Microbial Contamination of Handwashing Water and Tap Surfaces in Addis Ababa Hospitals: A Threat to Infection Prevention

Introduction: Hand hygiene is a cornerstone of infection prevention; however, the water and infrastructure used for handwashing can themselves become sources of microbial contamination. This study assessed the water quality and sanitary conditions of hand hygiene facilities in public and private hospitals in Addis Ababa, Ethiopia. Methods: A laboratory-based cross-sectional study was conducted from May to June 2025 in 10 hospitals. Forty samples were collected, including 20 tap water samples and 20 swab samples from tap handles. A sanitary survey evaluated water supply and hand hygiene stations, with onsite physicochemical measurements, and targeted microbial analyses performed. Data were recorded in an Excel spreadsheet and analyzed using SPSS, employing descriptive statistics and Chi-square tests, with significance defined at P  < .05. Results: The sanitary survey showed that 62.5% of hospitals had continuous running water, with 75% of water systems free from leaks. Handwashing stations were accessible in 55% of facilities, primarily hand-operated (67.5%), followed by elbow-operated (25%) and foot-operated (7.5%). Maintenance deficiencies were noted in 37.5% of stations, with soap available at only 55%. Hand drying materials were present in 12.5% of hospitals, and only 45% of facilities reported regular cleaning of handwashing stations. Physicochemical water quality parameters were generally within acceptable limits. Microbiological analysis revealed high contamination: Escherichia coli was detected in 66.7% of all samples, found on 100% of tap handles compared to 31.6% of water samples ( P  < .001). Other pathogens included Staphylococcus aureus (55%), Klebsiella (52.5%), Shigella (50%), and Salmonella (50%), all significantly prevalent on swabs than water samples ( P  < .001), with no significant difference by hospital ownership. Conclusion: The study found significant microbial contamination in handwashing infrastructure. To reduce risks, facilities should install non-hand-operated stations, enhance routine cleaning and disinfection, and ensure proper maintenance. Regular water quality monitoring and infection control training are essential.