Researchers Study HH Adherence in Resource-Limited Settings

Hand hygiene is the cornerstone of infection control and has reduces rates of healthcare associated infection. There are limited data evaluating hand hygiene adherence and hand hygiene campaign effect in resource-limited settings, especially in sub-Saharan Africa. This study bySchmitz, et al. (2014) assessed the impact of implementing a World Health Organization (WHO)-recommended multimodal hand hygiene campaign at a hospital in Ethiopia.

This study included a before-and-after assessment of healthcare worker (HCW) adherence with WHO hand hygiene guidelines. It was implemented in three phases: 1) baseline evaluation of hand hygiene adherence and hospital infrastructure; 2) intervention (distribution of commercial hand sanitizer and implementation of an abbreviated WHO-recommended multimodal hand hygiene campaign); and 3) post-intervention evaluation of HCW hand hygiene adherence. HCWs' perceptions of the campaign and hand sanitizer tolerability were assessed through a survey performed in the post-intervention period.

At baseline, handwashing materials were infrequently available, with only 20 percent of sinks having hand-washing materials. There was a significant increase in hand hygiene adherence among HCWs following implementation of a WHO multimodal hand hygiene program. Adherence increased from 2.1 percent at baseline (21 hand hygiene actions/1,000 opportunities for hand hygiene) to 12.7 percent (127 hand hygiene actions/1,000 opportunities for hand hygiene) after the implementation of the hand hygiene campaign OR = 6.8, 95%CI 4.2-10.9). Hand hygiene rates significantly increased among all HCW types except attending physicians. Independent predictors of HCW hand hygiene compliance included performing hand hygiene in the post-intervention period (aOR = 5.7, 95%CI 3.5-9.3), in the emergency department (aOR = 4.9, 95%CI 2.8-8.6), during patient care that did not involve attending physician rounds (aOR = 2.4, 95%CI 1.2-4.5), and after patient contact (aOR = 2.1, 95%CI 1.4-3.3).

In the perceptions survey, 64.0 percent of HCWs indicated preference for commercially manufactured hand sanitizer and 71.4 percent indicated their hand hygiene adherence would improve with commercial hand sanitizer.

The researchers concluded that there was a significant increase in hand hygiene adherence among Ethiopian HCWs following the implementation of a WHO-recommended multimodal hand hygiene campaign. Dissatisfaction with the current WHO-formulation for hand sanitizer was identified as a barrier to hand hygiene adherence in this setting. Their research was published in Antimicrobial Resistance and Infection Control.

Reference: Schmitz K, Kempker RR, et al. Effectiveness of a multimodal hand hygiene campaign and obstacles to success in Addis Ababa, Ethiopia. Antimicrobial Resistance and Infection Control 2014, 3:8  doi:10.1186/2047-2994-3-8.