Hand Hygiene Opportunities Research Articles

Validation and implementation of group electronic hand hygiene monitoring across twenty-four critical care units.

An accurate estimate of the average number of hand hygiene opportunities per patient hour (HHO rate) is required to implement group electronic hand hygiene monitoring systems (GEHHMSs). We sought to identify predictors of HHOs to validate and implement a GEHHMS across a network of critical care units. Multicenter, observational study (10 hospitals)followed by quality improvement intervention involving 24 critical care units across 12 hospitals in Ontario, Canada. Critical care patient beds were randomized to receive 1 hour of continuous direct observation to determine the HHO rate. A Poisson regression model determined unit-level predictors of HHOs. Estimates of average HHO rates across different types of critical care units were derived and used to implement and evaluate use of GEHHMS. During 2,812 hours of observation, we identified 25,417 HHOs. There was significant variability in HHO rate across critical care units. Time of day, day of the week, unit acuity, patient acuity, patient population and use of transmission-based precautions were significantly associated with HHO rate. Using unit-specific estimates of average HHO rate, aggregate HH adherence was 30.0% (1,084,329 of 3,614,908) at baseline with GEHHMS and improved to 38.5% (740,660 of 1,921,656) within 2 months of continuous feedback to units (P < .0001). Unit-specific estimates based on known predictors of HHO rate enabled broad implementation of GEHHMS. Further longitudinal quality improvement efforts using this system are required to assess the impact of GEHHMS on both HH adherence and clinical outcomes within critically ill patient populations.

Impact of a Multimodal Improvement Strategy to Promote Hand Hygiene at a Hospital in Mauritius.

IntroductionLimited data is available on which interventions are likely to improve compliance to hand hygiene, especially in underdeveloped countries. The objective of this study is to explore whether the introduction of a particular bundle of strategies to improve hand hygiene is effective.Material and methodsIn this pre-post study, a multimodal strategy comprised of educating healthcare staff, using reminders, providing feedback and increasing the availability of soap and alcohol, was implemented over a period of one year from 2019 to 2020. Trained observers assessed compliance to hand hygiene before and after the intervention.ResultsA total of 143 hand hygiene opportunities were observed. Hand hygiene compliance rate did not improve despite the introduction of multiple measures.ConclusionsOther approaches should be considered to promote hand hygiene. The choice of which strategies to use should be adapted to the local setting. For instance, in some healthcare facilities, emphasis should be placed on leadership support and on the training of hand hygiene champions.

Clinical Evaluation with Automated Hand Hygiene Monitoring System: A Prospective Observational Study on Compliance Improvement Using Feedback Data

Background Hand hygiene compliance (HHC) among healthcare workers (HCWs) remains suboptimal. Hand hygiene (HH) among HCWs is regarded one of the most effective measures to reduce healthcare-associated infections. We aimed to evaluate HH improvement in HCWs using an automated monitoring system to provide systematic feedback on staff HHC. Methods A prospective observational study was conducted in a Danish medical hospital ward (23 beds) between February-November 2020. Sensors were placed on alcohol-based sanitizers, HCW name tags, and patient beds. The sensors measured HH opportunities and sanitizations to be able to provide compliance feedback to staff groups and individuals. Baseline data were obtained before the reporting of feedback data. HCWs were grouped as caregivers (n=58) and doctors (n=18). Rooms were classified by type e.g., medication room and patient room. Overall data was regularly presented to the staff group and subgroups, caregivers, and doctors. Student's t-test was used for comparisons. A two-tailed value of p Results Baseline was performed twice (at weeks 4 and 5 because the COVID19 pandemic interrupted the study for a period). Both baselines showed similar initial compliance among HCW. Baseline HHC was lowest before patient contact (BPC) compared to after patient contact (APC) for both the doctors (16% vs. 26%) and the nurses (22% vs. 39%). Once data were shown and feedback provided, both the doctors (BPC: 16% vs. 24%, p=0.014; APC: 26% vs. 35% p=0.059) and caregivers (BPC: 22% vs. 37%, p Conclusions Feedback data from the automated hand hygiene monitoring system helped the HCWs to improve their HHC significantly.

Implementing an electronic hand hygiene system improved compliance in the intensive care unit

Hand hygiene (HH) compliance is low and difficult to improve among health care workers. We aim to validate an electronic HH system and assess the impact of this system on HH compliance and quality changes over time at both group and individual levels. An automated electronic HH system was installed in a 10-bed surgical intensive care unit. The full HH compliance rate increased significantly from 8.4% in week 1 to 20.5% in week 16 with week 10 being the highest (27.4%). The partial compliance rate maintained relative consistency between 13.2% and 20.0%. The combined compliance rate (full compliance rate+partial compliance rate) increased from 23.5% in week 1 to 34.6% in week 16 with week 10 being the highest (41.4%). We found significant variations among providers in terms of HH opportunities per shift, full compliance, partial compliance and combined compliance rates. The average duration of hand rubbing over time in partial compliance occurrences did not change significantly over time. A sensor-based platform with automated HH compliance and quality monitoring, real time feedback and comprehensive individual level analysis, improved providers' HH compliance in an intensive care unit. There were significant variations among individual providers.

The impact of workload on hand hygiene compliance: Is 100% compliance achievable?

Hand hygiene compliance decreased significantly when opportunities exceeded 30 per hour. At higher workloads, the number of healthcare worker types involved and the proportion of hand hygiene opportunities for which physicians and other healthcare workers were responsible increased. Thus, care complexity and risk to patients may both increase with workload.

Apego a higiene de manos en 5 momentos y protección específica en un hospital de tercer nivel ante la pandemia de COVID-19

Introduction: During the COVID-19 pandemic, adherence to hygiene measures is an objective aimed at reducing morbidity and mortality. Objective: To evaluate adherence to hand hygiene and protection measures during the COVID-19 pandemic in a tertiary care hospital. Methods: Cross-sectional study on health personnel handwashing at the five moments recommended by the World Health Organization, as well as on the use of specific personal protective equipment. Results: One hundred and seventeen hand hygiene opportunities were observed in health personnel. Hand washing was observed in 40 (34 %) and omission in 76 (65 %). Adherence to the use of face shield was observed in five (4 %), and lack of adherence in 112 (96%). Adherence to the use of face mask was observed in 65 nursing professionals (87 %), with appropriate use of the mask in 56 of them (60 %) and use of face shield in one (1 %). Conclusion: Health personnel showed low proportions of adherence to hand hygiene and use of equipment for specific protection during the COVID-19 pandemic.

Hand Hygiene during the Early Neonatal Period: A Mixed-Methods Observational Study in Healthcare Facilities and Households in Rural Cambodia.

Background: Globally, infections are the third leading cause of neonatal mortality. Predominant risk factors for facility-born newborns are poor hygiene practices that span both facilities and home environments. Current improvement interventions focus on only one environment and target limited caregivers, primarily birth attendants and mothers. To inform the design of a hand hygiene behavioural change intervention in rural Cambodia, a formative mixed-methods observational study was conducted to investigate the context-specific behaviours and determinants of handwashing among healthcare workers, and maternal and non-maternal caregivers along the early newborn care continuum. Methods: Direct observations of hygiene practices of all individuals providing care to 46 newborns across eight facilities and the associated communities were completed and hand hygiene compliance was assessed. Semi-structured interactive interviews were subsequently conducted with 35 midwives and household members to explore the corresponding cognitive, emotional and environmental factors influencing the observed key hand hygiene behaviours. Results: Hand hygiene opportunities during newborn care were frequent in both settings (n = 1319) and predominantly performed by mothers, fathers and non-parental caregivers. Compliance with hand hygiene protocol across all caregivers, including midwives, was inadequate (0%). Practices were influenced by the lack of accessible physical infrastructure, time, increased workload, low infection risk perception, nurture-related motives, norms and inadequate knowledge. Conclusions: Our findings indicate that an effective intervention in this context should be multi-modal to address the different key behaviour determinants and target a wide range of caregivers.

Has the COVID 19 Virus Changed Adherence to Hand Washing among Healthcare Workers?

The aim of the study was to assess adherence to hand washing by healthcare workers (HCWs) and its variations over time in hospital wards. We wanted to check whether the pandemic had changed the behavior of HCWs. The study was conducted between 1 January 2015, and 31 December 2020. The HCWs were observed to assess their compliance with the Five Moments for Hand Hygiene. We described the percentage of adherence to World Health Organization (WHO) guidelines stratified per year, per specialty areas, per different types of HCWs. We also observed the use of gloves. Descriptive data were reported as frequencies and percentages. We observed 13,494 hand hygiene opportunities. The majority of observations concerned nurses who were confirmed as the category most frequently involved with patients. Hospital’s global adherence to WHO guidelines did not change in the last six years. During the pandemic, the rate of adherence to the procedure increased significantly only in Intensive Care Unit (ICU). In 2020, the use of gloves increased in pre-patient contact. The hand-washing permanent monitoring confirmed that it is very difficult to obtain the respect of correct hand hygiene in all opportunities, despite the ongoing pandemic and the fear of contagion.

Hand hygiene and the sequence of patient care.

To determine whether the order in which healthcare workers perform patient care tasks affects hand hygiene compliance. For this retrospective analysis of data collected during the Strategies to Reduce Transmission of Antimicrobial Resistant Bacteria in Intensive Care Units (STAR*ICU) study, we linked consecutive tasks healthcare workers performed into care sequences and identified task transitions: 2 consecutive task sequences and the intervening hand hygiene opportunity. We compared hand hygiene compliance rates and used multiple logistic regression to determine the adjusted odds for healthcare workers (HCWs) transitioning in a direction that increased or decreased the risk to patients if healthcare workers did not perform hand hygiene before the task and for HCWs contaminating their hands. The study was conducted in 17 adult surgical, medical, and medical-surgical intensive care units. HCWs in the STAR*ICU study units. HCWs moved from cleaner to dirtier tasks during 5,303 transitions (34.7%) and from dirtier to cleaner tasks during 10,000 transitions (65.4%). Physicians (odds ratio [OR]: 1.50; P < .0001) and other HCWs (OR, 2.15; P < .0001) were more likely than nurses to move from dirtier to cleaner tasks. Glove use was associated with moving from dirtier to cleaner tasks (OR, 1.22; P < .0001). Hand hygiene compliance was lower when HCWs transitioned from dirtier to cleaner tasks than when they transitioned in the opposite direction (adjusted OR, 0.93; P < .0001). HCWs did not organize patient care tasks in a manner that decreased risk to patients, and they were less likely to perform hand hygiene when transitioning from dirtier to cleaner tasks than the reverse. These practices could increase the risk of transmission or infection.

Hand Hygiene by Healthcare Workers: a neglected practice

Hand Hygiene (HH) is a simple and essential action in the prevention of infectious diseases. Therefore, the aim of this study was to evaluate the levels of adherence, technique, and knowledge about HH by healthcare workers and perform an educational intervention. We conducted a cross-sectional analysis with 20 professionals, for six months. We observed and categorized the HH opportunities, evaluated the performance of the correct technique, determined the degree of HH compliance (Positivity Index proposed by Carter, IPC) and applied a questionnaire about HH. The data contributed to conduct training and discussion about COVID-19, using a didactic model of virus. We observed N = 791 opportunities for HH, but only N = 128 (16.18%) were performed, with the correct technique in 80.47% (N = 103). The categories with the greatest number of opportunities for HH were “after patient care” (N = 238) and “before patient care” (N = 214). However, HH occurred only in N = 76 (31.93%) and N = 28 (13.08%), respectively. Comparing the categories, the highest adherence was "after removing the gloves" (53.19%). The degree of HH compliance in this study is lower than that recommended by the IPC (70%). In the questionnaires, workers affirmed to have taken at least one course about HH throughout their careers; few of them mentioned virus as a microbe present in the hands; “Lack of time” was the major reason to not HH. The educational intervention reinforced the importance of the correct HH technique, stimulated adaptations in the hospital structure and in strategies for coping with the emergence of the pandemic.

Feasibility of Direct Observation and Consumption Method for Hand Hygiene Compliance in an Intensive Care Unit of a Tertiary Care Hospital

Background: Emerging pandemics, rampant multidrug resistance, and diversity of healthcare-associated infections entail hand hygiene (HH) compliance, surveillance, and documentation as the cornerstone of infection control practices. Methods: HH adherence rates (HHARs) were determined by the WHO's “Direct Observation” technique and compared with the “Indirect Hand-Rub Consumption” method, in the main intensive care unit of a tertiary care hospital over a period of 15 days, encompassing 3000 HH opportunities. HHARs were also compared over the study duration and among doctors and nurses. Results: The overall HHAR estimated by direct observation as per the WHO criteria was 28.5% and by “indirect hand-rub consumption” method was 12.12%. Healthcare workers adhered maximally to the WHO HH moment 3 (64.6%) followed by 5 (31.6%), 4 (27%), and 2 (27%). Conclusion: The direct observation technique for monitoring HH, though conventionally deemed as the gold standard, mandates skilled personnel and devoted time which may deter daily surveillance in resource-limited settings. The time constraints in addition to the observation biases often confound or may even push HH surveillance to the backburners. The indirect “hand-rub consumption” technique, on the other hand, might prove to be an attractive alternative in resource-limited settings, which, in addition to providing an overall glimpse of existing HH culture, is also devoid of observation biases.

The situation of routine hand hygiene compliance of health workers at Cu Jut Medical Center, Dak Nong district and some influencing factors in 2020

Background: Hand hygiene is a great way to ensure safety for health staff and prevent infections in hospital. Objective: The study aimed to determine the rate of compliance with routine hand hygiene and to analyze some factors affecting hand hygiene compliance routine of medical staff. Method: A study that describes a cross-sectional study, a study that combines both quantitative and qualitative methods through the observation by a checklist of 92 health-care workers who perform a procedure on 368 hand-hygiene opportunities and gather information through burns. interviewed 92 medical staff, conducted 04 in-depth interviews and 02 group discussions, and collected from March to the end of June 2020. Research Using Epidata 3.1 software to input data and manage data; Stata 14.0 software for data analysis. Results show that the percentage of health staffs who complied with routine hand hygiene was 14.13%, and the knowledge and attitudes of hospital staffs were related to routine hand hygiene compliance, with p&lt;0.05. Inspection and supervision, regulations on emulation and commendation; training and accessibility solutions were related withhand hygiene of health staffs. Conclusion: Hospital staffs' hand hygiene compliance rate was relatively low, which was related to knowledge and attitudes. Keywords: Routine hand hygiene, medical staff, influencing factors.

Effect of Wearing a Novel Electronic Wearable Device on Hand Hygiene Compliance Among Health Care Workers

Hand hygiene (HH) is essential to prevent hospital-acquired infections. To determine whether providing real-time feedback on a simplified HH action improves compliance with the World Health Organization's "5 Moments" and the quality of the HH action. This open-label, cluster randomized, stepped-wedge clinical trial was conducted between June 1, 2017, and January 6, 2018 (with a follow-up in March 2018), in a geriatric hospital of the University of Geneva Hospitals, Switzerland. All 12 wards and 97 of 306 eligible health care workers (HCWs) volunteered to wear a novel electronic wearable device that delivered real-time feedback on duration of hand rubbing and application of a hand-sized customized volume of alcohol-based handrub (ABHR). This study had 3 sequential periods: baseline (no device), transition (device monitoring without feedback), and intervention (device monitoring and feedback). The start of the transition period was randomly allocated based on a computer-generated block randomization. The primary outcome was HH compliance, according to the direct observation method during intervention as compared with baseline. Secondary outcomes included the volume of ABHR and duration of hand rubbing measured by the device during intervention as compared with transition. All wards and respective HCWs were evenly assigned to group 1 (26 participants), 2 (22 participants), 3 (25 participants), or 4 (24 participants). Twelve HCWs did not fully complete the intervention but were included in the analysis. During 759 observation sessions, 6878 HH opportunities were observed. HH compliance at intervention (62.9%; 95% CI, 61.1%-64.7%) was lower than at baseline (66.6%; 95% CI, 64.8%-68.4%). After adjusting for covariates, HH compliance was not different between periods (odds ratio, 1.03; 95% CI, 0.75-1.42; P = .85). Days since study onset (OR, 0.997; 95% CI, 0.994-0.998; P < .001), older age (OR, 0.97; 95% CI, 0.95-0.99; P = .015), and workload (OR, 0.29; 95% CI, 0.20-0.41; P < .001) were independently associated with reduced HH compliance. The median (interquartile range) volume of ABHR and duration of hand rubbing in transition and intervention increased from 1.12 (0.76-1.68) mL to 1.71 (1.01-2.76) mL and from 6.5 (4.5-10.5) seconds to 8 (4.5-15.5) seconds, respectively. There were no serious adverse events. The use of this device did not change HH compliance, but increased the duration of hand rubbing and volume of ABHR used by HCWs. isrctn.org Identifier: ISRCTN25430066.

Impact of replacing powdered gloves with powder-free gloves on hand-hygiene compliance among healthcare workers of an intensive care unit: a quasi-experimental study

Background/objectiveAfter wearing powdered gloves, healthcare workers (HCW) are supposed to wash their hands instead of using alcohol-based hand-rub (ABHR). Washing hands takes longer than using ABHR, and the use of powdered gloves may be an obstacle to hand-hygiene compliance. This study aimed to evaluate the impact of replacing powdered gloves with powder-free gloves on hand-hygiene compliance among HCW of an intensive care unit (ICU).MethodsA quasi-experimental study was conducted in a general ICU of a tertiary care university hospital in Brazil. From June 1st to July 15th, 2017, all HCW were provided with powdered latex gloves only for all clinical procedures. From July 15th to August 31st, 2017, HCW were provided with nitrile powder-free gloves only. Hand-hygiene compliance was assessed through direct observation, and evaluated according to the World Health Organization Hand Hygiene guidelines. We calculated that a sample size of 544 hand hygiene opportunities needed to be observed per period. Data analysis were performed using the STATA SE® version 14, and we compared the individual’s percentage of compliance using the t test for paired data before and after the intervention.ResultsOverall, 40 HCW were assessed before and after the introduction of nitrile powder-free gloves, with 1114 and 1139 observations of hand hygiene opportunities, respectively. The proportion of compliance with hand hygiene was 55% (95% confidence interval [CI] 51–59%) using powdered latex gloves and 60% (95% CI 57–63%) using powder-free gloves. The difference in proportions between the two types of gloves was 5.1% (95% CI 2.5–7.6%, p < 0.001).ConclusionOur data indicate that replacing powdered gloves with powder-free gloves positively influenced hand-hygiene compliance by HCW in an ICU setting.

Hand hygiene by the nursing team in home care: a cross-sectional study.

to identify whether nursing professionals carry out hand hygiene, how they do it, and what resources are available for this practice during home visits. cross-sectional study conducted in a public Home Care service. The World Health Organization instrument was used to observe the hand hygiene technique, the time of performance, and the product used. a total of 940 hand hygiene opportunities taking place in 231 home visits were observed. Overall adherence was 14.4%, with the practice of hand hygiene being higher after contact with the patient (53.7%). Before aseptic procedures, after risk/exposure to body fluids, after contact with the patient's environment, and before contact with the patient, adherence was 0.4%. Regarding the quality of the technique, in none of the 135 practices the recommended steps were followed. As for the structure available in the households, 35 (15.2%) had accessible sinks and none had liquid soap and alcohol-based formulation. adherence to hand hygiene by nursing professionals in home care was low, the technique was not performed, and households did not have resources for the practice.

857. Contact Precautions as a Barrier to Hand Hygiene: PDSA to Improve Compliance with Gloved Hand Hygiene

BackgroundFull compliance with personal protective equipment (PPE) is challenging, with multiple barriers noted: adherence to appropriate PPE, lack of knowledge of appropriate PPE, added time to workflow, and appropriate donning/doffing techniques of PPE to avoid self-contamination. Recent studies note that nurses tend to batch care to achieve more while in the room. A hand hygiene technology system alerted MRICU nurses to difficulties performing WHO’s Five Moments of hand hygiene (HH) when in contact precaution PPE.MethodsWe implemented the ‘Plan-Do-Study-Act’ (PDSA) framework to address the MRICU team concerns. Six nurses were directly observed while providing bedside care to understand nursing workflow and barriers to HH while in contact precautions.ResultsAll 6 nurses performed hand hygiene prior to entering the room and at the time of exiting the room. Once donning contact precautions, they had variable but low compliance with any additional HH opportunities. The average missed opportunities per encounter was 5.2 (range: 2-11). Moments that would require hand washing or sanitizer if nurse were not gloved were not met with changing gloves. An average of 9.8 tasks were achieved in each room (range: 3-18). On average, each visit was 16 (range: 4-30 minutes) minutes long.ConclusionThere is significant opportunity for improved HH while in PPE. Nurses may be more aware of the “Five moments” when not wearing gloves in contact precaution rooms, but lose the trigger once the gloves are on in the contact precaution rooms. An education campaign to improve hand sanitizer usage with gloves is the next step in this PDSA. More prominent placement of glove boxes in the rooms will also serve as a trigger to remind nurses to change gloves after certain tasks. Limitations of this PDSA cycle include Hawthorne effect of the nurses knowing they were observed and potentially changing their workflow. We also only observed morning workflow; nurses on different shifts may have different workflow.Disclosures All Authors: No reported disclosures

Using a multimodal strategy to improve patient hand hygiene

ObjectiveThe role of health care worker hand hygiene in preventing health care associated infections (HCAI) is well-established. There is less emphasis on the hand hygiene (HH) of hospitalized patients; in the context of COVID-19 mechanisms to support it are particularly important. The purpose of this study was to establish if providing patient hand wipes, and a defined protocol for encouraging their use, was effective in improving the frequency of patient HH (PHH).DesignBefore and after study.SettinGeneral Hospital, United Kingdom.ParticipantsAll adult patients admitted to 6 acute elderly care/rehabilitation hospital wards between July and October 2018.MethodsBaseline audit of PHH opportunities conducted over 6 weeks. Focus group with staff and survey of the public informed the development of a PHH bundle. Effect of bundle on PHH monitored by structured observation of HH opportunities over 12 weeks.ResultsDuring baseline 303 opportunities for PHH were observed; compliance with PHH was 13.2% (40/303; 95% confidence interval 9.9-7.5). In the evaluation of PHH bundle, 526 PHH opportunities were observed with HH occurring in 58.9% (310/526); an increase of 45.7% versus baseline (95% confidence interval 39.7%-51.0%; P < .001).ConclusionProviding patients with multiwipe packs of handwipes is a simple, cost-effective approach to increasing PHH and reducing the risk of HCAI in hospital. Health care workers play an essential role in encouraging PHH.

Light-guided nudging and data-driven performance feedback improve hand hygiene compliance among nurses and doctors

Evidence-based practices to increase hand hygiene compliance (HHC) among health care workers are warranted. We aimed to investigate the effect of a multimodal strategy on HHC. During this 14-month prospective, observational study, an automated monitoring system was implemented in a 29-bed surgical ward. Hand hygiene opportunities and alcohol-based hand rubbing events were measured in patient and working rooms (medication, utility, storerooms, toilets). We compared baseline HHC of health care workers across periods with light-guided nudging from sensors on dispensers and data-driven performance feedback (multimodal strategy) using the Student's t test. The doctors (n = 10) significantly increased their HHC in patient rooms (16% vs 42%, P< .0001) and working rooms (24% vs 78%, P= .0006) when using the multimodal strategy. The nurses (n = 26) also increased their HHC significantly from baseline in both patient rooms (27% vs 43%, P = .0005) and working rooms (39% vs 64%, P< .0001). The nurses (n = 9), who subsequently received individual performance feedback, further increased HHC, compared with the period when they received group performance feedback (patient rooms: 43% vs 55%, P< .0001 and working rooms: 64% vs 80%, P< .0001). HHC of doctors and nurses can be significantly improved with light-guided nudging and data-driven performance feedback using an automated hand hygiene system.

Installation of pedal-operated alcohol gel dispensers with behavioral nudges and changes in hand hygiene behaviors during the COVID-19 pandemic: A hospital-based quasi-experimental study.

We conducted a quasi-experimental study and compared hand hygiene behaviors at potential pathogen transmission events among outpatient visitors (according to structured observations a trained enumerator) before and after installation of 12 pedal-operated alcohol gel dispensers with behavioral nudges (signs attached to the dispensers) at a tertiary hospital in southern Thailand during the COVID-19 pandemic. The enumerator observed 243 events during the pre-intervention period and 223 events during the postintervention period. Prevalence of hand hygiene was significantly different between the pre-intervention and post-intervention periods (0 vs 24 events, or 0% vs 11%, respectively; p-value <0.001). However, 21 of 24 hand hygiene events were of participants who came from outside the observation area, used the dispensers, then left. Nonetheless, the intervention might have helped to increase access to hand hygiene materials and created opportunities for hand hygiene among hospital visitors in general.Significance for public healthThis study compared hand hygiene behaviors after installation of pedal-operated alcohol gel dispensers compared to hand hygiene behaviors before the installation. Prevalence of observed hand hygiene was higher after installation compared to before installation, which suggested that the installation might have eliminated some barriers to hand hygiene. However, use of the alcohol gel might not necessarily indicate proper hand disinfection, and the prevalence of hand hygiene remained low, which highlighted the ongoing need to improve hand hygiene at potential pathogen transmission events (including transmission of COVID-19) at health facilities. Future studies should aim to understand the reasons(s) for missed hand hygiene opportunities and consider incorporating interventions that have shown effectiveness in improving hand hygiene behaviors among healthcare workers, as well as materials from the World Health Organization’s Guidelines on hand hygiene in health care.

Hygiene along the continuum of care in the early post-natal period: an observational study in Nigeria

BackgroundNewborns delivered in healthcare facilities in low- and middle-income countries are at an increased risk of healthcare associated infections. Facility–based studies have focused primarily on healthcare worker behaviour during labour & delivery with limited attention to hygiene practices in post-natal care areas and largely ignore the wide variety of actors involved in maternal and neonatal care.MethodsThis exploratory mixed-methods study took place in six healthcare facilities in Nigeria where 31 structured observations were completed during post-natal care, discharge, and the first 6 hours after return to the home. Frequency of hand hygiene opportunities and hand hygiene actions were assessed for types of patient care (maternal and newborn care) and the role individuals played in caregiving (healthcare workers, cleaners, non-maternal caregivers). Qualitative interviews with mothers were completed approximately 1 week after facility discharge.ResultsMaternal and newborn care were performed by a range of actors including healthcare workers, mothers, cleaners and non-maternal caregivers. Of 291 hand hygiene opportunities observed at health facilities, and 459 observed in home environments, adequate hand hygiene actions were observed during only 1% of all hand hygiene opportunities. Adequate hand hygiene prior to cord contact was observed in only 6% (1/17) of cord contact related hand hygiene opportunities at healthcare facilities and 7% (2/29) in households. Discharge advice was infrequent and not standardised and could not be remembered by the mother after a week. Mothers reported discomfort around telling non-maternal caregivers to practice adequate hand hygiene for their newborn.ConclusionsIn this setting, hand hygiene practices during post-natal care and the first 6 hours in the home environment were consistently inadequate. Effective strategies are needed to promote safe hand hygiene practices within the post-natal care ward and home in low resource, high-burden settings. Such strategies need to target not just mothers and healthcare workers but also other caregivers.