Abstract
Recent research calls for distinguishing whether the failure to comply with World Health Organisation hand hygiene guidelines is driven by omitting to rub/wash hands, or subsequently recontamination of clean hands or gloves prior to a procedure. This study examined the determinants of these two behaviours. Across the 10 highest-volume labour wards in Zanzibar, we observed 103 birth attendants across 779 hand hygiene opportunities before aseptic procedures (time-and-motion methods). They were then interviewed using a structured cross-sectional survey. We used mixed-effect multivariable logistic regressions to investigate the independent association of candidate determinants with hand rubbing/washing and avoiding glove recontamination. After controlling for confounders, we found that availability of single-use material to dry hands (OR:2.9; CI:1.58–5.14), a higher workload (OR:29.4; CI:12.9–67.0), more knowledge about hand hygiene (OR:1.89; CI:1.02–3.49), and an environment with more reminders from colleagues (OR:1.20; CI:0.98–1.46) were associated with more hand rubbing/washing. Only the length of time elapsed since donning gloves (OR:4.5; CI:2.5–8.0) was associated with avoiding glove recontamination. We identified multiple determinants of hand washing/rubbing. Only time elapsed since washing/rubbing was reliably associated with avoiding glove recontamination. In this setting, these two behaviours require different interventions. Future studies should measure them separately.
Highlights
Hand hygiene of birth attendants is a key infection prevention act for both mothers and newborns worldwide [1,2,3]
Avoiding glove recontamination compliance did not vary by region (Pemba: 61.2%, N = 85; Unguja: 62.2%: N = 405) or shift
We found that availability of single-use drying material, lower workload, demonstrated knowledge, and an environment with more reminders were determinants associated with more hand rubbing/washing
Summary
Hand hygiene of birth attendants is a key infection prevention act for both mothers and newborns worldwide [1,2,3]. Hand hygiene is considered the single most important intervention to reduce healthcare-associated infections (HAIs) [4] These infections affect 15% of patients in low and middle-income countries (LMICs) [5], including Tanzania which is our study context [6]—twice as high than in Europe [7]. In our previous work in Zanzibar (Tanzania), we identified the need to distinguish whether the failure to comply with the hand hygiene guidelines stemmed from omitting to rub/wash hands, or the process of subsequently avoiding recontamination of hands/gloves before a procedure [13]. This distinction cannot be made using the current WHO HH
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