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

Abstract

Introduction The most frequent adverse health events in healthcare worldwide are healthcare-associated infection. Despite ongoing implementation of the WHO multimodal Hand Hygiene (HH) Improvement Strategy, healthcare-associated infection rate continues to be twofold higher in low- than in high-income countries. This study focused on continued evaluation of HH compliance and knowledge. The mixed method approach, with inclusion of patients and care-givers, provided insight into challenges and facilitators of the WHO HH Improvement Strategy, and highlighted improvement points. Methods An uncontrolled, before-and–after intervention, mixed methods study in Faranah Regional Hospital was conducted from December 2017 to August 2019. The intervention implemented the WHO HH Strategy including HH training for healthcare workers (HCWs), and the relaunch of the local production of alcohol-based handrub (ABHR). A baseline assessment of HH knowledge, perception and compliance of HCWs was done prior to the intervention and compared to two follow-up assessments. The second follow-up assessment was complemented by a qualitative component. Results Overall compliance six months post-intervention was 45.1% and significantly higher than baseline but significantly lower than in first follow-up. Knowledge showed similar patterns of improvement and waning. The perception survey demonstrated high appreciation of the intervention, such as local production of ABHR. HCW’s were concerned about overconsuming of ABHR, however simultaneous quantitative measurements showed that consumption in fact was 36% of the estimated amount needed for sufficient HH compliance. Potential fields for improvement identified by HCWs to enhance sustainability were permanent ABHR availability, having a dedicated person with ownership over continuous simulation HH trainings including simulations to improve technique. Conclusion The study shows that the WHO multimodal HH strategy has a positive effect on HCW compliance and knowledge. Improvement points identified by local staff like sensitization on appropriate ABHR amount per HH action should be considered for sustainable HH improvement.

Qualitative assessment of hand hygiene knowledge, attitudes and practices among healthcare workers prior to the implementation of the WHO Hand Hygiene Improvement Strategy at Faranah Regional Hospital, Guinea

“…Building on the findings of this assessment and on those of the quantitative baseline evaluation, the PASQUALE intervention was implemented [10]. A post-intervention assessment was carried out in August 2019, highlighting the impact of the project on healthcare workers' hand hygiene knowledge, attitudes and practices [11]. The use of cues was a striking factor regarding hand hygiene by healthcare workers at FRH.…”

“…The use of cues was a striking factor regarding hand hygiene by healthcare workers at FRH. The local production of alcohol-based hand rubs, its availability (ready-to-use hand hygiene product) and accessibility to the hospital's personnel [10,11], as well as several training sessions held on hand hygiene, improved knowledge, attitudes and practices among healthcare workers in general, and had a considerable impact on their hand hygiene practices within the hospital. These findings show how visible resources can enhance hand hygiene related practices among healthcare workers in a hospital setting.…”

“…Each participant was provided with a thorough explanation of the study objectives and then invited either to an individually arranged interview or to a group discussion, depending on their daily service duties. The interview guides comprised three sections which sought to Follow-up 1 quantitative � Follow-up 2 quantitative and qualitative � � These steps have been examined in separate publications [10,11].…”

“…A long-term follow-up mixed methods study at the hospital showed, however, that knowledge and compliance waned over time. The study found that healthcare workers took pride in the local production of alcohol-based hand rubs, but that they felt they needed further training on hand hygiene [11]. The latter need was expressed even though the majority of the hospital's healthcare workers had been trained during and after the Ebola outbreak [10].…”

Healthcare workers’ knowledge, attitude and practices on infection prevention and control in the context of the COVID-19 pandemic at the Faranah regional hospital and associated healthcare centers, Guinea

“…The implementation of the triage algorithm included the use of PPE and the screening for suspected COVID-19 cases, and was assessed by direct observations using an observation form designed by the study team based on recommendations by the Centers for Disease Control and Prevention (CDC) [ 18 ]. HH compliance was assessed using the WHO observation form for “5 Moments of Hand hygiene” [ 19 ] that has been used at the hospital repeatedly since the beginning of the PASQUALE project in 2017 [ 20 – 22 ], with two additional HH indications for this study: “before use of PPE” and “after use of PPE”. These two indications were covered in the training.…”