Trend analysis in hand hygiene from the early COVID pandemic to the post-COVID periods at a Tunisian University Hospital

Imen Mlouki; Baraa Twahria; Emna Hariz; Nejla Rezg; Aida Khouildi; Rim Gharbi; Mohamed Masmoudi; Maher Saidane; Hazem Ben Ghozlane; Bahri Mahjoub; Hechmi Ben Hammouda; Faouzi Abid; Khalifa Mighri; Souheil Atrous; Sana El Mhamdi

doi:10.3855/jidc.21231

Trend analysis in hand hygiene from the early COVID pandemic to the post-COVID periods at a Tunisian University Hospital

Authors

Imen Mlouki Department of Preventive and Community Medicine, Mahdia University Hospital 5100, Tunisia
Baraa Twahria Department of Preventive and Community Medicine, Mahdia University Hospital 5100, Tunisia
Emna Hariz Department of Preventive and Community Medicine, Mahdia University Hospital 5100, Tunisia
Nejla Rezg Department of Preventive and Community Medicine, Mahdia University Hospital 5100, Tunisia
Aida Khouildi Department of Preventive and Community Medicine, Mahdia University Hospital 5100, Tunisia
Rim Gharbi Intensive Care Department, Mahdia University Hospital 5100, Tunisia
Mohamed Masmoudi Otolaryngology Department, Mahdia University Hospital 5100, Tunisia
Maher Saidane Neonatology Department, Mahdia University Hospital 5100, Tunisia
Hazem Ben Ghozlane Orthopedic Department, Mahdia University Hospital 5100, Tunisia
Bahri Mahjoub Pediatric Department, Mahdia University Hospital 5100, Tunisia
Hechmi Ben Hammouda Neonatology Department, Mahdia University Hospital 5100, Tunisia
Faouzi Abid Orthopedic Department, Mahdia University Hospital 5100, Tunisia
Khalifa Mighri Otolaryngology Department, Mahdia University Hospital 5100, Tunisia
Souheil Atrous Intensive Care Department, Mahdia University Hospital 5100, Tunisia
Sana El Mhamdi Department of Preventive and Community Medicine, Mahdia University Hospital 5100, Tunisia

DOI:

https://doi.org/10.3855/jidc.21231

Keywords:

Hand Hygiene, compliance, health personnel, COVID-19, patient safety, Tunisia

Abstract

Introduction: The COVID-19 pandemic has further underscored the importance of Hand Hygiene (HH) adherence as an effective measure for infection prevention and control. This study aims to evaluate trends in HH practices from 2020 to 2023 and assess the impact of the COVID-19 pandemic at the University Hospital of Mahdia (Tunisia).

Methodology: From June 2020 to October 2023, annual direct observations of HH were performed among health care workers (HCWs) at Mahdia hospital based on the ''HygMain Hygiene audit'' validated by the Practice Assessment Group of Hospital Hygiene in France. Data were collected through structured observations by trained doctors and hygienists. Compliance and relevance rates were analyzed for each observation period.

Results: A total of 993 HH opportunities were observed across five periods from 2020 to 2023, involving 731 HCWs, predominantly paramedical staff (54.4%). Among them, 478 (65%) were female. The overall HH compliance was 22.1%, with a higher compliance rate after patient contact (28.4% vs 39%, p = 0.08). Overall, HH compliance increased significantly during the COVID-19 pandemic, peaking at 33.1% in 2022 before declining to 14.7% in 2023. Similarly, the overall HH relevance rates rose from 6.5% in 2020 to 30% in 2022, but fell to 19.4% in 2023. Compliance was higher in high-risk departments and during invasive procedures.

Conclusions: The study highlights the positive impact of the COVID-19 pandemic on HH, though the post-pandemic adherence rate has declined. Continuous monitoring and institutional support are essential to enhance and maintain compliance levels, ensuring long-term improvements in infection control practices.

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Published

2026-09-30

How to Cite

Mlouki I, Twahria B, Hariz E, Rezg N, Khouildi A, Gharbi R, Masmoudi M, Saidane M, Ben Ghozlane H, Mahjoub B, Ben Hammouda H, Abid F, Mighri K, Atrous S, El Mhamdi S (2026) Trend analysis in hand hygiene from the early COVID pandemic to the post-COVID periods at a Tunisian University Hospital. J Infect Dev Ctries 20:1298–1307. doi: 10.3855/jidc.21231

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Issue

Vol. 20 No. 09: September 2026

Section

Coronavirus Pandemic

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Copyright (c) 2026 Imen Mlouki, Baraa Twahria, Emna Hariz, Nejla Rezg, Aida Khouildi, Rim Gharbi, Mohamed Masmoudi, Maher Saidane, Hazem Ben Ghozlane, Bahri Mahjoub, Hechmi Ben Hammouda, Faouzi Abid, Khalifa Mighri, Souheil Atrous, Sana El Mhamdi

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