Clinical Pharmacy Research Group (CLIP), Louvain Drug Research Institute (LDRI), Université catholique de Louvain UCLouvain, Brussels, Belgium.
Laboratoire de Référence des Mycobactéries (LRM), Cotonou, Benin.
Antimicrob Resist Infect Control. 2020 Jun 15;9(1):85. doi: 10.1186/s13756-020-00748-z.
Hand Hygiene (HH) has been described as the cornerstone and starting point in all infection control. Compliance to HH is a fundamental quality indicator. The aim of this study was to investigate the HH compliance among Health-care Workers (HCWs) in Benin surgical care units.
A multicenter prospective observational study was conducted for two months. The World Health Organization (WHO) Hand Hygiene Observation Tool was used in obstetric and gastrointestinal surgery through six public hospitals in Benin. HH compliance was calculated by dividing the number of times HH was performed by the total number of opportunities. HH technique and duration were also observed.
A total of 1315 HH opportunities were identified during observation period. Overall, the compliance rate was 33.3% (438/1315), without significant difference between professional categories (nurses =34.2%; auxiliaries =32.7%; and physicians =32.4%; p = 0.705). However, compliance rates differed (p < 0.001) between obstetric (49.4%) and gastrointestinal surgery (24.3%). Generally, HCWs were more compliant after body fluid exposure (54.5%) and after touching patient (37.5%), but less before patient contact (25.9%) and after touching patient surroundings (29.1%). HCWs were more likely to use soap and water (72.1%) compared to the alcohol based hand rub solution (27.9%). For all of the WHO five moments, hand washing was the most preferred action. For instance, hand rub only was observed 3.9% after body fluid exposure and 16.3% before aseptic action compared to hand washing at 50.6 and 16.7% respectively. Duration of HH performance was not correctly adhered to 94% of alcohol hand rub cases (mean duration 9 ± 6 s instead of 20 to 30 s) and 99.5% of hand washing cases (10 ± 7 s instead of the recommended 40 to 60 s). Of the 432 HCWs observed, 77.3% followed HH prerequisites (i.e. no artificial fingernails, no jewellery). We also noted a lack of permanent hand hygiene infrastructures such as sink, soap, towels and clean water.
Compliance in surgery was found to be low in Benin hospitals. They missed two opportunities out of three to apply HH and when HH was applied, technique and duration were not appropriate. HH practices should be a priority to improve patient safety in Benin.
手卫生（HH）已被描述为所有感染控制的基石和起点。遵守 HH 是基本的质量指标。本研究的目的是调查贝宁外科护理单位医护人员（HCWs）的 HH 依从性。
进行了为期两个月的多中心前瞻性观察研究。在贝宁的六家公立医院中，通过世界卫生组织（WHO）的手部卫生观察工具对妇产科和胃肠外科进行了研究。HH 依从性通过将 HH 执行次数除以总机会数来计算。还观察了 HH 技术和持续时间。
在观察期间共发现 1315 次 HH 机会。总体而言，依从率为 33.3%（438/1315），不同职业类别之间无显著差异（护士为 34.2%；助理为 32.7%；医生为 32.4%；p=0.705）。然而，妇产科（49.4%）和胃肠外科（24.3%）之间的依从率存在差异（p<0.001）。一般来说，医护人员在接触体液后（54.5%）和接触患者后（37.5%）的依从性更高，但在接触患者前（25.9%）和接触患者周围环境后（29.1%）的依从性较低。与使用酒精基手部擦手液（27.9%）相比，医护人员更倾向于使用肥皂和水（72.1%）。对于所有 WHO 的五个时刻，洗手都是最受欢迎的操作。例如，与洗手时的 50.6%和 16.7%相比，接触体液后仅使用手部擦手液的情况为 3.9%，进行无菌操作前仅使用手部擦手液的情况为 16.3%。在 94%的酒精手部擦手液情况下（平均持续时间为 9±6s，而不是 20-30s）和 99.5%的洗手情况下（10±7s，而不是推荐的 40-60s），手部擦手液的使用时间没有正确遵守。在观察到的 432 名 HCWs 中，77.3%遵守了 HH 前提条件（即无人工指甲，无首饰）。我们还注意到缺乏永久性的手部卫生基础设施，如水槽、肥皂、毛巾和清洁水。
在贝宁医院，手术中的依从性发现很低。他们错过了三次 HH 应用中的两次机会，当 HH 被应用时，技术和持续时间都不合适。HH 实践应作为改善贝宁患者安全的优先事项。
