USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Kampala, Uganda.
Department of Clinical Services, Ministry of Health, Kampala, Uganda.
Front Public Health. 2024 Oct 22;12:1465439. doi: 10.3389/fpubh.2024.1465439. eCollection 2024.
Hand hygiene (HH) plays a crucial role in mitigating healthcare-associated infections. Improving HH compliance in healthcare facilities in resource-limited settings is urgently needed.
We implemented the World Health Organization (WHO) HH improvement strategy using a continuous quality improvement (CQI) approach targeting improvement in HH compliance by healthcare workers (HCWs). An intervention was implemented in six hospitals using a longitudinal study design between May 2019 and April 2023. We set up and monitored infection prevention and control (IPC) and HH programs using WHO's infection prevention and control assessment framework at the facility level (IPCAF) and hand hygiene self-assessment framework (HHSAF) tools. We implemented HH interventions using CQI techniques while targeting HCW HH knowledge and compliance with the WHO's Five Moments of HH.
By the end of the intervention, IPC and HH capacity improved in all six hospitals, from a median score of 547.0 and 252.5 on IPCAF and HHSAF tools at baseline to an advanced score of 635.0 and 350.0 at endline assessment, respectively. Similarly, HCWs' HH knowledge improved in all hospitals, from a mean score of 45.0% at baseline to 76.0% at endline assessment, most notably among nurses. HH compliance, as assessed using WHO's HH observation tool, at least doubled in all hospitals, rising from 19.9% to 53.8%, with before touching a patient registering the highest (22-fold) improvement. On linear regression analysis, no significant association was observed between HH compliance and IPCAF = -0.0004 (95% CI -0.093, 0.93) = 0.990, HHSAF = 0.009 (95% CI -.0127, 0.145) = 0.842 and HCW knowledge on HH/IPC = -0.165 (95% CI 0.815, 0.485) = 0.519. This is the first documented comprehensive utilization of CQI approaches to implement HH as an entry point for the development of hospital IPC programs, and evaluation of WHO tools and approaches for IPC and HH improvement in Uganda.
Implementation of the WHO HH improvement strategy using a CQI approach can lead to remarkable improvement in HH capacity, and HCW compliance and knowledge in hospitals within resource-limited settings.
手部卫生（HH）在减轻医源性感染方面起着至关重要的作用。在资源有限的环境中，提高医疗机构的 HH 依从性是迫切需要的。
我们使用世界卫生组织（WHO）HH 改进策略，采用持续质量改进（CQI）方法，针对医疗保健工作者（HCWs）的 HH 依从性进行改进。2019 年 5 月至 2023 年 4 月期间，我们使用纵向研究设计，在六家医院实施了一项干预措施。我们使用 WHO 的感染预防和控制评估框架（IPCAF）和手部卫生自我评估框架（HHSAF）工具，建立和监测感染预防和控制（IPC）和 HH 计划。我们使用 CQI 技术实施 HH 干预措施，同时针对 HCW 的 HH 知识和遵守 WHO 的五个 HH 时刻进行干预。
干预结束时，六家医院的 IPC 和 HH 能力均有所提高，IPCAAF 和 HHSAF 工具的基线中位数得分分别从 547.0 和 252.5 提高到终点评估的 635.0 和 350.0，而 HCWs 的 HH 知识也有所提高，所有医院的平均得分从基线时的 45.0%提高到终点评估时的 76.0%，其中护士的提高最为显著。使用 WHO 的 HH 观察工具评估的 HH 依从性至少翻了一番，所有医院的依从性从 19.9%上升到 53.8%，其中接触患者前的依从性提高幅度最高（22 倍）。线性回归分析显示，HH 依从性与 IPCAF 之间没有显著关联（= -0.0004，95%CI-0.093，0.93）=0.990，HHSAF=0.009（95%CI-.0127，0.145）=0.842，HCW 关于 HH/IPC 的知识（= -0.165，95%CI0.815，0.485）=0.519。这是首次记录到全面利用 CQI 方法实施 HH，作为开发医院 IPC 计划的切入点，并评估 WHO 工具和方法在乌干达改善 IPC 和 HH 的应用。
在资源有限的环境中，使用 CQI 方法实施 WHO HH 改进策略可显著提高 HH 能力，以及 HCW 在医院的依从性和知识水平。
