Abstract
BackgroundThe burden of healthcare-associated infection (HAI) is 2 to 18 times higher in developing countries. However, few data are available regarding infection prevention and control (IPC) process indicators in these countries. We evaluated hand hygiene (HH) facilities and compliance amongst healthcare workers (HCW) in a 600-bed healthcare facility in Northcentral Nigeria providing tertiary care service for a catchment population of about 20 million.MethodsAn in-house facility assessment tool and the World Health Organization (WHO) direct observation method were used to assess the HH facilities and compliance, respectively. Factors associated with good compliance were determined by multivariate analysis.ResultsThe facility survey was carried out in all 46 clinical units of the hospital. 72% of the units had no poster or written policy on HH; 87% did not have alcohol-based hand rubs; 98% had at least one handwash sink; 28% had flowing tap water all day while 72% utilized cup and bucket; and 58% had no hand drying facilities. A total of 406 HH opportunities were observed among 175 HCWs. The overall compliance was 31%, ranging from 18% among ward attendants to 82% among medical students. Based on WHO “5 moments” for HH, average compliance was 21% before patient contact, 23% before aseptic procedure, 63% after body fluid exposure risk, 41% after patient contact and 40% after contact with patients’ surrounding. Being a medical student was independently associated with high HH compliance, adjusted odds ratio: 13.87 (1.70–112.88).ConclusionsAvailability of HH facilities and HCW compliance in a large tertiary hospital in Nigeria is poor. Our findings confirm that HCWs seem more sensitized to their risk of exposure to potential pathogens than to the prevention of HAI cross-transmission. Inadequate HH facilities probably contributed to the poor compliance. Specific measures such as improved facilities, training and monitoring are needed to improve HH compliance.
Highlights
The burden of healthcare-associated infection (HAI) is 2 to 18 times higher in developing countries
The World Health Organization (WHO) itemized five key moments when healthcare workers (HCWs) should practice hand hygiene (HH): these are before patient contact, before an aseptic procedure, after bodily fluid exposure risk, after patient contact, and after contact with patient surroundings
We evaluated the level of compliance across different wards and units and among different categories of HCWs
Summary
The burden of healthcare-associated infection (HAI) is 2 to 18 times higher in developing countries. We evaluated hand hygiene (HH) facilities and compliance amongst healthcare workers (HCW) in a 600bed healthcare facility in Northcentral Nigeria providing tertiary care service for a catchment population of about 20 million. HAI are frequently preventable through infection prevention and control (IPC) measures, with HH as key activity [5, 6]. This reality has led organizations such as the Joint Commission, the World Health Organization (WHO), Centers for Disease Control and Prevention (CDC) and European Center for Disease Prevention (ECDC) to recommend HH practices and interventions in all healthcare facilities worldwide [ 1, 7, 8]. WHO recommends using a validated methodology for training observers to directly monitor HH using “My five moments for hand hygiene” [1, 9, 10]
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