Abstract
BackgroundHand hygiene is recognized as an important measure to prevent healthcare-associated infections. Hand hygiene adherence among healthcare workers is associated with their knowledge and perception. This study aimed to evaluate the effect of three different educational programs on improving hand hygiene compliance, knowledge, and perception among healthcare workers in a tertiary care hospital in Indonesia.MethodsThe study was performed from May to October 2014 and divided into a pre-intervention, intervention, and post-intervention phase. This cluster randomized controlled trial allocated the implementation of three interventions to the departments, including role model training-pediatrics, active presentation-surgery, a combination of role model training and active presentation-internal medicine, and a control group-obstetrics-gynecology. Both direct observation and knowledge-perception survey of hand hygiene were performed using WHO tools.ResultsHand hygiene compliance was observed during 2,766 hand hygiene opportunities, and knowledge-perception was assessed among 196 participants in the pre-intervention and 88 in the post-intervention period. After intervention, the hand hygiene compliance rate improved significantly in pediatrics (24.1% to 43.7%; P < 0.001), internal medicine (5.2% to 18.5%; P < 0.001), and obstetrics-gynecology (10.1% to 20.5%; P < 0.001). The nurses’ incorrect use of hand rub while wearing gloves increased as well (P < 0.001). The average knowledge score improved from 5.6 (SD = 2.1) to 6.2 (SD = 1.9) (P < 0.05). In the perception survey, “strong smell of hand alcohol” as a reason for non-compliance increased significantly in the departments with intervention (10.1% to 22.9%; P = 0.021).ConclusionThe educational programs improved the hand hygiene compliance and knowledge among healthcare workers in two out of three intervention departments in a limited-resource hospital in Indonesia. Role model training had the most impact in this setting. However, adjustments to the strategy are necessary to further improve hand hygiene.
Highlights
Hand hygiene is recognized as an important measure to prevent healthcare-associated infections
The hand hygiene compliance rate increased both in the departments with intervention and in the department without intervention from 16.1% to 27.1% and from 10.1% to 20.5%, respectively
For the 538 opportunities with good hand hygiene compliance, it was observed that Healthcare workers (HCW) used hand rub at 379 (70.6%) opportunities, whereas at 159 (29.6%) opportunities they washed their hands
Summary
Hand hygiene is recognized as an important measure to prevent healthcare-associated infections. This study aimed to evaluate the effect of three different educational programs on improving hand hygiene compliance, knowledge, and perception among healthcare workers in a tertiary care hospital in Indonesia. Hospitals are still facing problems that typically occur in a developing country, such as overcrowding of wards and shortage of certain supplies [10, 11] It is unknown which of the elements of the WHO multi-modal approach would have the greatest impact on the improvement of hand hygiene in such a setting [8]. This study aimed to assess the healthcare workers’ (HCWs’) hand hygiene compliance, knowledge, and perception in a limited-resource hospital in Indonesia before and after the implementation of three different educational programs
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