/1,344 in 2024. Monthly compliance rates showed consistent upward trends, peaking in early 2024. Nurses demonstrated the highest compliance, followed by physicians and allied staff. CONCLUSION 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.