Hand Hygiene Compliance at Two Tertiary Hospitals in Freetown, Sierra Leone, in 2021: A Cross-Sectional Study

Abstract

Hand hygiene actions are essential to reduce healthcare-associated infections and the development of antimicrobial resistance. In this cross-sectional study at two tertiary hospitals, Freetown, Sierra Leone, we observed hand hygiene compliance (defined as using handwash with soap and water or alcohol-based hand rub (ABHR) amongst healthcare workers between June and August 2021. Using the WHO Hand Hygiene tool, observations were made in relation to the type of opportunity, different wards and types of healthcare worker. Overall, 10,461 opportunities for hand hygiene were observed, of which 5086 (49%) resulted in hand hygiene actions. ABHR was used more often than handwash (26% versus 23%, p < 0.001). Overall, compliance was significantly better: after being with a patient/doing a procedure than before (78% after body fluid exposure risk compared with 24% before touching a patient—p < 0.001); in Paediatric (61%) compared with Medical wards (46%)—p < 0.001; and amongst nurses (52%) compared with doctors (44%)—p < 0.001. Similar patterns of compliance were observed within each hospital. In summary, hand hygiene compliance was sub-optimal, especially before being with a patient or before clean/aseptic procedures. Improvement is needed through locally adapted training, hand hygiene reminders in wards and outpatient departments, uninterrupted provision of ABHR and innovative ways to change behaviour.

Bir Üniversite Hastanesinin Sağlık Çalışanlarında COVID-19 Korkusu ve El Hijyeni Uygulamalarının Değerlendirilmesi

“…Toraman et al (2009) found the overall average handwashing rate of health personnel to be 73%, while the distribution occurred as 86% for nurses, 56% for the physicians, and 72% for the assistant health personnel. Similar to our study, the handwashing habits of doctors are at a lower rate (Al-Maani et al, 2022;Duman-Karakuş, Tanyel, and Deveci, 2022;Kamara et al, 2022).…”

“…Prior to our study, we did not investigate support structures such as adequate hospital availability of hand hygiene products, hand hygiene posters/reminders, or healthcare worker leadership, or employee perceptions such as fatalism, all of which may have influenced the a very weak, positive relationship. As a matter of fact, it has been revealed in a study that hand hygiene compliance is different at various levels of the health system and it is known that research is needed to learn more about compliance (Kamara et al, 2022). Across countries and time, levels of handwashing adherence and strictness of policies were high.…”

“…Recently, there has been a lot of research showing the level of hand hygiene compliance at different levels of the healthcare system. The compliance of healthcare workers with hand hygiene has changed with the fluctuations of COVID-19 (Al-Maani et al, 2022;Kamara et al, 2022;Luszczynska et al, 2022). Investigating how pandemics and epidemics affect the hand hygiene practices of healthcare professionals is important in terms of present and future studies, as well as determining the factors that will affect compliance.…”

Hand hygiene practices among healthcare workers – An audit conducted in a tertiary care hospital in the central province of Sri Lanka

“…Hand hygiene practices among healthcare workers -An audit conducted in a tertiary care hospital in the central province of Sri Lanka highly inadequate especially during the pandemic, where maintaining good HH was of utmost importance. Our total HH compliance was very similar to observations made in studies done in Sri Lanka, Sierra Leone, Southwest Nigeria and Ghana (17,29,30,31). The moment1, "bef-pat."…”

Level of Hand Hygiene Compliance and Its Associated Factors Among Health Care Workers at Eka Kotebe General Hospital, Addis Ababa, Ethiopia

“…This finding was supported by other studies. 17,28,[33][34][35][36] Training is an effective tool to increase the knowledge about hand hygiene actions for the prevention of nosocomial infections. 37 Training is essential to enhance awareness of microbial transmission by hands, emphasize the importance of hand hygiene and its indications, and demonstrate the correct procedures for hand rubbing and hand washing.…”