Application of the gold standard direct observation tool to estimate hand hygiene compliance among healthcare providers in Dessie referral hospital, Northeast Ethiopia

Observational assessment of hand hygiene compliance among healthcare workers in public hospitals of Northeastern Ethiopia

This study examined the magnitude and predictors of hand hygiene compliance among 325 healthcare workers in three public hospitals of Northeastern Ethiopia using standardized observational tool. A multivariable logistic regression analysis was computed to identify factors associated with non-compliance. The overall proportion of observed hand hygiene non-compliance was 41.8% (95%CI: 36.6-48.1). Having <5 years of work experience (AOR = 1.5; 95%CI: 1.2-2.5), absence of hand washing soap (AOR = 3.1; 95%CI: 2.3-5.4), work overload (AOR = 2.5; 95%CI: 1.9-4.1), pipe water supply interruption (AOR = 2.8; 95%CI: 2.1-4.9), lack of hand hygiene training (AOR = 3.1; 95%CI: 2.2-4.4), and absence of infection prevention committee (AOR = 2.1; 95%CI: 1.5-4.9) were determinant factors for hand hygiene non-compliance. Therefore, regional health bureau and hospitals' managers should work towards the provision of regular hand hygiene trainings, uninterrupted piped water supply, hand washing soap, and establishment of functional infection prevention committee. Moreover, healthcare workers should be also committed to comply with hand hygiene.

Infection prevention and control compliance of healthcare workers towards COVID-19 in conflict-affected public hospitals of Ethiopia

OBJECTIVE

Non-compliance with COVID-19 infection prevention and control (IPC) is one of the global public health problems particularly among those frontline healthcare workers. However, there are no detailed investigations on COVID-19 IPC compliance among healthcare workers in conflict-affected settings. The objective of this research was to assess compliance with COVID-19 IPC measures and determine the factors associated with it among healthcare providers in Ethiopian governmental hospitals affected by conflict.

DESIGN

A cross-sectional study was carried out within institutional settings.

STUDY SETTING AND PERIOD

The study was conducted in three public hospitals located in northeastern Ethiopia during the period of March to April 2022.

PARTICIPANTS

Simple random sampling technique was used to select 325 healthcare workers after proportional allocation was made to each public hospital.

PRIMARY OUTCOME MEASURES

The primary outcome was non-compliance with COVID-19 IPC. A multivariable logistic regression analysis was employed to identify factors associated with the lack of adherence to the COVID-19 IPC protocol.

RESULTS

Nearly half (150, 46.2%) of the healthcare workers had non-compliance with COVID-19 IPC protocol. Absence of hand washing soap (adjusted OR (AOR)=2.99; 95% CI 2.46 to 5.76), workload (AOR=2.25; 95% CI 1.33 to 3.84), disruption in the supply of piped water (AOR=1.82; 95% CI 1.11 to 2.99), did not undergo training in COVID-19 IPC (AOR=2.85; 95% CI 1.85 to 4.84), absence of COVID-19 IPC guidelines (AOR=2.14; 95% CI 1.11 to 4.13) and chewing khat (AOR=2.3; 95% CI 1.32 to 3.72) were determinant factors for non-compliance.

CONCLUSIONS

The magnitude of non-compliance with COVID-19 IPC was high. Hospital managers and federal ministry of health should provide regular training on COVID-19 IPC, continuous piped water and personal protective facilities for healthcare workers. Ultimately, improving the security situation in the area would help improve COVID-19 IPC compliance among healthcare workers in these and other similar conflict-affected settings.

Have Hand Hygiene Practices in Two Tertiary Care Hospitals, Freetown, Sierra Leone, Improved in 2023 following Operational Research in 2021?

In 2021, an operational research study in two tertiary hospitals in Freetown showed poor hand hygiene compliance. Recommended actions were taken to improve the situation. Between February-April 2023, a cross-sectional study was conducted in the same two hospitals using the World Health Organization hand hygiene tool to assess and compare hand hygiene compliance with that observed between June-August 2021. In Connaught hospital, overall hand hygiene compliance improved from 51% to 60% (p < 0.001), and this applied to both handwash actions with soap and water and alcohol-based hand rub. Significant improvements were found in all hospital departments and amongst all healthcare worker cadres. In 34 Military Hospital (34MH), overall hand hygiene compliance decreased from 40% to 32% (p < 0.001), with significant decreases observed in all departments and amongst nurses and nursing students. The improvements in Connaught Hospital were probably because of more hand hygiene reminders, better handwash infrastructure and more frequent supervision assessments, compared with 34MH where interventions were less well applied, possibly due to the extensive hospital reconstruction at the time. In conclusion, recommendations from operational research in 2021 contributed towards the improved distribution of hand hygiene reminders, better handwash infrastructure and frequent supervision assessments, which possibly led to improved hand hygiene compliance in one of the two hospitals. These actions need to be strengthened, scaled-up and guided by ongoing operational research to promote good hand hygiene practices elsewhere in the country.

Hand hygiene compliance and associated factor among nurses working in public hospitals of Hararghe zones, Oromia region, eastern Ethiopia

Background

Healthcare workers are in constant contact with a wide variety of materials and surfaces, including waste, body fluids, mucous membranes, food, their own bodies, and the skin of patients. As a result, their hands are colonized by different groups of pathogens. Hand hygiene of healthcare workers is recognized to be the main factor in reducing healthcare-associated infections. Therefore, this study aimed to assess hand hygiene adherence and related factors among nurses working in public hospitals in eastern Ethiopia.

Methods

An institutional based cross-sectional study was conducted in Hospital, Hararghe zone, Eastern Ethiopia from July 1 to 30, 2021. A total of 451 study participants were randomly selected, after the proportional allocation of study participants to each selected hospital. The data was collected using self-administered questionnaire and observation checklist. SPSS version 26 was used to analyze the data. Bivariable and multivariable analysis were employed to assess the association between outcome and independent variables. Finally, a p-value of < 0.05 was used as a cutoff point for statistical significance.

Results

Out of 436 eligible nurses, the overall hand hygiene compliance was 37.4% [95% CI (0.33, 0.42)]. The overall compliance among those working in medical, surgical, OR ward, OPD, Gynecology/obstetrics, emergency ward, Intensive care units, Pediatrics, and other wards/departments was 46.8, 44.8, 35.7, 28.2, 20.7, 45.1, 23.1, 40.5, and 29.4%, respectively. The mean knowledge score was 21.6% (SD: 2.08). Furthermore, there was a statistically significant association between hand hygiene compliance and gender, work experience, training in hand hygiene, availability of running water, and knowledge of hand hygiene.

Conclusion

The current study found overall compliance with hand hygiene accounted for 34.7%. Therefore, an exemplary worker may initiate others to do so, and strong managerial and leadership commitment may also help the workers stick to the rules and regulations to follow the multimodal hand hygiene practice as per WHO recommendation.

Level of Hand Hygiene Compliance and Its Associated Factors Among Health Care Workers at Eka Kotebe General Hospital, Addis Ababa, Ethiopia

BACKGROUND

Poor hand hygiene is an important source of infection, but maintaining hand hygiene is the most important measure to prevent infections. Hand hygiene compliance and its associated factors are not well recognized in Ethiopia. Therefore, this study was intended to determine hand hygiene compliance and its associated factors among health care workers in Eka Kotebe General Hospital.

METHODS

A cross-sectional study was conducted among health care workers at Eka Kotebe General Hospital. A self-administered questionnaire supplemented by a World Health Organization Hand Hygiene Technical Reference Manual was used to collect data. Data was entered using Epi Info 7.2.0.1 and exported to SPSS 23 for analysis. The data were analyzed using descriptive and inferential statistics. Statistical significance was determined using a P-value of ⩽.05 with a 95% confidence interval.

RESULTS

Hand hygiene compliance among healthcare workers was 22.2%. Hand hygiene training (AOR = 2.9, 95% CI: 1.13-7.52), presence of hand hygiene indication poster (AOR = 3.38, 95% CI: 1.18-9.66), hand hygiene promotion by IPC team (AOR = 4.2, 95% CI: 2.53-8.58)), working experience ⩾5 years of a health care providers (AOR = 3.96, 95% CI: 1.12-13.9), being midwife (AOR = 17.1, 95% CI: 2.8-10), being nurse (AOR = 5.3, 95% CI: 2.09-7.8) by profession, and presence of water (AOR = 2.50, 95% CI: 2.20-11.78) were significantly associated factors to hand hygiene compliance.

CONCLUSION

The level of hand hygiene compliance among health care providers was found to be low. Training about hand hygiene, the presence of hand hygiene indication posters, hand hygiene promotion by the IPC team, working experience of health care providers, being a nurse and midwife, and the presence of water were independent predictors of hand hygiene compliance. Health care workers need to be given training on hand hygiene as well as hand hygiene facilities shall be installed and supplied by the hospital in a sustained manner.

Hand Hygiene Compliance at Two Tertiary Hospitals in Freetown, Sierra Leone, in 2021: A Cross-Sectional Study

Hand hygiene actions are essential to reduce healthcare-associated infections and the development of antimicrobial resistance. In this cross-sectional study at two tertiary hospitals, Freetown, Sierra Leone, we observed hand hygiene compliance (defined as using handwash with soap and water or alcohol-based hand rub (ABHR) amongst healthcare workers between June and August 2021. Using the WHO Hand Hygiene tool, observations were made in relation to the type of opportunity, different wards and types of healthcare worker. Overall, 10,461 opportunities for hand hygiene were observed, of which 5086 (49%) resulted in hand hygiene actions. ABHR was used more often than handwash (26% versus 23%, p < 0.001). Overall, compliance was significantly better: after being with a patient/doing a procedure than before (78% after body fluid exposure risk compared with 24% before touching a patient—p < 0.001); in Paediatric (61%) compared with Medical wards (46%)—p < 0.001; and amongst nurses (52%) compared with doctors (44%)—p < 0.001. Similar patterns of compliance were observed within each hospital. In summary, hand hygiene compliance was sub-optimal, especially before being with a patient or before clean/aseptic procedures. Improvement is needed through locally adapted training, hand hygiene reminders in wards and outpatient departments, uninterrupted provision of ABHR and innovative ways to change behaviour.