Abstract
Sustainability of hand hygiene is challenging in low resource settings. Adding ownership and goal setting to the WHO-5 multimodal intervention may help sustain high compliance. To increase and sustain compliance of nursing and medical staff with hand hygiene in a tertiary referral center with limited resources. A quality improvement initiative was conducted over two years (2016-2018). After determining baseline compliance rates, the WHO-5 multimodal intervention was implemented with staff education and training, system change, hospital reminders, direct observation and feedback, and hospital safety climate. Additionally, the medical staff was responsible for continuous surveillance of compliance (ownership) until rates above 90% were achieved and sustained (goal setting). Of 2987 observations collected between August 2016 and April 2018, 1630 (54.5%) were before, and 1357 (45.5%) were after patient encounters. The average overall compliance with hand hygiene was sustained at 94% for nursing and medical staff. Two instances of drops below 90% were associated with incidence of nosocomial Rotavirus infections. There were no similar infections during intervention periods with compliance rates above the set goal. Analysis using p-charts revealed significant improvement in compliance rates from baseline (χ2 (1) = 7.94, p = 0.005). Adding ownership and goal setting to the WHO-5 multimodal intervention may help achieve, and sustain high rates of compliance with hand hygiene. Involving health care workers in quality improvement initiatives is feasible, durable, reliable, and cheap, especially in settings with limited financial resources.
Highlights
Hospital-acquired infections have serious repercussions on patients’ morbidity and mortality, length of hospital stay, and health care expenditure [1,2,3]
Two instances of drops below 90% were associated with incidence of nosocomial Rotavirus infections
There were no similar infections during intervention periods with compliance rates above the set goal
Summary
Hospital-acquired infections have serious repercussions on patients’ morbidity and mortality, length of hospital stay, and health care expenditure [1,2,3]. Compliance among health care workers averages about 50% [8], representing a major challenge to hospital-acquired infection control. Health care workers’ compliance with hand hygiene is determined by knowledge and awareness about its importance, culture, memory and attention, and social influences [9]. Compliance with hand hygiene can be achieved with multimodal interventions such as the WHO-5 campaign, which has five components: system change, staff education and training, observation and feedback, hospital reminders, and hospital safety climate [10, 11]. Accountability, or reward incentives to WHO-5 may further increase compliance with hand hygiene [10]. Sustainability of hand hygiene is challenging in low resource settings. Adding ownership and goal setting to the WHO-5 multimodal intervention may help sustain high compliance
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