Abstract

Our primary objective was to assess hand hygiene (HH) compliance before aseptic procedures among birth attendants in the 10 highest-volume facilities in Zanzibar. We also examined the extent to which recontamination contributes to poor HH. Recording exact recontamination occurrences is not possible using the existing World Health Organization HH audit tool. In this time-and-motion study, 3 trained coders used WOMBATv2 software to record the hand actions of all birth attendants present in the study sites. The percentage compliance and 95% confidence intervals (CIs) for individual behaviors (hand washing/rubbing, avoiding recontamination and glove use) and for behavioral sequences during labor and delivery were calculated. We observed 104 birth attendants and 781 HH opportunities before aseptic procedures. Compliance with hand rubbing/washing was 24.6% (95% CI, 21.6-27.8). Only 9.6% (95% CI, 7.6-11.9) of birth attendants also donned gloves and avoided recontamination. Half of the time when rubbing/washing or glove donning was performed, hands were recontaminated prior to the aseptic procedure. In this study, HH compliance by birth attendants before aseptic procedures was poor. To our knowledge, this is the first study in a low- to middle-income country to show the large contribution to poor HH compliance from hand and glove recontamination before the procedure. Recontamination is an important driver of infection risk from poor HH. It should be understood for the purposes of improvement and therefore included in HH monitoring and interventions.

Highlights

  • Healthcare associated infections (HAIs) in low and middle-income countries (LMICs) affect an estimated 15% of patients; five times more than in Europe.[1]

  • In this study, Hand hygiene (HH) compliance by birth attendants was poor before aseptic procedures

  • To our knowledge this is the first study in a LMIC to show the large contribution to poor HH compliance from hand and glove recontamination before the procedure

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Summary

Introduction

Healthcare associated infections (HAIs) in low and middle-income countries (LMICs) affect an estimated 15% of patients; five times more than in Europe.[1]. Hand hygiene (HH) is deemed the single most important behaviour for preventing HAIs.[5] Historical evidence suggests the importance of HH in reducing maternal infections in European hospitals and recent studies support its value for newborns in LMICs.[6] The World Health Organization (WHO) recommends five moments for hand hygiene (5MHH) during patient care.[7] Among these, Moment 2 – HH before clean/aseptic tasks when there is potential contact with patient’s mucous membranes or non-intact skin – is considered the most significant for preventing bacterial transmission to patients including the bloodstream that could result in infection During birth, this primarily occurs before and during a vaginal examination or delivery, and related procedures. Our specific research questions were: 1. What is the compliance with hand rubbing/washing (and avoiding hand recontamination) and donning gloves (and avoiding glove recontamination)?

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