Abstract
Healthcare-associated infections, commonly caused by poor hand hygiene, represent a significant source of disease and economic burden for healthcare systems, especially those in resource-limited settings. The few existing studies on hand hygiene compliance in resource-limited hospital settings suggest that compliance is insufficient. The difference in compliance rates between units in resource-limited trauma hospitals is largely unknown. We aimed to assess hand hygiene compliance rates among healthcare workers at a trauma hospital in Iraqi Kurdistan and compare the levels of compliance between the emergency room (ER), the intensive care unit (ICU), and the acute care ward (ACW). We carried out overt observations in 2018 using the validated World Health Organization ‘five moments for hand hygiene’ observational tool. We observed a total of 622 hand hygiene opportunities performed by 149 healthcare workers. Hand hygiene compliance was defined as handwashing with soap and water or the use of alcohol-based hand rub, in accordance with the ‘five moments for hand hygiene’ concept. Overall, the hand hygiene compliance rate was found to be 6.8% (95% confidence interval 5.0–9.1). Compliance was significantly lower in the ER (1.0%), compared with the ICU (8.1%) (p = 0.0012), and the ACW (11.1%) (p < 0.0001). In all three units, the availability of alcohol-based hand rub and handwashing sinks was insufficient in relation to the number of patient beds. We conclude that the overall level of hand hygiene compliance was low, with the lowest level of compliance in the ER. Our findings call for improved resource allocation and strengthened hand hygiene routines. These relatively simple measures could potentially lower the incidence of healthcare-associated infections and improve the mortality and morbidity of patients in already overburdened healthcare systems.
Highlights
Healthcare-associated infections (HAIs) are spread by the transmission of microorganisms from a patient or a patient’s surroundings to another patient, usually via equipment or via the hands of healthcare workers (HCWs) [1]
Some 622 hand hygiene opportunities performed by 149 HCWs were observed
Overall, there was an insufficient level of compliance with the World Health Organization (WHO)’s recommendations on hand hygiene, with significantly lower compliance in the emergency room (ER) than the intensive care unit (ICU) and the acute care ward (ACW)
Summary
Healthcare-associated infections (HAIs) are spread by the transmission of microorganisms from a patient or a patient’s surroundings to another patient, usually via equipment or via the hands of healthcare workers (HCWs) [1]. In European high-income countries, more than 4 million patients are affected by HAIs annually, with urinary tract infections being the most frequent type of HAI, followed by lower respiratory tract infections, surgical site infections, and bloodstream infections [3,4]. HAIs are of greatest prevalence in low- and middle-income countries, in part due to the limited resources available at public hospitals, including those for hand hygiene, with surgical site infections being the most frequent type of HAIs [5,6]. Cesarean sections are among the most common operative procedures in low- and middle-income countries and are associated with maternal and neonatal mortality caused by HAIs [7].
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