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Nalugya A, Ssempebwa JC, Muleme J, Wafula ST, Tamale BN, Tigaiza A, Nakalembe D, Kansiime WK, Isunju JB, Ssekamatte T, Mugambe RK. Exposure behaviour to Escherichia coli among households in Imvepi refugee settlement, Terego district Uganda. BMC Public Health 2024; 24:2041. [PMID: 39080627 PMCID: PMC11290189 DOI: 10.1186/s12889-024-19525-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 07/18/2024] [Indexed: 08/02/2024] Open
Abstract
INTRODUCTION Exposure to Escherichia coli (E. coli) is a risk factor for diarrhoeal diseases, which pose a significant problem in refugee settlements. Refugee populations are exposed to faecal microorganisms through multiple pathways including sub-optimal sanitary facilities, contaminated drinking water, produce and food, flood water, bathing water, and soil among others. While these pathways are well-documented, specific exposure behaviours remain underexplored. We assessed exposure behaviour to E. coli among households in Imvepi refugee settlement, Uganda, and provided evidence-based recommendations for the design of interventions to reduce excreta-related disease in refugee settlements. METHODS Guided by the Sanitation Safety Planning approach, we surveyed 426 households in Imvepi refugee settlement, Uganda, using a digitized questionnaire and an observation checklist. We collected data on the background characteristics and exposure behaviour of women and emancipated girls (minors living on their own, having borne a child, married, or pregnant). The outcome variable, E. coli exposure behaviour, was measured using a five-point Likert scale, assessing behaviours that increase the risk of exposure. Data were cleaned in Microsoft Excel and analyzed in Stata version 17. Descriptive statistics were performed to summarize the data. We used modified Poisson regression to determine the factors associated with the outcome. RESULTS Over 59.4% (253) exhibited high-risk exposure behaviour. Residing in compound homes (Adjusted Prevalence Ratio (APR) = 0.72, 95% Confidence interval (CI): 0.58-0.90), being aged 35-49 years (APR = 0.76, 95% CI: 0.60-0.97), having household heads with post-primary education (APR = 0.54, 95% CI: 0.38-0.77), high knowledge (APR = 0.69, 95% CI: 0.59-0.80), and high-risk perceptions regarding exposure to E. coli (APR = 0.75, 95% CI: 0.64-0.88) were associated with a lower prevalence of high-risk E. coli exposure behaviours. Conversely, having sanitary facilities with excreta overflowing from the squat hole (APR = 1.26, 95% CI: 1.08-1.48) was associated with a higher prevalence of high-risk exposure behaviours. CONCLUSION The study indicates a substantial prevalence of high-risk E. coli exposure behaviours in the refugee settlement.. There's a need to implement behaviour change interventions targeted at preventing or minimizing exposure, especially among households whose heads have low education attainment, those with young caretakers and those with limited knowledge and low-risk perceptions regarding exposure to E. coli.
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Affiliation(s)
- Aisha Nalugya
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University, P.O Box 7072, Kampala, Uganda.
- SWEEM Health Consult Limited, Kampala, Uganda.
| | - John C Ssempebwa
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University, P.O Box 7072, Kampala, Uganda
| | - James Muleme
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Solomon T Wafula
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University, P.O Box 7072, Kampala, Uganda
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Bridget Nagawa Tamale
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University, P.O Box 7072, Kampala, Uganda
- SWEEM Health Consult Limited, Kampala, Uganda
| | - Arnold Tigaiza
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Doreen Nakalembe
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University, P.O Box 7072, Kampala, Uganda
- SWEEM Health Consult Limited, Kampala, Uganda
| | - Winnifred K Kansiime
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University, P.O Box 7072, Kampala, Uganda
| | - John Bosco Isunju
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Tonny Ssekamatte
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University, P.O Box 7072, Kampala, Uganda
- SWEEM Health Consult Limited, Kampala, Uganda
| | - Richard K Mugambe
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University, P.O Box 7072, Kampala, Uganda
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Kamara MN, Lakoh S, Kallon C, Kanu JS, Kamara RZ, Kamara IF, Moiwo MM, Kpagoi SSTK, Adekanmbi O, Manzi M, Fofanah BD, Shewade HD. Hand Hygiene Practices and Promotion in Public Hospitals in Western Sierra Leone: Changes Following Operational Research in 2021. Trop Med Infect Dis 2023; 8:486. [PMID: 37999605 PMCID: PMC10674222 DOI: 10.3390/tropicalmed8110486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/09/2023] [Accepted: 10/24/2023] [Indexed: 11/25/2023] Open
Abstract
Hand hygiene is the most important intervention for preventing healthcare-associated infections and can reduce preventable morbidity and mortality. We described the changes in hand hygiene practices and promotion in 13 public hospitals (six secondary and seven tertiary) in the Western Area of Sierra Leone following the implementation of recommendations from an operational research study. This was a "before and after" observational study involving two routine cross-sectional assessments using the WHO hand hygiene self-assessment framework (HHSAF) tool. The overall mean HHSAF score changed from 273 in May 2021 to 278 in April 2023; it decreased from 278 to 250 for secondary hospitals but increased from 263 to 303 for tertiary hospitals. The overall mean HHSAF score and that of the tertiary hospitals remained at the "intermediate" level, while secondary hospitals declined from "intermediate" to "basic" level. The mean score increased for the "system change" and "institutional safety climate" domains, decreased for "training and education" and "reminders in the workplace" domains, and remained the same for the "evaluation and feedback" domain. Limited resources for hand hygiene promotion, lack of budgetary support, and formalized patient engagement programs are the persistent gaps that should be addressed to improve hand hygiene practices and promotion.
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Affiliation(s)
- Matilda N Kamara
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone
| | - Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown 00232, Sierra Leone
| | - Christiana Kallon
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown 00232, Sierra Leone
| | - Joseph Sam Kanu
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown 00232, Sierra Leone
| | - Rugiatu Z Kamara
- US Center for Disease Control and Prevention, Freetown 00232, Sierra Leone
| | | | - Matilda Mattu Moiwo
- Republic of Sierra Leone Armed Forces, Government of Sierra Leone, Freetown 00232, Sierra Leone
| | - Satta S T K Kpagoi
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown 00232, Sierra Leone
| | - Olukemi Adekanmbi
- Department of Medicine, University of Ibadan, Ibadan 200005, Nigeria
- Department of Medicine, University College Hospital, Ibadan 200005, Nigeria
| | | | | | - Hemant Deepak Shewade
- Division of Health Systems Research, ICMR-National Institute of Epidemiology (ICMR-NIE), Chennai 600077, India
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Moiwo MM, Kamara GN, Kamara D, Kamara IF, Sevalie S, Koroma Z, Kamara KN, Kamara MN, Kamara RZ, Kpagoi SSTK, Konteh SA, Margao S, Fofanah BD, Thomas F, Kanu JS, Tweya HM, Shewade HD, Harries AD. Have Hand Hygiene Practices in Two Tertiary Care Hospitals, Freetown, Sierra Leone, Improved in 2023 following Operational Research in 2021? Trop Med Infect Dis 2023; 8:431. [PMID: 37755893 PMCID: PMC10538178 DOI: 10.3390/tropicalmed8090431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/28/2023] Open
Abstract
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.
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Affiliation(s)
- Matilda Mattu Moiwo
- Ministry of Defence, Republic of Sierra Leone Armed Forces, Joint Medical Unit, Freetown 00232, Sierra Leone; (G.N.K.); (S.S.)
| | - Gladys Nanilla Kamara
- Ministry of Defence, Republic of Sierra Leone Armed Forces, Joint Medical Unit, Freetown 00232, Sierra Leone; (G.N.K.); (S.S.)
- Department of Clinical Research, Sustainable Health Systems, 34 Military Hospital Research Center, Freetown 00232, Sierra Leone
| | - Dauda Kamara
- Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (D.K.); (Z.K.); (K.N.K.); (S.S.T.K.K.); (S.M.); (J.S.K.)
| | | | - Stephen Sevalie
- Ministry of Defence, Republic of Sierra Leone Armed Forces, Joint Medical Unit, Freetown 00232, Sierra Leone; (G.N.K.); (S.S.)
- Department of Clinical Research, Sustainable Health Systems, 34 Military Hospital Research Center, Freetown 00232, Sierra Leone
| | - Zikan Koroma
- Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (D.K.); (Z.K.); (K.N.K.); (S.S.T.K.K.); (S.M.); (J.S.K.)
| | - Kadijatu Nabie Kamara
- Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (D.K.); (Z.K.); (K.N.K.); (S.S.T.K.K.); (S.M.); (J.S.K.)
| | - Matilda N. Kamara
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone; (M.N.K.); (F.T.)
| | - Rugiatu Z. Kamara
- United States Centres for Diseases Control and Prevention, Freetown 00232, Sierra Leone;
| | | | | | - Senesie Margao
- Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (D.K.); (Z.K.); (K.N.K.); (S.S.T.K.K.); (S.M.); (J.S.K.)
| | - Bobson Derrick Fofanah
- World Health Organization Country Office, Freetown 00232, Sierra Leone; (I.F.K.); (B.D.F.)
| | - Fawzi Thomas
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone; (M.N.K.); (F.T.)
- Pharmacy Board of Sierra Leone, National Pharmacovigilance Centre, Freetown 00232, Sierra Leone
| | - Joseph Sam Kanu
- Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (D.K.); (Z.K.); (K.N.K.); (S.S.T.K.K.); (S.M.); (J.S.K.)
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone; (M.N.K.); (F.T.)
| | - Hannock M. Tweya
- International Training and Education Centre for Health, Lilongwe P.O. Box 30369, Malawi;
| | - Hemant Deepak Shewade
- Division of Health Systems Research, ICMR-National Institute of Epidemiology (ICMR-NIE), Chennai 600077, India;
| | - Anthony David Harries
- International Union Against Tuberculosis and Lung Disease (The Union), 2 Rue Lantier, 75001 Paris, France;
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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Livshiz-Riven I, Azulay H, Koyfman L, Gushanski A, Askira S, Abar VI, Gruenbaum BF, Ivanov E, Klein M, Danziger A, Nativ R, Borer A, Ziv-Baran T, Brotfain E. The long-term impact of immediate verbal feedback of hand hygiene compliance after overt observation sessions, as assessed by continuous closed-circuit television monitoring in an intensive care setting. Arch Public Health 2022; 80:141. [PMID: 35585634 PMCID: PMC9115739 DOI: 10.1186/s13690-022-00887-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 04/27/2022] [Indexed: 12/03/2022] Open
Abstract
Background Hand hygiene compliance by health care workers (HCWs) is pivotal in controlling and preventing health care associated infections. The aim of this interventional study is to assess the long-term impact of personal verbal feedback on hand hygiene compliance of HCWs in an intensive care unit (ICU) immediately after overt observation by an infection control nurse. Methods An infection control nurse overtly observed HCWs’ hand hygiene compliance and immediately gave personal verbal feedback with emphasis on aseptic technique. Overt non-interventional sessions were also performed. We measured compliance rates using covert continuous closed-circuit television (CCTV) monitoring. We compared these rates to previously-published hand hygiene compliance data. Results Overall compliance rates in the first (41.5%) and third phases (42%) of the study, before and after the intervention were similar. The two moments that were lowest in the first phase, “before aseptic contact” and “after exposure to body fluids”, showed significant improvement, but two moments showed a significant decline in compliance: “before patient contact” and “after contact with patient surrounding”. The compliance rates during the intervention phase were 64.8% and 63.8% during the sessions with and without immediate verbal personal feedback, respectively. Conclusion The overall hand hygiene compliance rate of HCWs did not show an improvement after immediate verbal personal feedback. Covert CCTV observational sessions yielded much lower hand hygiene compliance rates then overt interventional and non-interventional observations. We suggest that a single intervention of personal feedback immediately after an observational session is an ineffective strategy to change habitual practices.
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Affiliation(s)
- Ilana Livshiz-Riven
- Quality Unit, Soroka Medical Center, Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheva, Israel.,Department of Nursing, Faculty of Health Science, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Hovav Azulay
- Department of Internal Medicine C, Soroka Medical Center, Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Leonid Koyfman
- Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Alex Gushanski
- Infection Control Unit, Soroka Medical Center, Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Seada Askira
- Infection Control Unit, Soroka Medical Center, Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Vered Ischa Abar
- Infection Control Unit, Soroka Medical Center, Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Benjamin F Gruenbaum
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Evgenia Ivanov
- Department of Internal Medicine A, Soroka Medical Center, Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Moti Klein
- Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Asaf Danziger
- Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Ronit Nativ
- Infection Control Unit, Soroka Medical Center, Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Abraham Borer
- Infection Control Unit, Soroka Medical Center, Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Tomer Ziv-Baran
- School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Evgeni Brotfain
- Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheva, Israel.
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Lakoh S, Maruta A, Kallon C, Deen GF, Russell JBW, Fofanah BD, Kamara IF, Kanu JS, Kamara D, Molleh B, Adekanmbi O, Tavernor S, Guth J, Sagili KD, Wilkinson E. How Well Are Hand Hygiene Practices and Promotion Implemented in Sierra Leone? A Cross-Sectional Study in 13 Public Hospitals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073787. [PMID: 35409471 PMCID: PMC8997996 DOI: 10.3390/ijerph19073787] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/11/2022] [Accepted: 03/17/2022] [Indexed: 02/01/2023]
Abstract
Healthcare-associated infections (HAIs) result in millions of avoidable deaths or prolonged lengths of stay in hospitals and cause huge economic loss to health systems and communities. Primarily, HAIs spread through the hands of healthcare workers, so improving hand hygiene can reduce their spread. We evaluated hand hygiene practices and promotion across 13 public health hospitals (six secondary and seven tertiary hospitals) in the Western Area of Sierra Leone in a cross-sectional study using the WHO hand hygiene self-Assessment framework in May 2021. The mean score for all hospitals was 273 ± 46, indicating an intermediate level of hand hygiene. Nine hospitals achieved an intermediate level and four a basic level. More secondary hospitals 5 (83%) were at the intermediate level, compared to tertiary hospitals 4 (57%). Tertiary hospitals were poorly rated in the reminders in workplace and institutional safety climate domains but excelled in training and education. Lack of budgets to support hand hygiene implementation is a priority gap underlying this poor performance. These gaps hinder hand hygiene practice and promotion, contributing to the continued spread of HAIs. Enhancing the distribution of hand hygiene resources and encouraging an embedded culture of hand hygiene practice in hospitals will reduce HAIs.
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Affiliation(s)
- Sulaiman Lakoh
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; (G.F.D.); (J.S.K.); (J.B.W.R.)
- Department of Medicine, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone
- Sustainable Health Systems Sierra Leone, Freetown, Sierra Leone;
- Correspondence: ; Tel.: +232-78-287-492
| | - Anna Maruta
- World Health Organization Country Office, Freetown, Sierra Leone; (A.M.); (B.D.F.); (I.F.K.)
| | - Christiana Kallon
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone; (C.K.); (D.K.)
| | - Gibrilla F. Deen
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; (G.F.D.); (J.S.K.); (J.B.W.R.)
- Department of Medicine, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone
| | - James B. W. Russell
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; (G.F.D.); (J.S.K.); (J.B.W.R.)
- Department of Medicine, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone
| | - Bobson Derrick Fofanah
- World Health Organization Country Office, Freetown, Sierra Leone; (A.M.); (B.D.F.); (I.F.K.)
| | - Ibrahim Franklyn Kamara
- World Health Organization Country Office, Freetown, Sierra Leone; (A.M.); (B.D.F.); (I.F.K.)
| | - Joseph Sam Kanu
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; (G.F.D.); (J.S.K.); (J.B.W.R.)
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone; (C.K.); (D.K.)
| | - Dauda Kamara
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone; (C.K.); (D.K.)
| | - Bailah Molleh
- Sustainable Health Systems Sierra Leone, Freetown, Sierra Leone;
| | - Olukemi Adekanmbi
- Department of Medicine, University of Ibadan, Ibadan 200005, Nigeria;
- Department of Medicine, University College Hospital, Ibadan 200005, Nigeria
| | - Simon Tavernor
- School of Medicine, University of Liverpool, Cedar House, Ashton Street, Liverpool L69 3GE, UK;
| | - Jamie Guth
- Global Health Connections, Center Barnstead, Barnstead, NH 03225, USA;
| | - Karuna D. Sagili
- International Union Against Tuberculosis and Lung Disease (The Union), Southeast Asia Office, New Delhi 110016, India;
| | - Ewan Wilkinson
- Institute of Medicine, University of Chester, Countess Way, Chester CH2 1BR, UK;
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Rayson D, Basinda N, Pius RA, Seni J. Comparison of hand hygiene compliance self-assessment and microbiological hand contamination among healthcare workers in Mwanza region, Tanzania. Infect Prev Pract 2021; 3:100181. [PMID: 34778743 PMCID: PMC8577144 DOI: 10.1016/j.infpip.2021.100181] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 10/18/2021] [Indexed: 11/17/2022] Open
Abstract
Background Compliance with hand hygiene (HH) practices remains a major challenge in preventing healthcare-associated infections (HCAI). Little is known whether self-reported HH compliance reflects the level of hand contamination microbiologically as a guide for specific infection prevention and control (IPC) measures. Methods A cross-sectional study was conducted between July and September 2019 involving 18 healthcare facilities (HCF) in Mwanza region, Tanzania. It assessed HH using astructured questionnaire and microbiological analysis of hand samples for culture (n=212), and the WHO Hand Hygiene Self-Assessment Framework (2010) (n=74). Results The overall median HH score (interquartile range) was 212.5 (190–245) and designated at basic level in the WHO framework. The scores progressively increased from basic level in health centres to intermediate level in a tertiary hospital. Self-reported HH compliance using the WHO recommended cut-off value of ≥81.0% was 10.8% (8/74). A total of 56 (26.4%) healthcare workers (HCWs) hands had bacterial contamination; 17.9% (n=38) by Gram negative bacteria (including coliforms, Acinetobacter spp and Pseudomonas aeruginosa), 8.0% (n=17) by meticillin-resistant Staphylococcus aureus (MRSA) and 0.5% (n=1) by both. Hand contamination was significantly higher in district hospitals (P-value=0.0437), and among HCWs residing in the rural areas (P-value=0.017). Conclusion The median HH score amongst HCF in Mwanza region was at basic level. A quarter of HCWs hands were contaminated by bacteria which mismatched self-reported HH. A need to incorporate HH microbiological paramaters to the WHO HH assessment tool is needed, and future IPC interventional measures should be tailored to the HCF tier and in rural areas.
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Affiliation(s)
- Devis Rayson
- School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
- Mwanza Interventional Trial Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - Namanya Basinda
- School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Ruanda Adam Pius
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Jeremiah Seni
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
- Corresponding author. Address: Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, P. O. Box 1464, Mwanza, Bugando, Tanzania.
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Clancy C, Delungahawatta T, Dunne CP. Hand-hygiene-related clinical trials reported between 2014 and 2020: a comprehensive systematic review. J Hosp Infect 2021; 111:6-26. [PMID: 33744382 PMCID: PMC9585124 DOI: 10.1016/j.jhin.2021.03.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/08/2021] [Accepted: 03/08/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND There is general consensus that hand hygiene is the most effective way to prevent healthcare-associated infections. However, low rates of compliance amongst healthcare workers have been reported globally. The coronavirus disease 2019 pandemic has further emphasized the need for global improvement in hand hygiene compliance by healthcare workers. AIM This comprehensive systematic review provides an up-to-date compilation of clinical trials, reported between 2014 and 2020, assessing hand hygiene interventions in order to inform healthcare leaders and practitioners regarding approaches to reduce healthcare-associated infections using hand hygiene. METHODS CINAHL, Cochrane, EMbase, Medline, PubMed and Web of Science databases were searched for clinical trials published between March 2014 and December 2020 on the topic of hand hygiene compliance among healthcare workers. In total, 332 papers were identified from these searches, of which 57 studies met the inclusion criteria. FINDINGS Forty-five of the 57 studies (79%) included in this review were conducted in Asia, Europe and the USA. The large majority of these clinical trials were conducted in acute care facilities, including hospital wards and intensive care facilities. Nurses represented the largest group of healthcare workers studied (44 studies, 77%), followed by physicians (41 studies, 72%). Thirty-six studies (63%) adopted the World Health Organization's multi-modal framework or a variation of this framework, and many of them recorded hand hygiene opportunities at each of the 'Five Moments'. However, recording of hand hygiene technique was not common. CONCLUSION Both single intervention and multi-modal hand hygiene strategies can achieve modest-to-moderate improvements in hand hygiene compliance among healthcare workers.
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Affiliation(s)
- C Clancy
- School of Medicine, University of Limerick, Limerick, Ireland
| | | | - C P Dunne
- School of Medicine, University of Limerick, Limerick, Ireland; Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland.
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