Barriers and Opportunities for Sustainable Hand Hygiene Interventions in Rural Liberian Hospitals.

Lucy K Tantum,Ashley R Styczynski,Fatorma K Bolay,John R Gilstad,Lily M Horng,Stephen P Luby,Andrew G Letizia,Ronan F Arthur,Alpha D Simpson

doi:10.3390/ijerph18168588

Abstract

Hand hygiene is central to hospital infection control. During the 2014–2016 West Africa Ebola virus disease epidemic in Liberia, gaps in hand hygiene infrastructure and health worker training contributed to hospital-based Ebola transmission. Hand hygiene interventions were undertaken post-Ebola, but many improvements were not sustainable. This study characterizes barriers to, and facilitators of, hand hygiene in rural Liberian hospitals and evaluates readiness for sustainable, locally derived interventions to improve hand hygiene. Research enumerators collected data at all hospitals in Bong and Lofa counties, Liberia, in the period March–May 2020. Enumerators performed standardized spot checks of hand hygiene infrastructure and supplies, structured observations of hand hygiene behavior, and semi-structured key informant interviews for thematic analysis. During spot checks, hospital staff reported that handwashing container water was always available in 89% (n = 42) of hospital wards, piped running water in 23% (n = 11), and soap in 62% (n = 29). Enumerators observed 5% of wall-mounted hand sanitizer dispensers (n = 8) and 95% of pocket-size dispensers (n = 53) to be working. In interviews, hospital staff described willingness to purchase personal hand sanitizer dispensers when hospital-provided supplies were unavailable. Low-cost, sustainable interventions should address supply and infrastructure-related obstacles to hospital hand hygiene improvement.

Highlights

Hospital-acquired infection endangers the health of patients, healthcare workers, and community members [1,2]
The risk of hospital-acquired infection is high in low- and middle-income country (LMIC) settings, with the prevalence of hospitalacquired infection estimated at 15.5 infections per 100 patients in LMICs compared to
Findings from interviews, spot checks, and structured observations at Liberian health facilities suggest that hand hygiene practices are strengthened by a high level of knowledge and motivation for infection prevention among hospital staff, but undermined in both implementation and sustainability by funding shortages and infrastructure deficiencies

Summary

Introduction

Hospital-acquired infection endangers the health of patients, healthcare workers, and community members [1,2]. The risk of hospital-acquired infection is high in low- and middle-income country (LMIC) settings, with the prevalence of hospitalacquired infection estimated at 15.5 infections per 100 patients in LMICs compared to. Health worker hand hygiene practices are often sub-optimal, especially in low-income settings: in one multi-site baseline assessment, health workers at LMIC sites performed hand hygiene during 22% of total opportunities on average, compared to 54% of opportunities at highincome country sites [5]. Studies in Ghana, Nigeria, Eritrea, and Bangladesh found that average health worker adherence to hand hygiene guidelines ranged from 1% to 44% using direct observation [6,7,8,9,10,11].

Methods

Discussion

Conclusion