{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T05:53:40Z","timestamp":1776664420897,"version":"3.51.2"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T00:00:00Z","timestamp":1776643200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"\n Introduction<\/jats:title>\n This study aimed to evaluate hand hygiene compliance among healthcare workers of different roles, identify key barriers using the Consolidated Framework for Implementation Research (CFIR), and assess the effectiveness of a CFIR-guided stratified intervention in a tertiary hospital.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n An exploratory sequential mixed-methods study was conducted at Beijing Hospital, National Center of Gerontology, from December 2024 to September 2025. The observational phase included 9,767 non-announced direct observation hand hygiene observations and a survey of 275 staff (71 physicians, 173 nurses, 31 support staff), supplemented by 15 semi-structured interviews. A six-month CFIR-guided intervention was then implemented, incorporating role-specific training sessions, data-driven feedback, visual reminders, and position-based supervision tailored to physicians, nurses, and support staff. Outcomes included hand hygiene compliance and correctness, knowledge scores, and hospital-acquired infection (HAI) rates.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n At baseline, compliance differed by role: nurses 81.6%, physicians 72.6%, and support staff 39.3% (\n p<\/jats:italic>\n &lt; 0.001). Knowledge scores were significantly lower among support staff (58.6 \u00b1 9.4) than physicians and nurses (66.1 \u00b1 6.9,\n p<\/jats:italic>\n &lt; 0.001). Qualitative interviews and CFIR-based surveys identified barriers including workflow constraints, insufficient supervision, inadequate training coverage, and knowledge gaps. Following the intervention, overall compliance increased from 74.9 to 85.4% (\n p<\/jats:italic>\n &lt; 0.001), with the largest improvement among support staff (39.3% vs. 56.0%,\n p<\/jats:italic>\n = 0.002). Compliance improved across all \u201cfive moments,\u201d particularly before patient contact (+18.5%, p &lt; 0.001). HAI rates were lower from 3.05 per 1,000 patient-days to 1.66 per 1,000 patient-days (\n p<\/jats:italic>\n = 0.002), with reductions observed in respiratory, urinary tract, bloodstream, and surgical site infections during the study period.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Hand hygiene compliance varies substantially across healthcare worker roles, with support staff representing a critical gap. A CFIR-guided, stratified intervention was associated with increases in compliance and correctness, particularly at high-risk moments, and reduced HAI incidence, suggesting its potential value as a sustainable framework for hospital-wide infection prevention.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1750206","type":"journal-article","created":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T05:24:33Z","timestamp":1776662673000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Hand hygiene compliance among healthcare workers before and after a CFIR-guided role-stratified intervention: a mixed-methods study in a tertiary hospital"],"prefix":"10.3389","volume":"14","author":[{"given":"Na","family":"Li","sequence":"first","affiliation":[{"name":"Department of Hospital Infection Control, Beijing Hospital, National Center for Gerontology, National Clinical Research Center for Gerontology, The Key Laboratory of Geriatrics of NHC, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xin","family":"Guan","sequence":"additional","affiliation":[{"name":"Department of Hospital Infection Control, Beijing Hospital, National Center for Gerontology, National Clinical Research Center for Gerontology, The Key Laboratory of Geriatrics of NHC, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rui","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Hospital Infection Control, Beijing Hospital, National Center for Gerontology, National Clinical Research Center for Gerontology, The Key Laboratory of Geriatrics of NHC, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juyuan","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Hospital Infection Control, Beijing Hospital, National Center for Gerontology, National Clinical Research Center for Gerontology, The Key Laboratory of Geriatrics of NHC, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaolin","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Hospital Infection Control, Beijing Hospital, National Center for Gerontology, National Clinical Research Center for Gerontology, The Key Laboratory of Geriatrics of NHC, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,20]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"422","DOI":"10.1089\/sur.2016.048","article-title":"Prevention of hospital-acquired infections","volume":"17","author":"Dellinger","year":"2016","journal-title":"Surg Infect."},{"key":"B2","doi-asserted-by":"publisher","first-page":"e1002150","DOI":"10.1371\/journal.pmed.1002150","article-title":"Burden of six healthcare-associated infections on European population health: estimating incidence-based disability-adjusted life years through a population prevalence-based modelling study","volume":"13","author":"Cassini","year":"2016","journal-title":"PLoS Med."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1199","DOI":"10.1016\/S1473-3099(25)00217-8","article-title":"Incidence of health-care-associated infections in long-term care facilities in nine European countries: a 12-month, prospective, longitudinal cohort study","volume":"25","author":"Ricchizzi","year":"2025","journal-title":"Lancet Infect Dis."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1610","DOI":"10.1001\/jama.2020.3227","article-title":"Air, surface environmental, and personal protective equipment contamination by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from a symptomatic patient","volume":"323","author":"Ong","year":"2020","journal-title":"Jama."},{"key":"B5","doi-asserted-by":"publisher","first-page":"Cd015029","DOI":"10.1002\/14651858.CD015029","article-title":"Measures implemented in the school setting to contain the COVID-19 pandemic","volume":"1","author":"Krishnaratne","year":"2022","journal-title":"Cochrane Database Syst Rev."},{"key":"B6","unstructured":"Beijing\n National Health Commission of the People's Republic of China\n National Health Commission of the People's Republic of China. 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