Assessment of hand hygiene facilities and staff compliance in a large tertiary health care facility in northern Nigeria: a cross sectional study

Abstract

Background: The burden of healthcare-associated infection (HAI) is 2 to 18 times higher in developing countries. However, few data are available regarding infection prevention and control (IPC) process indicators in these countries. We evaluated hand hygiene (HH) facilities and compliance amongst healthcare workers (HCW) in a 600bed healthcare facility in Northcentral Nigeria providing tertiary care service for a catchment population of about 20 million. Methods: An in-house facility assessment tool and the World Health Organization (WHO) direct observation method were used to assess the HH facilities and compliance, respectively. Factors associated with good compliance were determined by multivariate analysis. Results: The facility survey was carried out in all 46 clinical units of the hospital. 72% of the units had no poster or written policy on HH; 87% did not have alcohol-based hand rubs; 98% had at least one handwash sink; 28% had flowing tap water all day while 72% utilized cup and bucket; and 58% had no hand drying facilities. A total of 406 HH opportunities were observed among 175 HCWs. The overall compliance was 31%, ranging from 18% among ward attendants to 82% among medical students. Based on WHO "5 moments" for HH, average compliance was 21% before patient contact, 23% before aseptic procedure, 63% after body fluid exposure risk, 41% after patient contact and 40% after contact with patients' surrounding. Being a medical student was independently associated with high HH compliance, adjusted odds ratio: 13.87 (1.70-112.88). Conclusions: Availability of HH facilities and HCW compliance in a large tertiary hospital in Nigeria is poor. Our findings confirm that HCWs seem more sensitized to their risk of exposure to potential pathogens than to the prevention of HAI cross-transmission. Inadequate HH facilities probably contributed to the poor compliance. Specific measures such as improved facilities, training and monitoring are needed to improve HH compliance.

Knowledge, Attitude and Self-Reported Performance and Challenges of Hand Hygiene Using Alcohol-Based Hand Sanitizers Among Healthcare Workers During COVID-19 Pandemic at a Tertiary Hospital: A Cross-Sectional Study

“…And those who practice ABHS often, sometimes, seldom, or never (received 0 point) and responded <50% correctly (always) were considered as non-compliant. 17 , 18 , 20–23 , 25 , 26 …”

Knowledge and practice of hand hygiene among undergraduate students and junior doctors in the Regional Institute of Medical Sciences, Imphal

“…[ 21 ] Participants (40%) used common towels, 58% used personal hankerchief which was not a good practice, 33.3% used disposable paper towels, and 12.4% used other methods of hand drying after hand washing like letting it get dried by itself (air drying), sterile cotton swabs, aprons, curtains, and whatever available like other studies. [ 17 22 23 24 ] Reusing or sharing towels should be avoided because of the risk of cross-infection. Careful hand drying is a critical factor determining the level of bacterial transfer.…”

Hand Hygiene in Pediatric Emergency Care Unit in a Teaching Hospital in Benin

“…Engdaw et al in Ethiopia reported that factors influencing hand hygiene adherence involved access to soap and water [10]. This lack of hand washing equipment is a common situation in low and middles countries [11], and that is the reason WHO recommends alcohol-based hand rub, which is easier to implement [2] [7]. Clothing requirements should be improved within the care unit, especially the wearing of rings, which can be a breeding ground for germs [12].…”

“…Ahmed J et al recorded a rate of 12.3% in Karachi, Tang et al 11% to 36% depending on the season in a rural hospital in Niger[16] [17]. Higher rates of 31% are reported in Nigeria but still significantly lower than those reported in advanced countries such as England[11] [18]. The implementation of a multimodal strategy based on WHO recommendations will certainly improve hand hygiene adherence within the care unit, as various teams experimented[19] [20] [21][22].…”