A Quasi Experiment to Implement Multimodal Strategy to Improve Hand Hygiene Behavior in a Healthcare Facility in Central Saudi Arabia

Abstract

Background: Hand hygiene (HH) compliance of healthcare workers (HCWs) remains suboptimal despite standard multimodal promotion, and evidence for the effectiveness of novel interventions is urgently needed. Aim: Improve HCWs’ HH compliance toward minimizing healthcare associated infection (HCAI) risk in Wadi Al Dawasir Hospital (WDH), central Kingdom of Saudi Arabia (KSA). Methodology: A quasi experimental approach was adopted to achieve study aim. The HCWs’ behavior of HH during the duration between 2015 and 2016 was evaluated before and after a HH educational plan based on the World Health Organization (WHO) “Multimodal HH Improvement Strategy” (MMHHIS). The HCWs’ compliance in response to HH indications represented by the WHO’s “My 5-Moments for HH” and the type of HH action taken, whether hand washing (HW) or hand-rubbing (HR) were analyzed. Results: The number of opportunities observed of HH performance accounted 230 in 2015 (pre-education), and 237 in 2016 (post-education). The HCWs’ HH compliance rate in the pre-education phase did not vary by the 5-moment indications [χ2(df 4) = 0.01, p = 0.98]. Conversely, the compliance rate after HH education was higher than non-compliance across all 5-moment indication opportunities (ranged between 57.0% up to 88.9%) [χ2(df 1) = 18.25, p < 0.001]. Only the 3rd and 4th 5-moment indications (“after body fluid exposure” and “after patient contact,” respectively) were met with a significant HH improvement [χ2(df 1) = 8.98, p = 0.003; and χ2(df 1) = 16.3, p < 0.0001, respectively]. An overall improvement of HH compliance from 49.1% to 69.6% was significantly achieved as a result of submission to the selected HH educational plan (Z = −4.38, p = 0.001). Only physicians and nurses showed a significant “within-profession” improvement in HH compliance after education, compared to that before education (Z = −3.51, p = 0.001, Z = −2.48, p = 0.013, respectively). Conclusions: Applying a HH education plan based on standardized multimodal HH strategy proved effective in improving the HH compliance of the hospital’s staff. An ongoing observation policy within a HH-resourceful environment assures a sustainable and sound HCWs’ HH behavior.