The evaluation of a multimodal hand hygiene improvement strategy in Cambodian hospitals

Abstract

Introduction: Hand hygiene is the most effective method of preventing healthcare-associated infections. Healthcare-associated infections are considered serious in developing countries, and there are few reports on the hand-hygiene status of these countries. Thus, we evaluated hand-hygiene status in eight hospitals in Cambodia to understand and identify factors hindering effective infection control.
 Methodology: Eight infection-management instructors working in one of the eight Cambodian government hospitals in a large city were interviewed with the WHO Hand Hygiene Self-Assessment Framework.
 Results: The mean Hand Hygiene Self-Assessment Framework score across the eight hospitals was 177.81 ± 56.73. The overall level of compliance with the multimodal hand hygiene improvement strategy across these eight hospitals was basic-two hospitals scored inadequate and six hospitals scored basic. The scores for the 5 factors of the Hand Hygiene Self-Assessment Framework were as follows: 45.63 ± 15.45 for system change, 33.13 ± 16.89 for education and training, 27.81 ± 21.65 for evaluation and feedback, 58.13 ± 5.30 for reminders in the workplace, and 13.13 ± 11.00 for institutional safety climate for hand hygiene
 Conclusions: The promotion of hand hygiene compliance requires the establishment of a basic infrastructure, reinforcement of the hand hygiene education system, and provision of diverse educational materials, as well as the fostering of a professional workforce for education. Hospitals should also bolster their management systems for hand hygiene compliance.

How Well Are Hand Hygiene Practices and Promotion Implemented in Sierra Leone? A Cross-Sectional Study in 13 Public Hospitals

“…The mean level of hand hygiene in our study was higher than that reported in Cambodia (HHSAF score = 178), India (HHSAF score = 225), and Tanzania (HHSAF score = 187) [ 25 , 26 , 27 ]. Unlike the health facilities in Cambodia, in which no hospital achieved an intermediate hand hygiene level [ 25 ], nine of the 13 hospitals in our study achieved an intermediate hand hygiene level. Sierra Leone is one of the countries in West Africa that has had high-risk infectious disease outbreaks, including the 2014/2016 Ebola virus disease epidemic [ 28 ].…”

“…We have identified gaps that should be addressed to ensure further improvement and progress on hand hygiene promotion activities in Sierra Leone. First, there are gaps in the provision of continuous supplies of soap and running water, as well as the availability of single-use towels for hand drying, similar to Cambodia [ 25 ]. This is due to a lack of practical plans and dedicated budgets to improve hand hygiene infrastructure and maintain these supplies.…”

Hand hygiene during facility-based childbirth in Cambodia: a theory-driven, mixed-methods observational study

“…Previous hand hygiene studies in Cambodia have employed the use of self-reported behaviour and proxy measures of handwashing behaviour to assess HCW hand hygiene practices [ 26 , 27 , 44 , 45 ]. Self-reporting is not recommended as a reliable method to assess handwashing behaviour due to over-reporting, and proxy measures do not accurately reflect the actual handwashing practice [ 46 – 48 ].…”

“…Our study findings are consistent with a recent systematic review of birth attendants’ hand hygiene compliance in health facilities in LMIC that estimated low compliance rates ranging between 1.3% and 38% [ 14 ]. Facility-based hand hygiene studies in Cambodia similarly found practices across all staff levels in various HCF departments [ 44 , 45 ] and specifically among midwives during newborn post-natal care [ 26 , 27 ] to be suboptimal and were influenced by a lack of adequate training, basic infrastructure and poor implementation of multimodal hand hygiene improvement strategies.…”

Factors Affecting the Qualification Rate of Hand Disinfection Among Physicians: A Cross-Sectional Survey

“…Research has shown that increasing psychological cues and simplifying operational methods can enhance medical workers’ compliance with hand hygiene protocols. 13–17 In line with these findings, it is suggested that hospitals place hand hygiene posters in prominent locations and provide ample, user-friendly hand hygiene facilities for medical personnel. (4) Regular and unannounced hand hygiene inspections are essential to ensure compliance.…”