Abstract
Although critical to prevent healthcare-associated infections, hand hygiene (HH) compliance is poor in resource-limited settings. In 2012, three Kenyan hospitals began onsite production of alcohol-based handrub (ABHR) and HH promotion. Our aim is to determine the impact of local production of ABHR on HH compliance and perceptions of ABHR.We observed 25,738 HH compliance opportunities and conducted 15 baseline and post-intervention focus group discussions. Hand Hygiene compliance increased from 28% (baseline) to 38% (post-intervention, p = 0.0003). Healthcare workers liked the increased accessibility of ABHR, but disliked its smell, feel, and sporadic availability. Onsite production and promotion of ABHR resulted in modest HH improvement. Enhancing the quality of ABHR and addressing logistical barriers could improve program impact.
Highlights
Healthcare-associated infections (HAIs) cause preventable illness and death in patients around the globe [1]
Hand hygiene (HH) compliance was highest when the indication for HH was after healthcare workers (HCWs) exposure to potential contaminants [i.e., after body fluid exposure (93%), after touching patient (55%), and after contact with patient’s surroundings (26%)] as opposed to before patient contact [i.e., before touching a patient (2%) and before a clean/aseptic task (1%)]
Compliance decreased after body fluid exposure from 93 to 74% (p = .048), surveillance officers observed the fewest number of opportunities overall for this indication during the baseline period
Summary
Healthcare-associated infections (HAIs) cause preventable illness and death in patients around the globe [1]. Hand hygiene (HH) by healthcare workers (HCWs) is critical to preventing HAIs, but healthcare facilities often fall short of HH compliance goals [2]. The Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) recommend using ABHR for HH in healthcare settings, except in situations requiring the physical removal of microbes with soap and water (e.g., for pathogens Clostridioidies difficile or norovirus, or if hands are visibly soiled) [4, 5]. In 2011, the Kenya Ministry of Health and the CDC-Kenya adapted the WHO toolkit to train Kenyan pharmacists, HCWs, and other administrative staff in three hospitals on production of ABHR and on improving HH practices. We sought to determine the effect of this program on HH compliance and perceptions of ABHR
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