Health care worker hand hygiene in the pediatric special care unit at Mulago National Referral Hospital in Uganda

Abstract

The project provides another example of how audit can be used as a tool to improve health practice, even in a low-resource setting. At the same time, it showed how difficult it is to achieve compliance with best hand hygiene practice in a low-resource hospital. The project highlights the importance of continued education/awareness raising on the importance of good hand hygiene practice as well as investment in infrastructure and cleaning supplies for achieving and sustaining good hand hygiene among workers in a low-resource hospital setting. A key contribution of the project was the legacy it left in the form of knowledge about how to use audit and feedback as a tool to promote the best practice. A similar project has been implemented in the maternity ward at the hospital and further audits are planned.

Barriers and Facilitators to Implementing Evidence in African Health Care: A Content Analysis With Implications for Action

“…Eleven published (55%) and nine unpublished reports (45%) of implementation projects undertaken in Africa were reviewed. The majority of projects were conducted in Kenya (Amdamy & McMillan, ; Kaguongo & McArthur, ; Karua, ; Kebaya et al, ; Mirigo, ; Mwita et al, ; Nyakiba et al, ; Panga et al, ), Ghana (Amoah et al, ; Bayuo et al, ; Oduro, ; Tinkorang et al, ), Ethiopia (Admassu et al, ; Feyissa et al, ; Kerie et al, ), and Uganda (Ayiasi et al, ; Muhumuza et al, ), with one project each from Malawi (Chibwana & Gomersall, ), Tanzania (Jelly & Peters, ), and Cameroon (Okwen et al, ). A third of the projects were undertaken in a teaching hospital ( n = 6/20, 30%), another third were conducted in a regional, rural, district or public hospital ( n = 7, 35%), a few were carried out in a paediatric hospital ( n = 3, 15%), and one project each was implemented in a health centre ( n = 1, 5%), infectious disease hospital ( n = 1, 5%), health district ( n = 1, 5%) and a university‐based dental clinic ( n = 1, 5%).…”

“…The most frequently identified barrier that traversed countries and clinical settings was lack of material resources ( n = 16/20; 80%), including hospital equipment (e.g., endoscope, safety devices for sharp objects, ultrasound machine), supplies (e.g., hand hygiene products, water supply, sterile packs, medications), assessment tools (e.g., cardiovascular risk screening tool, pain assessment, thermometers) and reporting or documentation forms (Admassu, Abdulahi, Fogi, & Egziabher, ; Amdamy & McMillan, ; Amoah, Moola, & Newman‐Nartey, ; Bayuo et al., ; Chibwana & Gomersall, ; Feyissa, Gomersall, & Robertson‐Malt, ; Kaguongo & McArthur, ; Karua, ; Mirigo, ; Muhumuza et al., ; Mwita, Ogoti, Abila, Mbogo, & Sisenda, ; Nyakiba, McMillan, & Kenyatta, ; Oduro, ; Okwen et al., ; Panga et al., ; Tinkorang et al., ). An implementation project undertaken in a paediatric hospital in Kenya, which aimed to improve pain assessment in children postsurgery, identified the lack of an acute pain service (including a team of skilled practitioners and a dedicated facilitator to lead the service) as a key barrier to the implementation of best practice in acute postoperative pain assessment and management in children (Panga et al., ).…”

“…Another commonly reported organizational barrier was related to human resources ( n = 9/20; 45%). Heavy workload or inadequate staffing was identified in projects conducted in Uganda, Kenya, Ghana and Ethiopia across various clinical areas and was frequently described in rural‐ or regional‐based settings (Admassu et al., ; Amdamy & McMillan, ; Ayiasi et al., ; Feyissa et al., ; Karua, ; Mirigo, ; Muhumuza et al., ; Mwita et al., ; Oduro, ). Lack of or inadequate supervision and oversight of services provided to patients (i.e., postnatal women and patients postpulpotomy) was identified by two projects undertaken in Uganda and Ghana, respectively (Amoah et al., ; Ayiasi et al., ).…”

“…Lack of knowledge, misconceptions about EBHC and lack of access to best practice recommendations were the most frequently cited barriers ( n = 14/20; 70%) at the health practitioner level, across all countries and clinical settings (Amdamy & McMillan, ; Bayuo et al., ; Chibwana & Gomersall, ; Feyissa et al., ; Jelly & Peters, ; Kaguongo & McArthur, ; Karua, ; Mirigo, ; Muhumuza et al., ; Mwita et al., ; Oduro, ; Okwen et al., ; Panga et al., ; Tinkorang et al., ). This barrier was attributed to lack of resources to enable access to evidence‐based/best practice recommendations, lack of available professional development training and lack of time to attend training.…”

Criterion-Based Audit of Hand Hygiene Performance During Caesarean Section at a Referral Hospital in Northern Tanzania: An Uncontrolled Interventional Study

“…The main reason given was absence of previous training, in congruence with results reported by other studies. 29 Alcohol based hand rub use in health facilities is considered as the gold standard and cost effective in hand hygiene practice in the prevention of HCAIs. 5;14 Our finding show that provision of alcohol based hand rub has contributed to the improvement of hand wash with alcohol hand rub practices especially after procedure.…”