A Quality Improvement Initiative to Increase Hand Hygiene Awareness and Compliance in a Neonatal Intensive Care Unit in Haiti

Abstract

Introduction Healthcare-associated infections (HCAI) are major causes of morbidity, mortality, increased lengths of stay and are an economic burden on healthcare systems in resources-limited settings. This is especially true for neonates, who are more susceptible with underdeveloped immune systems. Hand hygiene (HH) is a key weapon against HCAI, yet globally, HH compliance remains substandard. This study sought to determine the compliance with HH among healthcare workers (HCWs) in a children’s hospital neonatal intensive care unit (NICU) in Haiti. Methods A HH educational intervention was performed in the NICU, including lectures and posters. Pre- and post-intervention HH data were collected on HCWs and parents using the World Health Organization ‘5 Moments for HH’. Data were analyzed using standard statistical analysis. Results HH increased in all HCW roles but not in parents. Correct HH increased in all groups, including parents. HH was more likely to occur prior to patient contact than after patient contact. Correct HH was more likely to occur with alcohol-based hand rub than with soap and water. Conclusion This study demonstrates that an inexpensive and simple intervention can significantly increase HH compliance in a resource-limited NICU, which may lead to decreased rates of hospital-acquired sepsis. Parents, however, due to cultural norms as well as literacy and language barriers, need targeted educational interventions distinct from those that HCW benefit from.

Hand hygiene practices in Caribbean and Latin American countries: An integrative review

“…Seven studies employed a cross‐sectional design (Beau de Rochars et al, 2011; Childs et al, 2016; Contzen & Mosler, 2013; Contzen & Mosler, 2015; Pengpid & Peltzer, 2020; Samapundo et al, 2015; Watson et al, 2014), five studies were observational in design (Deshommes et al, 2020; Giardina et al, 2013; Medgyesi et al, 2018; Nicholson et al, 2016; Thompson et al, 2015), four studies were qualitative (Godínez‐Oviedo et al, 2020; Guillaume et al, 2019; Timmins et al, 2018; Williams et al, 2015), one study was a secondary data analysis (McKittrick & Jacobsen, 2015) and one study was case control (Dunkle et al, 2011). The majority of studies were conducted in Haiti (Beau de Rochars et al, 2011; Childs et al, 2016; Contzen & Mosler, 2013; Contzen & Mosler, 2015; Deshommes et al, 2020; Dunkle et al, 2011; Guillaume et al, 2019; Giardina et al, 2013; Medgyesi et al, 2018; Samapundo et al, 2015; Timmins et al, 2018; Williams et al, 2015). Other studies were conducted in Jamaica (Nicholson et al, 2016; Watson et al, 2014) and in other Latin American countries such as the Dominican Republic, Guatemala, Honduras, Bolivia, Mexico and Peru (McKittrick & Jacobsen, 2015; Nicholson et al, 2016; Pengpid & Peltzer, 2020; Thompson et al, 2015; Watson et al, 2014) (Table 1).…”

“…Studies were conducted in metropolitan/urban dwellings ( n = 4) (Beau de Rochars et al, 2011; Contzen & Mosler, 2013; Contzen & Mosler, 2015; Dunkle et al, 2011), rural settings ( n = 3) (Contzen & Mosler, 2013; Contzen & Mosler, 2015; Guillaume et al, 2019), post‐disaster areas ( n = 2) (Contzen & Mosler, 2013; Contzen & Mosler, 2015), schools ( n = 3) (Giardina et al, 2013; McKittrick & Jacobsen, 2015; Pengpid & Peltzer, 2020), healthcare setting ( n = 5) (Deshommes et al, 2020; Nicholson et al, 2016; Thompson et al, 2015; Timmins et al, 2018; Watson et al, 2014) and the community including street vendors ( n = 4) (Godínez‐Oviedo et al, 2020; Medgyesi et al, 2018; Samapundo et al, 2015; Williams et al, 2015). Study characteristics of the 18 articles included in this review are presented in Table 2.…”

Infecções secundárias causadas por bactérias do grupo ESKAPE e impacto à saúde de pacientes com complicações da Covid-19 – uma revisão integrativa

“…Além disso, a fim de reduzir as expressivas consequências das IRAS causadas pelo grupo ESKAPE, uma pesquisa demonstrou que a limpeza à base de cloro e a implementação de um programa de conscientização do uso dos antibióticos, levou a uma redução nos índices (Mahida, et al, 2022). Outros dois estudos relataram taxas de 38,9% e 48,7% para a adesão à higiene das mãos e melhorias foram observadas após a intervenção (Nicholson, et al, 2016;Deshommes, et al, 2021).…”

Improving handwashing among parent-attendants visiting a newborn unit practising family participatory care

“… 14 There is limited published work on improving hand hygiene among parent-attendants visiting neonatal units in public healthcare facilities in low/middle-income countries. 15 16 …”

“…There is some certainty however that strategies involving performance feedback led to better hand hygiene compliance in NICUs 14. There is limited published work on improving hand hygiene among parent-attendants visiting neonatal units in public healthcare facilities in low/middle-income countries 15 16…”