Effectiveness of a multimodal hand hygiene campaign and obstacles to success in Addis Ababa, Ethiopia

Admasu Tenna,Karen Schmitz,Henry M Blumberg,Russell R Kempker,Ermias Kacha Jirru,Lia Tadesse,Edward Stenehjem,Engida Abebe

doi:10.1186/2047-2994-3-8

Abstract

BackgroundHand hygiene is the cornerstone of infection control and 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 assessed the impact of implementing a World Health Organization (WHO)-recommended multimodal hand hygiene campaign at a hospital in Ethiopia.MethodsThis study included a before-and-after assessment of health care 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.ResultsAt baseline, hand washing materials were infrequently available, with only 20% 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% at baseline (21 hand hygiene actions/1000 opportunities for hand hygiene) to 12.7% (127 hand hygiene actions /1000 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% of HCWs indicated preference for commercially manufactured hand sanitizer and 71.4% indicated their hand hygiene adherence would improve with commercial hand sanitizer.ConclusionsThere 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 our setting.

Highlights

Hand hygiene is the cornerstone of infection control and reduces rates of healthcare associated infection
Health care worker hand hygiene adherence A total of 2000 opportunities for hand hygiene were observed during the study, (1000 during the baseline assessment period and 1000 in the post-intervention period)
Health care worker (HCW) who completed the perceptions survey indicated that the hospital prepared sanitizer was more likely to cause drying of their hands compared to the commercially prepared sanitizer (76/161 [47.2%] vs. 21/161 [13.0%], OR = 6.0, 95% CI 3.4-10.4) (Table 6). 64.0% of HCWs indicated that they prefer commercially manufactured hand sanitizer and 71.4% indicated their hand hygiene adherence would improve with commercial hand sanitizer

Summary

Introduction

Hand hygiene is the cornerstone of infection control and reduces rates of healthcare associated infection. Numerous strategies have been evaluated in an attempt to improve rates of hand hygiene, including those that focus on infrastructure changes, education, visual reminders, or ongoing monitoring and feedback programs While these individual components have proven effective, interventions that combine these strategies into multimodal hand hygiene campaigns appear to be the most successful in improving hand hygiene adherence by health care workers (HCWs) [1,4,5,6,7]. The WHO Multimodal Hand Hygiene Strategy has been implemented extensively in high income, resource intensive countries, there remains limited data on the impact of such programs in resource-limited countries, especially in Sub-Saharan Africa [8,9,10,11]

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