Ayele BlenMullu Adissu2025-08-252025-08-252025-04-15https://etd.aau.edu.et/handle/123456789/7141Background: Hand hygiene (HH) is recognized as the single most effective strategy for preventing health care–associated infections. In developing countries, data on hand hygiene compliance is available only for few health-care facilities. This study aimed to assess hand hygiene adherence of health-care workers working at ICU of TASH, Addis Ababa, Ethiopia. Methods: This study employed the WHO hand hygiene observation method. Direct observation of the health care workers (HCWs) was conducted using an observation record form in five Intensive care units. Trained observers watched HCWs while they had direct contact with patients or their surroundings, and the observers then recorded all possible hand hygiene opportunities and hand hygiene actions with sample of at least 200 opportunities per ICU. HH compliance was percentage of the number of times hand hygiene action to the total number of opportunities for hand hygiene. Results: A total of 1016 hand hygiene opportunities with 227 HH actions were observed during the study. Overall HH compliance was 22.3% . Doctors had better HH compliance than Nurses and adhere more at morning. Levels of compliance were lower before patient contact (3.9%), before an aseptic procedure (6.3%) and after contact with patient surroundings (16.8%), whereas better levels of compliance were found after body fluid exposure (51.4%) and after patient contact (32.7%). Conclusion: HH compliance of HCWs was found to be low in ICU of TASH . Compliance with indications that protect patients from infection was lower than that protect the HCWs. The findings of this study indicate that HH compliance needs further improvement. Keywords: Hand hygiene compliance, Direct observation method, Health-care worker, ICU, TASH, WHOen-USHand hygiene compliance Direct observation method Health-care worker ICU TASH WHOThesis