Implementation of the WHO hand hygiene strategy in Faranah regional hospital, Guinea

Abstract

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 FRH staff and leadership was invited to identify priorities of the hospital prior to the start of PASQUALE. The local hygiene committee was empowered to increase its activities and take ownership of the HH improvement strategy. A baseline assessment of knowledge, perception and compliance was performed months before the intervention. The main intervention consisted of local alcohol-based-hand-rub (ABHR) production, with final product efficacy testing, in conjunction with a training adapted to the needs identified in the baseline assessment. A follow-up assessment was conducted directly after the training. Effectiveness of the intervention was assessed via uncontrolled before-and-after comparison. Results Baseline knowledge score (13.0/25) showed a significant increase to 19.0/25 in follow-up. Baseline-Compliance was 23.7% and increased significantly to 71.5% in follow-up. Compliance rose significantly across all professional groups except for midwifes and in all indications for HH, with the largest in the indication “Before aseptic tasks”. The increase in compliance was associated with the intervention and remained significant after adjusting for confounders. The local pharmacy successfully supplies the entire hospital. The local supply resulted in a ten-fold increase of monthly hospital disinfectant consumption. Conclusion The WHO HH strategy is an adaptable and effective method to improve HH knowledge and compliance in a resource-limited setting. Local production is a feasible method for providing self-sufficient supply of ABHR to regional hospitals like the FRH. Participatory approaches like hygiene committee ownership builds confidence of sustainability.

Mixed methods study evaluating the implementation of the WHO hand hygiene strategy focusing on alcohol based handrub and training among health care workers in Faranah, Guinea

“…HH compliance was 45.1% (95% CI 36.5–53.7) in second follow-up ( S1 Table ). Compared to previously published assessment round [ 13 ], compliance was significantly lower than in first follow-up (-26.4, p<0.001), but significantly higher than at baseline (+21.4, p<0.001). In the second follow-up compliance of “Technicians” was highest at 75.6% (95% CI 59.1–94.0) and compliance of “Midwifes” lowest at 13.3% (95% CI -22.3–48.9).…”

“…The median knowledge score of the second follow-up was 16.0/25 (IQR 15.0–18.0). Compared to previously published assessment rounds, second follow-up was significantly lower than first follow-up (-3.0, p<0.001), but significantly higher than in baseline (+6.0, p<0.001, Table 3 ) [ 13 ].…”

“…This study utilized a mixed method approach to assess the implementation of the WHO multimodal HH Strategy in a low-resource setting. This assessment focus on the long-term trends and challenges to sustainability, complementing a previous study on short term changes [ 13 ].…”

“…This decrease may be partially due to high staff turn-over, which is reflected by the decreasing proportion of previously trained HCWs. Nevertheless, knowledge at the second follow-up was still significantly higher than at baseline in all professional groups (“Medical Doctor” 13.5, “Nurse” 11.5, “Midwife” 13.0, “Technician” 13.0) except for “Others”, consisting primarily of medical students and auxiliary nurses and presumably particularly affected by high staff turn-over [ 13 ]. The qualitative study also identified high staff turn-over as a problem.…”

“…The results of baseline and first follow-up of this study have been reported in detail elsewhere [ 13 ]. To show long-term trends, including potential waning of knowledge and compliance, some results of baseline and first follow-up are cited and compared to results from second follow-up in the discussion section.…”