Pfäfflin Frieder, Tufa Tafese Beyene, Getachew Million, Nigussie Tsehaynesh, Schönfeld Andreas, Häussinger Dieter, Feldt Torsten, Schmidt Nicole
Department of Gastroenterology, Hepatology and Infectious Diseases (DGHID), Heinrich Heine University, Düsseldorf, Germany ; Hirsch Institute of Tropical Medicine, research and training centre of DGHID, operated in cooperation with Arsi University, Asella, Ethiopia ; Department of Infectious Diseases and Pulmonary Medicine, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
Hirsch Institute of Tropical Medicine, research and training centre of DGHID, operated in cooperation with Arsi University, Asella, Ethiopia ; Arsi University, Asella, Ethiopia.
Antimicrob Resist Infect Control. 2017 Jan 5;6:3. doi: 10.1186/s13756-016-0165-9. eCollection 2017.
The burden of health-care associated infections in low-income countries is high. Adequate hand hygiene is considered the most effective measure to reduce the transmission of nosocomial pathogens. We aimed to assess compliance with hand hygiene and perception and knowledge about hand hygiene before and after the implementation of a multimodal hand hygiene campaign designed by the World Health Organization.
The study was carried out at Asella Teaching Hospital, a university hospital and referral centre for a population of about 3.5 million in Arsi Zone, Central Ethiopia. Compliance with hand hygiene during routine patient care was measured by direct observation before and starting from six weeks after the intervention, which consisted of a four day workshop accompanied by training sessions and the provision of locally produced alcohol-based handrub and posters emphasizing the importance of hand hygiene. A second follow up was conducted three months after handing over project responsibility to the Ethiopian partners. Health-care workers' perception and knowledge about hand hygiene were assessed before and after the intervention.
At baseline, first, and second follow up we observed a total of 2888, 2865, and 2244 hand hygiene opportunities, respectively. Compliance with hand hygiene was 1.4% at baseline and increased to 11.7% and 13.1% in the first and second follow up, respectively (p < 0.001). The increase in compliance with hand hygiene was consistent across professional categories and all participating wards and was independently associated with the intervention (adjusted odds ratio, 9.18; 95% confidence interval 6.61-12.76; p < 0.001). After the training, locally produced alcohol-based handrub was used in 98.4% of all hand hygiene actions. The median hand hygiene knowledge score overall was 13 (interquartile range 11-15) at baseline and increased to 17 (15-18) after training (p < 0.001). Health-care workers' perception surveys revealed high appreciation of the different strategy components.
Promotion of hand hygiene is feasible and sustainable in a resource-constrained setting using a multimodal improvement strategy. However, absolute compliance remained low. Strong and long-term commitment by hospital management and health-care workers may be needed for further improvement.
低收入国家中与医疗保健相关的感染负担很重。充分的手部卫生被认为是减少医院病原体传播的最有效措施。我们旨在评估在实施世界卫生组织设计的多模式手部卫生运动之前和之后，手部卫生的依从性以及对手部卫生的认知和知识。
该研究在埃塞俄比亚中部阿尔西地区的阿塞拉教学医院开展，这是一家大学医院及转诊中心，服务人口约350万。在干预前以及干预开始六周后，通过直接观察来衡量常规患者护理期间的手部卫生依从性，干预包括为期四天的研讨会，伴有培训课程，并提供当地生产的含酒精洗手液以及强调手部卫生重要性的海报。在将项目责任移交给埃塞俄比亚合作伙伴三个月后进行了第二次随访。在干预前后评估医护人员对手部卫生的认知和知识。
在基线、第一次和第二次随访时，我们分别观察到2888次、2865次和2244次手部卫生机会。基线时手部卫生的依从性为1.4%，在第一次和第二次随访中分别提高到11.7%和13.1%（p<0.001）。手部卫生依从性的提高在各个专业类别和所有参与病房中都是一致的，并且与干预独立相关（调整后的优势比为9.18；95%置信区间6.61 - 12.76；p<0.001）。培训后，98.4%的手部卫生行动使用了当地生产的含酒精洗手液。总体手部卫生知识得分中位数在基线时为13（四分位间距11 - 15），培训后提高到17（15 - 18）（p<0.001）。医护人员的认知调查显示对不同策略组成部分高度认可。
在资源有限的环境中，使用多模式改进策略促进手部卫生是可行且可持续的。然而，绝对依从性仍然很低。医院管理层和医护人员可能需要做出坚定且长期的承诺以进一步改善。
