Emory University School of Medicine, 1648 Pierce Drive NE, Atlanta, GA 30322, USA.
Antimicrob Resist Infect Control. 2014 Mar 17;3(1):8. doi: 10.1186/2047-2994-3-8.
Hand hygiene is the cornerstone of infection control and reduces rates of healthcare associated infection. There are limited data evaluating hand hygiene adherence and hand hygiene campaign effect in resource-limited settings, especially in Sub-Saharan Africa. This study assessed the impact of implementing a World Health Organization (WHO)-recommended multimodal hand hygiene campaign at a hospital in Ethiopia.
This study included a before-and-after assessment of health care worker (HCW) adherence with WHO hand hygiene guidelines. It was implemented in three phases: 1) baseline evaluation of hand hygiene adherence and hospital infrastructure; 2) intervention (distribution of commercial hand sanitizer and implementation of an abbreviated WHO-recommended multimodal hand hygiene campaign); and 3) post-intervention evaluation of HCW hand hygiene adherence. HCWs' perceptions of the campaign and hand sanitizer tolerability were assessed through a survey performed in the post-intervention period.
At baseline, hand washing materials were infrequently available, with only 20% of sinks having hand-washing materials. There was a significant increase in hand hygiene adherence among HCWs following implementation of a WHO multimodal hand hygiene program. Adherence increased from 2.1% at baseline (21 hand hygiene actions/1000 opportunities for hand hygiene) to 12.7% (127 hand hygiene actions /1000 opportunities for hand hygiene) after the implementation of the hand hygiene campaign (OR = 6.8, 95% CI 4.2-10.9). Hand hygiene rates significantly increased among all HCW types except attending physicians. Independent predictors of HCW hand hygiene compliance included performing hand hygiene in the post-intervention period (aOR = 5.7, 95% CI 3.5-9.3), in the emergency department (aOR = 4.9, 95% CI 2.8-8.6), during patient care that did not involve Attending Physician Rounds (aOR = 2.4, 95% CI 1.2-4.5), and after patient contact (aOR = 2.1, 95% CI 1.4-3.3). In the perceptions survey, 64.0% of HCWs indicated preference for commercially manufactured hand sanitizer and 71.4% indicated their hand hygiene adherence would improve with commercial hand sanitizer.
There was a significant increase in hand hygiene adherence among Ethiopian HCWs following the implementation of a WHO-recommended multimodal hand hygiene campaign. Dissatisfaction with the current WHO-formulation for hand sanitizer was identified as a barrier to hand hygiene adherence in our setting.
手部卫生是感染控制的基石，可以降低医疗保健相关感染的发生率。在资源有限的环境中，特别是在撒哈拉以南非洲，评估手部卫生依从性和手部卫生运动效果的数据有限。本研究评估了在埃塞俄比亚的一家医院实施世界卫生组织（WHO）推荐的多模式手部卫生运动的效果。
本研究包括卫生保健工作者（HCW）对 WHO 手部卫生指南依从性的前后评估。它分三个阶段实施：1）基线评估手部卫生依从性和医院基础设施；2）干预（分发商业手部消毒剂和实施简化的 WHO 推荐的多模式手部卫生运动）；3）干预后评估 HCW 的手部卫生依从性。在干预后期间通过调查评估 HCW 对手部卫生运动和手部消毒剂耐受性的看法。
基线时，洗手材料很少，只有 20%的水槽有洗手材料。在实施 WHO 多模式手部卫生方案后，HCW 的手部卫生依从性显著提高。依从性从基线时的 2.1%（每 1000 次手部卫生机会有 21 次手部卫生操作）增加到实施手部卫生运动后的 12.7%（每 1000 次手部卫生机会有 127 次手部卫生操作）（OR=6.8，95%CI 4.2-10.9）。除主治医生外，所有 HCW 类型的手部卫生率均显著增加。HCW 手部卫生依从性的独立预测因素包括干预后进行手部卫生（aOR=5.7，95%CI 3.5-9.3）、在急诊部（aOR=4.9，95%CI 2.8-8.6）、在不涉及主治医生查房的患者护理期间（aOR=2.4，95%CI 1.2-4.5）和在接触患者后（aOR=2.1，95%CI 1.4-3.3）。在认知调查中，64.0%的 HCW 表示更喜欢商业生产的手部消毒剂，71.4%的 HCW 表示商业手部消毒剂的使用将提高他们的手部卫生依从性。
在实施 WHO 推荐的多模式手部卫生运动后，埃塞俄比亚 HCW 的手部卫生依从性显著提高。我们发现，对当前 WHO 配方的手部消毒剂不满意是我们环境中手部卫生依从性的一个障碍。
