Hospital-acquired infections (HAIs) remain a major global public health concern, contributing significantly to patient morbidity, prolonged hospital stays, and increased healthcare costs (1). The World Health Organization (WHO) has consistently emphasized that hand hygiene is the most effective, low-cost strategy to prevent the transmission of infectious agents in healthcare settings (2). Despite the availability of evidence-based guidelines and ongoing infection control efforts, compliance with hand hygiene practices among healthcare workers continues to be suboptimal worldwide (3,4).

Medical interns, as frontline healthcare providers, frequently interact with patients and are at a critical juncture of developing long-term professional habits. Their adherence to proper hand hygiene is crucial not only for patient safety but also for instilling a culture of infection control within healthcare institutions (5). However, several studies have identified poor compliance among medical trainees, often attributed to inadequate training, time constraints, and lack of role models (6,7).

In developing countries, including India, hand hygiene adherence is particularly challenging due to high patient loads, limited infrastructure, and inconsistent availability of hand sanitizing agents (8). Moreover, behavioral and attitudinal factors, such as perceived invulnerability and underestimation of infection risks, further contribute to non-compliance (9).

This study aims to assess the level of hand hygiene compliance among medical interns in a tertiary care teaching hospital and to explore the factors influencing their adherence. By identifying gaps in practice and potential barriers, this research seeks to inform strategies for enhancing infection control protocols and reducing the incidence of HAIs.

The study included 120 medical interns undergoing their compulsory rotatory internship. Interns were selected through convenience sampling based on their availability and willingness to participate during the observation period. Written informed consent was obtained from all participants prior to enrollment. Interns on extended leave or posted in non-clinical departments were excluded.

Study Tool and Data Collection

Hand hygiene compliance was assessed using a standardized direct observation method, following the WHO’s “Five Moments for Hand Hygiene” framework. Observations were conducted covertly by trained infection control personnel to reduce observer bias. Each intern was observed during at least three patient care encounters in various clinical departments, including medicine, surgery, pediatrics, and ICU. A structured checklist was used to record compliance for each hand hygiene indication.

In addition to observation, a pre-validated, self-administered questionnaire was distributed to assess the interns’ knowledge, attitudes, and perceived barriers regarding hand hygiene. The questionnaire included multiple-choice and Likert-scale items and was adapted from previous validated tools used in similar studies.

Data Analysis

All collected data were coded and entered into Microsoft Excel and analyzed using SPSS version 26.0. Descriptive statistics such as frequency, percentage, mean, and standard deviation were used to summarize the findings. Chi-square tests were applied to examine associations between compliance rates and categorical variables such as gender, department, and knowledge level. A p-value of <0.05 was considered statistically significant.

A total of 120 medical interns were included in the study, with 62 (51.7%) males and 58 (48.3%) females. The overall hand hygiene compliance rate was 52.4%. Compliance varied significantly across different clinical settings and hand hygiene indications.

Table 1 presents the compliance rates observed across the WHO’s “Five Moments for Hand Hygiene.” Compliance was highest before aseptic procedures (67.1%) and lowest after touching patient surroundings (38.2%). Interns demonstrated moderate compliance after body fluid exposure (59.5%), before patient contact (53.8%), and after patient contact (43.6%) (Table 1).

Table 1: Hand Hygiene Compliance Based on WHO Five Moments (n = 120)

Compliance also differed by department and gender. Interns posted in the intensive care unit (ICU) showed higher adherence (61.5%) compared to those in the general medicine ward (46.2%). Female interns exhibited significantly better compliance (58.9%) than their male counterparts (47.3%; p = 0.03). Knowledge scores were positively correlated with compliance rates.

Table 2 summarizes the relationship between gender, departmental posting, and hand hygiene compliance. The highest compliance was observed among interns posted in the ICU (61.5%), followed by surgery (55.8%), pediatrics (50.3%), and general medicine (46.2%) (Table 2).

Table 2: Compliance Rates by Gender and Department

The questionnaire analysis revealed a mean knowledge score of 7.3 ± 1.5 out of 10. Approximately 64% of interns reported lack of access to hand sanitizers at point-of-care as a major barrier. Other reported challenges included high workload (52%), skin irritation (34%), and forgetfulness (29%).

These findings underscore the importance of department-specific interventions and enhanced infrastructure to promote optimal hand hygiene practices among medical interns.

The present study evaluated hand hygiene compliance among medical interns in a tertiary care hospital, revealing an overall adherence rate of 52.4%. This finding aligns with earlier reports from developing countries, which document compliance rates ranging from 40% to 60% among healthcare professionals, especially those at the beginning of their clinical training (1,2).

Among the WHO’s “Five Moments for Hand Hygiene,” the highest compliance was observed before aseptic procedures (67.1%), while the lowest was after contact with patient surroundings (38.2%). Similar patterns have been observed in studies from Sri Lanka and Nigeria, suggesting that healthcare workers are more conscious of procedures involving direct patient care than indirect contamination risks (3,4). Such selective compliance highlights the need to reinforce the importance of all five indications equally to minimize hospital-acquired infections (HAIs) (5).

Notably, compliance was significantly higher among female interns compared to males, a trend consistent with global literature (6,7). This gender-based difference may reflect varying risk perceptions or attention to detail, as also suggested in a multicentric European study (8). Additionally, interns posted in intensive care units demonstrated better adherence, likely due to stricter monitoring protocols and higher awareness in critical care settings (9). These findings support the role of clinical environment and supervision in shaping hygiene behavior (10).

Knowledge assessment revealed moderate understanding of hand hygiene principles, with a mean score of 7.3 out of 10. However, knowledge alone did not guarantee high compliance, suggesting that behavior is also influenced by institutional culture, peer practices, and workload pressure (11). Previous studies have emphasized the need for continuous reinforcement through practical sessions, audits, and positive role modeling by senior healthcare staff (12,13).

Reported barriers such as unavailability of hand rubs, high patient load, and skin irritation were consistent with challenges identified in similar Indian and Southeast Asian contexts (14,15). Addressing these systemic barriers through improved infrastructure, ensuring continuous supply of hand hygiene products, and skin-friendly formulations could facilitate better compliance.

The study underscores the importance of targeted educational interventions and regular performance feedback. Simulation-based training, visual reminders, and electronic monitoring systems have shown promise in other studies and may be considered for future implementation in resource-limited settings (9,13).

Limitations of this study include its single-center design and the use of convenience sampling, which may limit generalizability. Observer bias, despite covert assessment, cannot be entirely ruled out. Nonetheless, the findings provide valuable insights into intern-level practices and identify key areas for intervention.

Hand hygiene compliance among medical interns in the tertiary care setting was found to be suboptimal, with notable variation across clinical departments and hand hygiene moments. Key influencing factors included gender, departmental posting, and availability of hand hygiene resources. Targeted training, infrastructure improvements, and behavior-focused interventions are essential to enhance compliance and reduce healthcare-associated infection risks.

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