Hand Hygiene Compliance at Two Tertiary Hospitals in Freetown, Sierra Leone, in 2021: A Cross-Sectional Study.

Gladys Nanilla Kamara,Hemant Deepak Shewade,Ibrahim Franklyn Kamara,Zikan Koroma,Saskia Van Henten,Anthony D Harries,Julian S O Campbell,Bailah Molleh,Stephen Sevalie,Anna Maruta,Christiana Kallon,Joseph Sam Kanu

doi:10.3390/ijerph19052978

Abstract

Hand hygiene actions are essential to reduce healthcare-associated infections and the development of antimicrobial resistance. In this cross-sectional study at two tertiary hospitals, Freetown, Sierra Leone, we observed hand hygiene compliance (defined as using handwash with soap and water or alcohol-based hand rub (ABHR) amongst healthcare workers between June and August 2021. Using the WHO Hand Hygiene tool, observations were made in relation to the type of opportunity, different wards and types of healthcare worker. Overall, 10,461 opportunities for hand hygiene were observed, of which 5086 (49%) resulted in hand hygiene actions. ABHR was used more often than handwash (26% versus 23%, p < 0.001). Overall, compliance was significantly better: after being with a patient/doing a procedure than before (78% after body fluid exposure risk compared with 24% before touching a patient—p < 0.001); in Paediatric (61%) compared with Medical wards (46%)—p < 0.001; and amongst nurses (52%) compared with doctors (44%)—p < 0.001. Similar patterns of compliance were observed within each hospital. In summary, hand hygiene compliance was sub-optimal, especially before being with a patient or before clean/aseptic procedures. Improvement is needed through locally adapted training, hand hygiene reminders in wards and outpatient departments, uninterrupted provision of ABHR and innovative ways to change behaviour.

Highlights

Healthcare-associated infections are a major threat to patient safety and are associated with prolonged hospital stays, long-term disability, increased resistance of microorganisms to antimicrobials, poor clinical outcomes, large additional costs to health systems and unnecessary deaths [1]
A total of 10,461 opportunities for hand hygiene actions were observed over 423 sessions
Resulted in hand hygiene actions: this was significantly lower than the 4248 (51%) hand hygiene actions observed in the 8389 opportunities in Connaught hospital (p < 0.001)

Summary

Introduction

Healthcare-associated infections are a major threat to patient safety and are associated with prolonged hospital stays, long-term disability, increased resistance of microorganisms to antimicrobials, poor clinical outcomes, large additional costs to health systems and unnecessary deaths [1]. The hands of healthcare workers play a pivotal role in the transmission of microorganisms responsible for healthcare-associated infections [3], and global efforts to reduce the burden of these infections have focused on hand hygiene. These include the World Health Organization (WHO)’s campaigns “clean care is safe care” and “fight antibiotic resistance, it’s in your hands” [4,5]. These campaigns are mainly based on improving hand hygiene practices in health care settings through the implementation of the WHO multimodal hand hygiene strategy [6]. Over the last two decades, an increasing body of evidence has accumulated to suggest that improved hand hygiene can reduce healthcare-associated infections [3,7]

Methods

Results

Discussion

Conclusion