Availability and utilization of hand hygiene facilities at latrines and points of care and their role in infection prevention and healthcare delivery in health facilities in upper Nile State, South Sudan

Resumo

The study assessed the availability and utilization of hand hygiene facilities at latrines and points of care, and their contribution to infection prevention and healthcare service delivery in healthcare facilities in Upper Nile State, South Sudan. The general objective was to evaluate the status of hygiene infrastructure and practices and determine how they influence infection prevention and quality of care in a conflict-affected health system. A mixed-methods, cross-sectional design was employed, combining quantitative facility observations with qualitative key informant interviews. Twenty government health facilities, including 16 Primary Health Care Centres (PHCCs) and 4 hospitals, were assessed. Data were collected using structured observation checklists, questionnaires, and in-depth interviews with health workers, inpatients, and lactating mothers. Quantitative data were analyzed using descriptive statistics, independent samples t-test, and multiple regression analysis, while qualitative data were thematically analyzed and integrated to enrich interpretation. Findings revealed major gaps in hygiene infrastructure and practices. Only 50% of facilities had functional hand hygiene stations at points of care, while 55% lacked handwashing facilities at toilets. Half of the facilities had no hygiene supplies, and only 15% had both soap and alcohol-based hand rub. Training levels were low, with 50% of clinical staff and 65% of non-clinical staff untrained. Hospitals performed better than PHCCs, with a statistically significant difference in hygiene service levels (p = 0.031). Regression results showed that hygiene supplies, staff training, and hygiene promotion explained 57.2% of variation in hygiene service levels. Qualitative findings confirmed poor hygiene conditions affecting patient safety, dignity, and trust in healthcare services. The study concludes that inadequate WASH infrastructure and weak human capacity significantly compromise infection prevention and healthcare delivery in Upper Nile State. It recommends strengthening national WASH policies, improving facility-level maintenance and supply chains, and expanding continuous training for healthcare workers, supported by development partners to improve hygiene standards and patient safety in conflict-affected settings.