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Improving Hand Hygiene Practices in a Rural Hospital in Sub-Saharan Africa

Published online by Cambridge University Press:  04 April 2016

Ian C. Holmen ,
Celestin Seneza ,
Berthine Nyiranzayisaba ,
Vincent Nyiringabo ,
Mugisha Bienfait  and
Nasia Safdar
Ian C. Holmen*
Affiliation:
Health-PACT, Palo Alto, California
Celestin Seneza
Affiliation:
Gitwe Hospital, Ruhango District, Rwanda
Berthine Nyiranzayisaba
Affiliation:
Gitwe Hospital, Ruhango District, Rwanda
Vincent Nyiringabo
Affiliation:
Gitwe Hospital, Ruhango District, Rwanda
Mugisha Bienfait
Affiliation:
Gitwe Hospital, Ruhango District, Rwanda
Nasia Safdar
Affiliation:
Department of Medicine, University of Wisconsin SMPH Williams S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
*
Address correspondence to Ian Holmen, 510 E Mifflin St, Apt 201, Madison, WI 53703 ([email protected]).
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Abstract

OBJECTIVE

To improve hand hygiene (HH) compliance among physicians and nurses in a rural hospital in sub-Saharan Africa (SSA) using the World Health Organization’s (WHO’s) Guidelines on Hand Hygiene in Health Care.

DESIGN

This study was a quasi-experimental design divided into 4 phases: (1) preparation of materials and acquisition of the hospital administration’s support, (2) baseline evaluation, (3) intervention, and (4) follow-up evaluation.

SETTING

A 160-bed, non-referral hospital in Gitwe, Rwanda

PARTICIPANTS

A total of 12 physicians and 54 nurses participated in this study.

METHODS

The intervention consisted of introducing locally produced alcohol-based hand rub (ABHR); educating healthcare workers (HCWs) on proper HH practice; providing pocket-sized ABHR bottles for HCWs; placing HH reminders in the workplace; and surveying HCWs at surrounding health centers regarding HH compliance barriers. Hand hygiene infrastructure, compliance, and knowledge were assessed among physicians and nurses using baseline observations and a follow-up evaluation survey.

RESULTS

Overall, HH compliance improved from 34.1% at baseline to 68.9% post intervention (P<.001), and HH knowledge was significantly enhanced (P<.001). The 3 departments included in this study had only 1 sink for 29 patient rooms, and 100% of HH opportunities used ABHR. Hand hygiene compliance was significantly higher among physicians than nurses both before and after the intervention. All measures of HH compliance improved except for “after body fluid exposure,” which was 51.7% before intervention and 52.8% after intervention (P>.05).

CONCLUSION

Hand hygiene campaigns using WHO methods in SSA have been implemented exclusively in large, referral hospitals. This study shows that an HH program using the WHO tools successfully improved HH in a low-income, rural hospital in SSA.

Infect Control Hosp Epidemiol 2016;37:834–839

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 7 , July 2016 , pp. 834 - 839
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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