Abstract
We aimed to apply the Systems Engineering Initiative for Patient Safety (SEIPS) model to increase effectiveness and sustainability of the World Health Organization's (WHOs) hand hygiene (HH) guidelines within healthcare systems. Our cross-sectional, mixed-methods study took place at Jimma University Medical Center (JUMC), a tertiary care hospital in Jimma, Ethiopia, between November 2018 and August 2020 and consisted of three phases: baseline assessment, intervention, and follow-up assessment. We conducted questionnaires addressing HH knowledge and attitudes, interviews to identify HH barriers and facilitators within the SEIPS framework, and observations at the WHO's 5 moments of HH amongst healthcare workers (HCWs) at JUMC. We then implemented HH interventions based on WHO guidelines and results from our baseline assessment. Follow-up HH observations were conducted months later during the Covid-19 pandemic. 250 HCWs completed questionnaires with an average knowledge score of 61.4% and attitude scores indicating agreement that HH promotes patient safety. Interview participants cited multiple barriers to HH including shortages and location of HH materials, inadequate training, minimal Infection Prevention Control team presence, and high workload. We found an overall baseline HH compliance rate of 9.4% and a follow-up compliance rate of 72.1%. Drastically higher follow-up compared to baseline compliance rates were likely impacted by our HH interventions and Covid-19. HCWs showed motivation for patient safety despite low HH knowledge. Utilizing the SEIPS model helped identify institution-specific barriers that informed targeted interventions beyond WHO guidelines aimed at increasing effectiveness and sustainability of HH efforts.
Highlights
Health care associated infections (HAIs) are common but avoidable adverse patient events that pose great threats to patient safety and increase morbidity, mortality, and length of hospital stays [1]
While there is abundant global evidence that this valuable, generic tool can help improve Hand hygiene (HH) compliance rates—including at two teaching hospitals in Ethiopia—significant barriers to and after implementation of World Health Organization (WHO) HH interventions exist in low to middle-income countries (LMICs) [8,9,10,11,12,13]
A 2015 meta-analysis and a 2017 systematic review demonstrated that implementation of WHO guidelines alongside another intervention strategy that takes human behavioral theory into account, such as incentives, goal setting, and accountability results in greater improvement in HH compliance rates [15, 16]
Summary
Health care associated infections (HAIs) are common but avoidable adverse patient events that pose great threats to patient safety and increase morbidity, mortality, and length of hospital stays [1]. Hand hygiene (HH) is an inexpensive and effective method for reducing HAIs, disease outbreaks, and antimicrobial resistance [2,3,4]. Despite this knowledge, reports from LMICs and Ethiopia consistently show HH compliance rates under 25% [2, 5, 6]. A 2015 meta-analysis and a 2017 systematic review demonstrated that implementation of WHO guidelines alongside another intervention strategy that takes human behavioral theory into account, such as incentives, goal setting, and accountability results in greater improvement in HH compliance rates [15, 16]
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