Implementation uptake and healthcare worker adherence following a WHO-aligned multimodal infection prevention and control intervention in Bangladeshi tertiary hospitals: a multicenter comparative study

Background Infection prevention and control (IPC) programs remain inconsistently implemented in Bangladeshi hospitals. However, implementation uptake is rarely evaluated alongside observation of healthcare worker (HCW) practices, limiting understanding of how multimodal IPC interventions translate into routine clinical practice. This study assessed ward-level uptake and healthcare worker adherence following a WHO-aligned multimodal IPC intervention in Bangladesh. Methods A post-intervention comparative study was conducted across six tertiary hospitals. Intervention wards received a multimodal IPC package, whereas non-intervention wards continued routine practices. Implementation uptake was assessed through ward audits, supply checks, and administrative records. HCW adherence (n=1,426) was measured by questionnaire and verified through direct observation of key IPC practices. Results IPC adherence scores were significantly higher in intervention wards (70.8% vs 59.4%; mean difference 11.4 percentage points, 95% CI 9.3–13.5; p<0.001). Intervention wards showed markedly greater uptake of alcohol-based hand rub availability (90.9% vs 29.4%), supervision (90.9% vs 64.7%), and administrative engagement (95.5% vs 11.8%). Observed hand hygiene compliance was higher in intervention wards than non-intervention wards (35.8% vs 16.4%), though substantially lower than self-reported rates in both groups. Working in an intervention ward was independently associated with an 11.85-point increase in IPC adherence (95% CI 9.71–13.99; p<0.001). Conclusions A WHO-aligned multimodal IPC intervention was associated with higher implementation uptake, healthcare worker adherence, and observed IPC practices. Persistent discrepancies between reported and observed hand hygiene behavior highlight the need for objective monitoring in IPC evaluation. These findings support bundled IPC implementation as a feasible strategy for resource-constrained healthcare settings.