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The barriers and facilitators to hand hygiene practices in Nigeria: A qualitative study: “There are so many barriers the barriers are limitless.”

Ataiyero, Yetunde; Dyson, Judith; Graham, Moira


Yetunde Ataiyero

Judith Dyson

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Dr Moira Graham
Lecturer in Public Health / Graduate Research Director in the School of Health and Social Work


Background: Health care associated infections (HCAIs) are a global challenge and hand hygiene is the primary measure to reduce these. In developing countries, patients are between 2 and 20 times more likely to acquire an HCAI compared with developed countries. Estimates of hand hygiene in Sub-Saharan Africa suggests 21% concordance. There are few studies investigating barriers and facilitators and those published tend to be surveys. This study aimed to understand barriers and facilitators to hand hygiene in a hospital in Nigeria. Methods: A theoretically underpinned in-depth qualitative interview study with thematic analysis of nurses and doctors working in surgical wards. Results: There were individual and institutional factors constituting barriers or facilitators: (1) knowledge, skills, and education, (2) perceived risks of infection to self and others, (3) memory, (4) the influence of others and (5) skin irritation. Institutional factors were (1) environment and resources and (2) workload and staffing levels. Conclusions: Our study presents barriers and facilitators not previously reported and offers nuances and detail to those already reported in the literature. Although the primary recommendation is adequate resources, however small local changes such as gentle soap, simple skills and reminder posters and mentorship or support could address many of the barriers listed.


Ataiyero, Y., Dyson, J., & Graham, M. (2023). The barriers and facilitators to hand hygiene practices in Nigeria: A qualitative study: “There are so many barriers the barriers are limitless.”. American Journal of Infection Control, 51(3), 295-303.

Journal Article Type Article
Acceptance Date Oct 24, 2022
Online Publication Date Feb 16, 2023
Publication Date 2023-03
Deposit Date Feb 17, 2023
Publicly Available Date Feb 20, 2023
Journal American Journal of Infection Control
Print ISSN 0196-6553
Electronic ISSN 1527-3296
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 51
Issue 3
Pages 295-303
Keywords Infection prevention and control; Concordance; Theoretical domains framework; Sub-Saharan Africa; Developing countries
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