Hostname: page-component-745bb68f8f-lrblm Total loading time: 0 Render date: 2025-02-02T04:36:24.854Z Has data issue: false hasContentIssue false
  • English
  • Français

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]).
Get access Rights & Permissions [Opens in a new window]

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 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. Burke, JP. Infection control: a problem for patient safety. N Engl J Med 2003;348:651–656.Google Scholar
2. Bates, DW, Larizgoitia, I, Prasopa-Plaizier, N, Jha, AK. Global priorities for patient safety research. BMJ 2009;338:b1775.Google Scholar
3. Pittet, D, Donaldson, L. Clean care is safer care: a worldwide priority. Lancet 2005;366:1246–1247.Google Scholar
4. Vincent, JL. Nosocomial infections in adult intensive-care units. Lancet 2003;361:2068–2077.Google Scholar
5. Suetens, C, Hopkins, S, Kolman, J, Högberg, LD. ECDC surveillance report: point prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals, 2011–2012. Stockholm: European Centre for Disease Prevention and Control, 2013.Google Scholar
6. Klevens, RM, Edwards, JR, Richards, CL Jr, et al. Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public Health Rep 2007;122:160–166.CrossRefGoogle ScholarPubMed
7. Allegranzi, B, Bagheri Nejad, S, Combescure, C, et al. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet 2011;377:228–241.Google Scholar
8. Nejad, SB, Allegranzi, B, Syed, SB, Ellis, B, Pittet, D. Health-care-associated infection in Africa: a systematic review. Bull World Health Organ 2011;89:757–765.Google Scholar
9. Conly, JM, Hill, S, Ross, J, Lertzman, J, Louie, TJ. Handwashing practices in an intensive care unit: the effects of an educational program and its relationship to infection rates. Am J Infect Control 1989;17:330–339.Google Scholar
10. Pittet, D, Hugonnet, S, Harbarth, S, et al. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Infection Control Programme. Lancet 2000;356:1307–1312.Google Scholar
11. Zerr, DM, Allpress, AL, Heath, J, Bornemann, R, Bennett, E. Decreasing hospital-associated rotavirus infection: a multidisciplinary hand hygiene campaign in a children’s hospital. Pediatr Infect Dis J 2005;24:397–403.Google Scholar
12. Stone, SP, Fuller, C, Savage, J, et al. Evaluation of the national Clean Your Hands campaign to reduce Staphylococcus aureus bacteraemia and Clostridium difficile infection in hospitals in England and Wales by improved hand hygiene: four year, prospective, ecological, interrupted time series study. BMJ 2012;344:e3005.CrossRefGoogle Scholar
13. Hand hygiene technical reference manual. World Health Organization website. http://apps.who.int/iris/bitstream/10665/44196/1/9789241598606_eng.pdf. Published 2009. Accessed May 28, 2015.Google Scholar
14. WHO Guidelines on Hand Hygiene in Health Care Starter Tool Kit. World Health Organization website. http://www.who.int/gpsc/5may/tools/en/index.html. Published 2009. Accessed May 28, 2015.Google Scholar
15. Rothe, C, Schlaich, C, Thompson, S. Healthcare-associated infections in sub-Saharan Africa. J Hosp Infect 2013 Dec;85:257–267.Google Scholar
16. Alfred, E. Yawson, Afua, A. J. Hesse. Hand hygiene practices and resources in a teaching hospital in Ghana. J Infect Dev Ctries 2013;7:338–347.Google Scholar
17. Allegranzi, B, Sax, H, Bengaly, L, et al. Successful implementation of the World Health Organization hand hygiene improvement strategy in a referral hospital in Mali, Africa. Infect Control Hosp Epidemiol 2010;31:133–141.Google Scholar
18. Asare, A, Enweronu-Laryea, CC, Newman, MJ. Hand hygiene practices in a neonatal intensive care unit in Ghana. J Infect Dev Countries 2009;3:352–356.Google Scholar
19. Samuel, R, Almedom, AM, Hagos, G, Albin, S, Mutungi, A. Promotion of handwashing as a measure of quality of care and prevention of hospital-acquired infections in Eritrea: the Keren study. Afr Health Sci 2005;5:4–13.Google Scholar
20. Jelly, S, Tjale, A. Hand decontamination practices in pediatric wards. Curationis 2003;26:72–76.CrossRefGoogle Scholar
21. Uneke, CJ, Ndukwe, CD, Oyibo, PG, Nwakpu, KO, Nnabu, RC, Prasopa-Plaizier, N. Promotion of hand hygiene strengthening initiative in a Nigerian teaching hospital: implication for improved patient safety in low-income health facilities. Braz J Infect Dis 2014;18:21–27.Google Scholar
22. Binagwaho, A, Farmer, PE, Nsanzimana, S, et al. Rwanda 20 years on: investing in life. Lancet 2014;384:371–375.Google Scholar
23. Eckmanns, T, Bessert, J, Behnke, M, Gastmeier, P, Ruden, H. Compliance with antiseptic hand rub use in intensive care units: the Hawthorne effect. Infect Control Hosp Epidemiol 2006;27:931–934.CrossRefGoogle ScholarPubMed
24. Bukhari, SZ, Hussain, WM, Banjar, A, Almaimani, WH, Karima, TM, Fatani, MI. Hand hygiene compliance rate among healthcare professionals. Saudi Med J 2011;32:515–519.Google ScholarPubMed
25. Randle, J, Arthur, A, Vaughan, N. Twenty-four-hour observational study of hospital hand hygiene compliance. J Hosp Infect 2010;76:252–255.CrossRefGoogle ScholarPubMed
26. Allegranzi, B, Gayet-Ageron, A, Damani, N, et al. Global implementation of WHO’s multimodal strategy for improvement of hand hygiene: a quasi-experimental study. Lancet Infect Dis 2013;13:843–851.Google Scholar