Abstract
BackgroundHand hygiene (HH) among healthcare workers (HCWs) is critical for infection prevention and control (IPC) in healthcare facilities (HCFs). Nonetheless, it remains a challenge in HCFs, largely due to lack of high-impact and efficacious interventions. Environmental cues and mobile phone health messaging (mhealth) have the potential to improve HH compliance among HCWs, however, these remain under-studied. Our study will determine the impact of mhealth hygiene messages and environmental cues on HH practice among HCWs in the Greater Kampala Metropolitan Area (GKMA).MethodsThe study is a cluster-randomized trial, which will be guided by the behaviour centred design model and theory for behaviour change. During the formative phase, we shall conduct 30 key informants’ interviews and 30 semi-structured interviews to explore the barriers and facilitators to HCWs’ HH practice. Besides, observations of HH facilities in 100 HCFs will be conducted. Findings from the formative phase will guide the intervention design during a stakeholders’ insight workshop.The intervention will be implemented for a period of 4 months in 30 HCFs, with a sample of 450 HCWs who work in maternity and children’s wards. HCFs in the control arm will receive innovatively designed HH facilities and supplies. HCWs in the intervention arm, in addition to the HH facilities and supplies, will receive environmental cues and mhealth messages. The main outcome will be the proportion of utilized HH opportunities out of the 9000 HH opportunities to be observed. The secondary outcome will be E. coli concentration levels in 100mls of hand rinsates from HCWs, an indicator of recent fecal contamination and HH failure. We shall run multivariable logistic regression under the generalized estimating equations (GEE) framework to account for the dependence of HH on the intervention.DiscussionThe study will provide critical findings on barriers and facilitators to HH practice among HCWs, and the impact of environmental cues and mhealth messages on HCWs’ HH practice.Trial registrationISRCTN Registry with number ISRCTN98148144. The trial was registered on 23/11/2020.
Highlights
Hand hygiene (HH) among healthcare workers (HCWs) is critical for infection prevention and control (IPC) in healthcare facilities (HCFs)
The process evaluation will seek to establish: whether the intervention is being implemented according to plan; whether the intervention is working or not; how many HCWs will be getting exposed to the touch points; how many HCWs will be responding to the mhealth intervention as well as the aspects of the intervention that participants will have liked
Social demographic, knowledge and attitudes questions will be collected from all participating HCWs through an interviewer administered questionnaire
Summary
Hand hygiene (HH) among healthcare workers (HCWs) is critical for infection prevention and control (IPC) in healthcare facilities (HCFs). It remains a challenge in HCFs, largely due to lack of high-impact and efficacious interventions. Sanitation and hygiene (WASH) is critical in the provision of quality health care in healthcare facilities (HCFs). Improved WASH infrastructure and practices in HCFs can significantly reduce the risk of healthcare acquired infections (HCAIs). It increases trust and uptake of healthcare service while increasing efficiency and improved staff morale. There is a strong biological plausibility that pathogens responsible for HCAIs are more prevalent in facilities with substandard WASH services [3], and mothers and neonates are at the greatest risk of getting exposed to HCAIs [4,5,6]
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