Kibira Jemima, Kihungi Loyce, Ndinda Mary, Wesangula Evelyn, Mwangi Catherine, Muthoni Faith, Augusto Orvalho, Owiso George, Ndegwa Linus, Luvsansharav Ulzii-Orshikh, Bancroft Elizabeth, Rabinowitz Peter, Lynch John, Njoroge Anne
International Training and Education Center for Health, P.O. Box 2614-00202, Nairobi, Kenya.
Department of Patient and Healthcare Worker Safety, Ministry of Health, Nairobi, Kenya.
Antimicrob Resist Infect Control. 2022 Apr 4;11(1):56. doi: 10.1186/s13756-022-01093-z.
Hand hygiene (HH) is central in prevention of health care-associated infections. In low resource settings, models to improve HH compliance are needed. We implemented a continuous quality improvement (CQI) program targeting HH in two hospitals in Kenya.
To determine the impact of the HH CQI program and identify factors associated with HH compliance between 2018 and 2019.
A CQI project targeting the improvement of hand hygiene was implemented, including training and mentorship. Data were collected monthly between April 2018 and December 2019 in Thika and Kitale Hospitals. Healthcare workers trained on Infection Prevention and Control (IPC) observed and recorded HH opportunities and subsequent compliance among staff, including nurses, clinicians, and auxiliary staff, using the World Health Organization's "My Five Moments for Hand Hygiene" tool. Covariates were explored using mixed-effects logistic regression with random department-level intercepts.
Hand hygiene compliance improved from 27% at baseline to 44% after 21 months. Indication/moment for HH was significantly associated with compliance. Adjusting for site, professional category and department, compliance was higher after a moment of body fluid exposure (aOR 1.43, 95% CI 1.17-1.74, p value < 0.001) and lower before an aseptic procedure (aOR 0.12, 95% CI 0.08-0.17, p value < 0.001) compared to after patient contact. Wearing of gloves often replaced proper HH in surgical departments, which although not significant, had lower compliance compared to departments for internal medicine (aOR 0.93, 95% CI 0.85-1.02). Adjusted HH compliance from all quarters improved from baseline, but comparing each quarter to the previous quarter, the improvement fluctuated over time.
Training and mentorship on the importance of HH for all moments is needed to improve overall HH compliance. CQI with regular monitoring and feedback of HH performance can be an effective approach in improving HH compliance in public hospitals in Kenya.
手部卫生（HH）是预防医疗保健相关感染的核心。在资源匮乏的环境中，需要改善手部卫生依从性的模式。我们在肯尼亚的两家医院实施了一项针对手部卫生的持续质量改进（CQI）计划。
确定手部卫生CQI计划的影响，并识别2018年至2019年期间与手部卫生依从性相关的因素。
实施了一项旨在改善手部卫生的CQI项目，包括培训和指导。2018年4月至2019年12月期间，每月在锡卡医院和基塔莱医院收集数据。接受过感染预防与控制（IPC）培训的医护人员使用世界卫生组织的“手部卫生的五个时刻”工具，观察并记录手部卫生机会以及包括护士、临床医生和辅助人员在内的工作人员随后的依从情况。使用具有随机部门级截距的混合效应逻辑回归探索协变量。
手部卫生依从性从基线时的27%提高到21个月后的44%。手部卫生的指征/时刻与依从性显著相关。在调整了地点、专业类别和科室后，与接触患者后相比，体液暴露时刻后的依从性更高（调整后比值比[aOR]为1.43，95%置信区间[CI]为1.17 - 1.74，p值<0.001），而在无菌操作前的依从性较低（aOR为0.12，95% CI为0.08 - 0.17，p值<0.001）。在外科科室，戴手套常常取代了正确的手部卫生，尽管差异不显著，但与内科科室相比，依从性较低（aOR为0.93，95% CI为0.85 - 1.02）。所有季度调整后的手部卫生依从性均较基线有所提高，但将每个季度与上一季度进行比较时，改善情况随时间波动。
需要针对手部卫生在所有时刻的重要性进行培训和指导，以提高总体手部卫生依从性。对手部卫生表现进行定期监测和反馈的CQI可以成为提高肯尼亚公立医院手部卫生依从性的有效方法。
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