Background Hand hygiene remains a cornerstone of infection prevention in surgical practice, particularly in orthopedic operating theatres where inadequate aseptic technique can increase the risk of surgical site infections and implant-related complications. Despite well-established recommendations from the World Health Organization (WHO) regarding proper surgical hand-scrubbing techniques, compliance in many healthcare settings remains inconsistent. Clinical audits provide a structured approach to evaluating adherence to such guidelines and implementing targeted improvements. This study aimed to assess baseline hand-scrubbing practices in an orthopedic operating theatre at a regional hospital in northern Pakistan and evaluate the impact of educational interventions on compliance with WHO standards.

Methods A prospective closed-loop clinical audit was conducted in the orthopedic operating theatre of Regional Headquarter Hospital Skardu, Pakistan, from December 1, 2025, to February 1, 2026. Approximately 40 healthcare personnel, including consultants, residents, nurses, and operating theatre assistants, participated in the audit. Baseline hand-scrubbing practices were observed during routine surgical sessions using a structured checklist based on WHO hand hygiene guidelines. Following the baseline assessment, educational interventions were introduced, including live demonstrations of correct hand-scrubbing techniques and placement of visual reminder posters in the scrub area. Post-intervention compliance was re-evaluated using the same checklist. Compliance rates before and after the intervention were compared using appropriate statistical analysis, with significance set at p < 0.05.

Results Baseline observations revealed suboptimal compliance with recommended hand-scrubbing standards, particularly with regard to scrubbing duration, coverage of all hand surfaces, and proper drying technique. Following the educational intervention, significant improvements were observed across all evaluated components. Compliance with scrubbing duration of at least two minutes increased from 45% to 90%, coverage of all hand surfaces improved from 50% to 88%, proper antiseptic usage increased from 60% to 93%, and correct drying technique improved from 55% to 87%. Adherence to overall aseptic protocol also increased from 70% to 95%. All observed improvements were statistically significant (p < 0.001).

Conclusions This prospective clinical audit demonstrates that structured educational interventions, including live demonstrations and visual reminders, can significantly improve compliance with recommended hand-scrubbing practices in orthopedic operating theatres. Regular audits combined with targeted educational strategies represent practical and cost-effective measures for improving infection control practices and enhancing patient safety in surgical settings.

The authors have declared no competing interest.

This study did not receive any funding

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Ethical oversight for this study was provided by the Ethical Review Committee of Regional Headquarter Hospital Skardu, Gilgit-Baltistan, Pakistan. The committee reviewed the study protocol and determined that the project constituted a clinical audit of operating theatre practices using anonymized observational data. Therefore, formal ethical approval was waived.

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All data produced in the present study are available upon reasonable request to the authors