Abstract
Hand hygiene adherence monitoring and feedback can reduce health care-acquired infections in hospitals. Few low-cost hand hygiene adherence monitoring tools exist in low-resource settings. To pilot an open-source application for mobile devices and an interactive analytical dashboard for the collection and visualization of health care workers' hand hygiene adherence data. This prospective multicenter quality improvement study evaluated preintervention and postintervention adherence with the 5 Moments for Hand Hygiene, as suggested by the World Health Organization, among health care workers from April 23 to May 25, 2018. A novel data collection form, the Hand Hygiene Observation Tool, was developed in open-source software and used to measure adherence with hand hygiene guidelines among health care workers in the inpatient therapeutic feeding center and pediatric ward of Anka General Hospital, Anka, Nigeria, and the postoperative ward of Noma Children's Hospital, Sokoto, Nigeria. Qualitative data were analyzed throughout data collection and used for immediate feedback to staff. A more formal analysis of the data was conducted during October 2018. Multimodal hand hygiene improvement strategy with increased availability and accessibility of alcohol-based hand sanitizer, staff training and education, and evaluation and feedback in near real-time. Hand hygiene adherence before and after the intervention in 3 hospital wards, stratified by health care worker role, ward, and moment of hand hygiene. A total of 686 preintervention adherence observations and 673 postintervention adherence observations were conducted. After the intervention, overall hand hygiene adherence increased from 32.4% to 57.4%. Adherence increased in both wards in Anka General Hospital (inpatient therapeutic feeding center, 24.3% [54 of 222 moments] to 63.7% [163 of 256 moments]; P < .001; pediatric ward, 50.9% [132 of 259 moments] to 68.8% [135 of 196 moments]; P < .001). Adherence among nurses in Anka General Hospital also increased in both wards (inpatient therapeutic feeding center, 17.7% [28 of 158 moments] to 71.2% [79 of 111 moments]; P < .001; pediatric ward, 45.9% [68 of 148 moments] to 68.4% [78 of 114 moments]; P < .001). In Noma Children's Hospital, the overall adherence increased from 17.6% (36 of 205 moments) to 39.8% (88 of 221 moments) (P < .001). Adherence among nurses in Noma Children's Hospital increased from 11.5% (14 of 122 moments) to 61.4% (78 of 126 moments) (P < .001). Adherence among Noma Children's Hospital physicians decreased from 34.2% (13 of 38 moments) to 8.6% (7 of 81 moments). Lowest overall adherence after the intervention occurred before patient contact (53.1% [85 of 160 moments]), before aseptic procedure (58.3% [21 of 36 moments]), and after touching a patient's surroundings (47.1% [124 of 263 moments]). This study suggests that tools for the collection and rapid visualization of hand hygiene adherence data are feasible in low-resource settings. The novel tool used in this study may contribute to comprehensive infection prevention and control strategies and strengthening of hand hygiene behavior among all health care workers in health care facilities in humanitarian and low-resource settings.
Highlights
Health care–associated infections (HAIs) are a leading concern for patient safety and are associated with prolonged hospital stays, long-term morbidity, increased resistance levels in pathogenic bacteria, higher costs for hospitals and patients, and higher mortality.[1]
Overall hand hygiene adherence increased from 32.4% to 57.4%
Key Points Question Is the implementation of an open-source monitoring and data visualization tool for hand hygiene adherence among health care workers feasible, and does it improve hand hygiene adherence in low-resource settings? Findings In this quality improvement study in 2 hospitals in Nigeria, including 686 preintervention and 673 postintervention observations of moments in which hand hygiene was recommended, overall hand hygiene adherence increased from 32.4% to 57.4%
Summary
Health care–associated infections (HAIs) are a leading concern for patient safety and are associated with prolonged hospital stays, long-term morbidity, increased resistance levels in pathogenic bacteria, higher costs for hospitals and patients, and higher mortality.[1]. Acquisition of an HAI occurs primarily through contact with contaminated hands of transiently colonized health care workers (HCWs) or from contaminated environmental surfaces.[4] hand hygiene for HCWs is the primary method to reduce the spread of HAIs. hand hygiene adherence rates in HCWs remain low globally.[5,6,7] To improve hand hygiene adherence, the World Health Organization (WHO) recommends implementing a multimodal approach to strengthening hand hygiene in health care.[8] This improvement strategy focuses on increasing awareness and adherence of HCWs following the 5 Moments for Hand Hygiene,[8] which has proven successful in reducing HAIs in numerous countries.[9,10,11,12] in low-resource contexts (including humanitarian hospitals), there are implementation challenges to increasing HCWs’ adherence. Most hospitals in these contexts lack the appropriate infrastructure and resources to facilitate hand hygiene (eg, insufficient space between beds, crowding of patients), and staff and family caretakers are not trained in appropriate hand hygiene measures and sometimes lack knowledge of the consequences of poor adherence.[3,13]
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