Barriers to hand hygiene practices among health care workers in sub-Saharan African countries: A narrative review

Abstract

Background: Hand hygiene (HH) is the primary measure in the prevention of healthcare associated infections though from published studies, compliance of healthcare workers to HH guidelines is low. There is currently no review on HH compliance rate in developing countries, specifically Sub-Saharan Africa (SSA) or the barriers to compliance. We therefore, through a narrative review sought to identify the compliance with and the barriers to HH in SSA.Methods: From three databases, we performed a search of peer-reviewed studies from SSA, conducted among healthcare workers, published in English language and between 2005 and 2017. Only studies that reported HH compliance and/or barriers were included.Results: A total of 278 articles were identified and the final sample of 27 analyzed in full length. Overall HH compliance rate was estimated to be 21.1% and doctors had better compliance irrespective of the type of patient contact. The main barriers identified were heavy workload, infrastructural deficit (e.g. lack of water, soap, hand sanitizers and blocked/leaking sinks) and poorly positioned facilities. Conclusion:HH compliance is poor among SSA healthcare workers. There is a need for more reports of HH compliance in SSA and emphasis needs to be placed on surgical wards where surgical sites infections, the commonest form of HCAI in SSA are likeliest. Barriers identified in this review are consistent with the findings of studies conducted elsewhere however it appears that heavy workload, infrastructural deficit and poorly positioned facilities are more likely in developing countries.

Influence of workload, mental health and professional quality of life on healthcare workers’ hand hygiene behavior in medical aid during COVID-19 pandemic

“…The indirect effect of workload on hand hygiene was also found to be signi cant in our study, which provides more explanation on how workload in uence hand hygiene compared to previous studies. For example, Ataiyero and Smith found that workload is one of the main barriers to hand hygiene, especially in developing countries based on narrative review and Theoretical Domains Framework [30,31], while Zhang found that high nursing workload is con rmed to be a main associated factor of poor hand hygiene in China [32]. Furthermore, the indirect effect of mental health on hand hygiene was also found to be signi cant in our study, while the direct effect was insigni cant, which was different from previous studies.…”

Antibiotics prescription for febrile patients: associated factors in a health facility-based survey in the Greater Accra region of Ghana

“…Less experienced prescribers may uphold the seeming theoretical ideals of rational use of medicines, less encumbered by the practical challenges of inadequately treated diseases and the associated patient dissatisfaction. Over time, prescribers may prefer treating as many likely causes of a set of symptoms in the face of overwhelming workload, inadequate human resources and poorly resourced laboratories [41,42]. It must be pointed out that at the time of the study, review of the STG was overdue by a year [43].…”

Observed and Self-reported Hand Hygiene Compliances and Associated Factors among Healthcare Workers at a County Referral Hospital in Kenya

“…Evidence suggests that by performing hand hygiene, we break the chain of transmission of the pathogens between patients and the healthcare environment (6) and can result in a reduction of 15% to 30% of HCAIs (7). Even though, hand hygiene compliance in low-income countries is as low as 21.1% due to the varied factors (8).…”

“…Previous studies have informed that self-assessment using questionnaires often indicate exaggerated ndings on hand hygiene compliance as compared to direct observation (8,9). Therefore, WHO (2009) has recommended direct observation based on the 5 moments for hand hygiene as a gold standard technique for monitoring hand hygiene practices among HCWs during patient care and remains widely used and reliable method (10).…”