Implementation of the WHO Multimodal Hand Hygiene Improvement Strategy in a Tertiary Academic Hospital in Rwanda (original) (raw)
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Antimicrobial Resistance and Infection Control, 2017
Background: The burden of health-care associated infections in low-income countries is high. Adequate hand hygiene is considered the most effective measure to reduce the transmission of nosocomial pathogens. We aimed to assess compliance with hand hygiene and perception and knowledge about hand hygiene before and after the implementation of a multimodal hand hygiene campaign designed by the World Health Organization. Methods: The study was carried out at Asella Teaching Hospital, a university hospital and referral centre for a population of about 3.5 million in Arsi Zone, Central Ethiopia. Compliance with hand hygiene during routine patient care was measured by direct observation before and starting from six weeks after the intervention, which consisted of a four day workshop accompanied by training sessions and the provision of locally produced alcohol-based handrub and posters emphasizing the importance of hand hygiene. A second follow up was conducted three months after handing over project responsibility to the Ethiopian partners. Health-care workers' perception and knowledge about hand hygiene were assessed before and after the intervention. Results: At baseline, first, and second follow up we observed a total of 2888, 2865, and 2244 hand hygiene opportunities, respectively. Compliance with hand hygiene was 1.4% at baseline and increased to 11.7% and 13.1% in the first and second follow up, respectively (p < 0.001). The increase in compliance with hand hygiene was consistent across professional categories and all participating wards and was independently associated with the intervention (adjusted odds ratio, 9.18; 95% confidence interval 6.61-12.76; p < 0.001). After the training, locally produced alcohol-based handrub was used in 98.4% of all hand hygiene actions. The median hand hygiene knowledge score overall was 13 (interquartile range 11-15) at baseline and increased to 17 (15-18) after training (p < 0.001). Health-care workers' perception surveys revealed high appreciation of the different strategy components. Conclusion: Promotion of hand hygiene is feasible and sustainable in a resource-constrained setting using a multimodal improvement strategy. However, absolute compliance remained low. Strong and long-term commitment by hospital management and health-care workers may be needed for further improvement.
East African Medical Journal, 2014
To assess the impact of multimodal low-cost interventions on hand hygiene practices among medical teams. A four week prospective observational study. Medical wards of the University Teaching Hospital of Kigali (CHUK), Kigali, Rwanda. Medical teams comprising students, residents and consultant physicians. During week one, baseline hand sanitising rate (HSR)--the percentage of hand hygiene opportunities during which hands were sanitised- was recorded. On week two, alcohol based handrubs (ABHRs) were provided and placed strategically on every ward. For week three and four respectively, hand hygiene posters (HHPs) were placed at entry sites of each ward at eye level and subsequently at the head of each patient's bed. Post-intervention HSR was recorded weekly during morning ward rounds. The differences between pre-intervention and post-intervention HSRs as well as end-of-study pre- and post-contact HSR were assessed for significance using Pearson chi square test. A total of 780 HHOs ...
Background: Hand hygiene compliance is challenging in both developed and developing countries. In Brazil there are more than 179,000 thousand registered health services, from which 6,851 are hospitals, including private, public and philanthropic institutions. Objective: To describe a pilot project implementation of the WHO Multimodal Hand Hygiene Improvement Strategy in 5 Brazilian healthcare services in order to encourage interventions for the prevention of healthcare associated infections. Methods: The (WHO)/Brazil/Pan American Organization (PAHO)/National Health surveillance Agency (Anvisa)/Hand Hygiene Project has been developed in 5 hospitals by National Coordination (ANVISA and Brazil-PAHO/WHO). The project was supported by the Brazilian government which formally signed an agreement in November 2007 to participate in the World Alliance for Patient Safety. Since then, ANVISA has been developing actions related to the First Global Patient Safety Challenge, specially regarding “H...
Implementation of the WHO Hand Hygiene Strategy in Faranah Regional Hospital, Guinea
2019
Background: Healthcare-associated infections are the most frequent adverse events in healthcare worldwide, with limited available evidence suggesting highest burden in resource-limited settings. Recent Ebola epidemics emphasize the disastrous impact that spread of infectious agents within healthcare facilities can have, accentuating the need for improvement of infection control practices. Hand hygiene (HH) measures are considered to be the most effective tool to prevent Healthcare-associated infections. However, HH knowledge and compliance are low, especially in vulnerable settings such as Guinea. The aim of PASQUALE (Partnership to Improve Patient Safety and Quality of Care) was to assess knowledge and compliance with HH and improve HH by incorporating the WHO HH Strategy within the Faranah Regional Hospital (FRH), Guinea.Methods: In a participatory approach, a team of HRF staff and leadership was invited to identify priorities of the hospital prior to the start of PASQUALE. The lo...
Implementation of a Multimodal Multicentre Hand Hygiene Study: Evidence From Bangladesh Hospitals
Global Journal of Health Science
INTRODUCTION: Hand hygiene (HH), one of the most important preventive measures of Healthcare-associated infections (HCAIs), is often neglected by healthcare workers (HCWs) in low and middle-income countries (LMICs). PURPOSE: The purpose of the study is to assess the role of a multimodal intervention (MMI) for enhancing hand hygiene compliance (HHC) of HCWs in a resource-limited setting. METHODOLOGY: A pretest-posttest quasi-experimental study was conducted in five hospitals of Bangladesh where 984 HCWs (342 physicians and 642 nurses) were selected purposively. Using a structured checklist, a direct observational assessment was carried out on HCWs’ HHC both before and after the intervention. The MMI provided to HCWs comprised of: (i) system change, (ii) educational intervention, (iii) visual reminders, (iv) monitoring and performance feedback and (v) formation of infection control committees. RESULTS: Following intervention, overall HH compliance before and after patient contact sign...
International Journal of Infection Control, 2021
Background: Proper hand hygiene (HH) practices have been shown to reduce healthcare-acquired infections. Several potential challenges in low-income countries might limit the feasibility of effective HH, including preexisting knowledge gaps and staffing. Aim: We sought to evaluate the feasibility of the implementation of effective HH practice at a teaching hospital in Rwanda. Methods: We conducted a prospective quality improvement project in the intensive care unit (ICU) at the Kigali University Teaching Hospital. We collected data before and after an intervention focused on HH adherence as defined by the World Health Organization ‘5 Moments for Hand Hygiene’ and assuring availability of HH supplies. Pre-intervention data were collected throughout July 2019, and HH measures were implemented in August 2019. Post-implementation data were collected following a 3-month wash-in. Results: In total, 902 HH observations were performed to assess pre-intervention adherence and 903 observations...
American Journal of Infection Control, 2014
Background-The World Health Organization (WHO) launched a multimodal strategy and campaign in 2009 to improve hand hygiene practices worldwide. Our objective was to evaluate the implementation of the strategy in United States health care facilities. Methods-From July through December 2011, US facilities participating in the WHO global campaign were invited to complete the Hand Hygiene Self-Assessment Framework online, a validated tool based on the WHO multimodal strategy. Results-Of 2,238 invited facilities, 168 participated in the survey (7.5%). A detailed analysis of 129, mainly nonteaching public facilities (80.6%), showed that most had an advanced or intermediate level of hand hygiene implementation progress (48.9% and 45.0%, respectively). The total Hand Hygiene Self-Assessment Framework score was 36 points higher for facilities with staffing levels of infection preventionists > 0.75/100 beds than for those with lower ratios (P =. 01) and 41 points higher for facilities participating in hand hygiene campaigns (P = .002). Conclusion-Despite the low response rate, the survey results are unique and allow interesting reflections. Whereas the level of progress of most participating facilities was encouraging, this may reflect reporting bias, ie, better hospitals more likely to report. However, even in respondents, further improvement can be achieved, in particular by embedding hand hygiene in a stronger institutional safety climate and optimizing staffing levels dedicated to infection prevention. These
Improving Hand Hygiene Compliance Through Who’s Multimodal Hand Hygiene Improvement Strategy
Journal of Health and Translational Medicine, 2020
Introduction: Hand hygiene compliance of Health Care Workers (HCW) in Indonesia for the year 2014 was only 73.34%, a rate that was much lower than WHO’s recommended standard. This is indication that there is a need to implement quality improvement. In 2015, the WHO’s multimodal hand hygiene improvement strategy was implemented in all units or wards of hospitals as a measure to improve Hand Hygiene among healthcare workers. This paper aims to demonstrate the improvement of hand hygiene compliance amongst HCWs in hospitals by using the WHO multimodal hand hygiene improvement strategy. Materials and Methods: This study is cross sectional involving observations performed of different HCWs in the hospital site. Quantitative in design, this study is supported by the chi-square analysis which helps to determine the significance of hand hygiene compliance improvement among healthcare workers in Indonesian hospitals. The WHO’s multimodal improvement strategy which comprised system change in...