Effectiveness of a multimodal hand hygiene campaign and obstacles to success in Addis Ababa, Ethiopia

Antimicrobial Resistance and Infection Control

Karen Schmitz³  Russell R Kempker⁶  Admasu Tenna²  Edward Stenehjem¹  Engida Abebe⁴  Lia Tadesse⁷  Ermias Kacha Jirru²  Henry M Blumberg⁵ 

[1] Department of Clinical Epidemiology and Infectious Diseases, Intermountain Medical Center, 5212 Cottonwood Street, LL2, Murray, UT 84157, USA

[2] Division of Infectious Diseases, Department of Medicine, Addis Ababa University, P.O. Box 24792 Code 1000, Addis Ababa, Ethiopia

[3] 120 S. Pennsylvania St #101, Denver, CO 80209, USA

[4] Department of Surgery, St. Paul’s Hospital Millennium Medical College, P.O. Box 1271, Addis Ababa, Ethiopia

[5] Departments of Epidemiology and Global Health, Emory Rollins School of Public Health, 1518 Clifton Rd NE, Atlanta, GA 30329, USA

[6] Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, 49 Jesse Hill Jr Drive, Atlanta, GA 30303, USA

[7] Department of Obstetrics and Gynecology, St. Paul’s Hospital Millennium Medical College, P.O. Box 1271, Addis Ababa, Ethiopia

关键词: Health personnel;    Infection control;    World Health Organization;    Ethiopia;    Hand hygiene;   

Others  :  790582
DOI  :  10.1186/2047-2994-3-8

 received in 2013-05-06, accepted in 2014-03-06,  发布年份 2014

【 摘 要 】

Background

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.

Methods

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.

Results

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.

Conclusions

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.

【 授权许可】

   
2014 Schmitz et al.; licensee BioMed Central Ltd.

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