Hands washing, glove use, and avoiding recontamination before aseptic procedures at birth: A multicenter time-and-motion study conducted in Zanzibar

Gon, Giorgia; Bruin, Marijn de; Barra, Mícheál de; Ali, Said M.; Campbell, Oona M. R.; Graham, Wendy; Juma, Mohammed Hamad; Nash, Stephen; Kilpatrick, Claire; Penn‐Kekana, Loveday; Virgo, Sandra; Woodd, Susannah

doi:10.1016/j.ajic.2018.07.021

Cited by 21 publications

(65 citation statements)

References 27 publications

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“…In a recent study in Tanzania during which 781 hand hygiene indications were observed, approximately half of the times when birth attendants rubbed or washed their hands, they then recontaminated their hands on potentially unclean surfaces before performing an aseptic procedure. 3 Similar findings come from obstetric wards in Nigeria and Ghana. 4,5 Recontamination is not only a problem in low-income settings.…”

supporting

confidence: 59%

“…Recontamination may be an indication that staff fail to understand the definition of the WHO hand hygiene recommendations or how those apply in rapidly changing healthcare settings. 3 An understanding of surfaces that are safe to touch depend upon assumptions about appropriate cleaning of surfaces, cleaning frequencies, established methods, and sufficient trained cleaning staff. In spite of amazing efforts from all staff, including environmental cleaning staff, standards are not always optimal in the United Kingdom, as in many other countries.…”

mentioning

confidence: 99%

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Reducing hand recontamination of healthcare workers during COVID-19

Gon

Dancer

Dreibelbis

et al. 2020

Infect. Control Hosp. Epidemiol.

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supporting

confidence: 59%

mentioning

confidence: 99%

Reducing hand recontamination of healthcare workers during COVID-19

Gon

Dancer

Dreibelbis

et al. 2020

Infect. Control Hosp. Epidemiol.

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“…Within HANDS, between September and December 2016, we used time-and-motion methods and a cross-sectional survey to capture the HH behaviour and its determinants amongst 103 birth attendants. We used the STROBE guidelines to design and report this study as described in Gon et al [13]. For the time-and-motion component, three observers (trained midwives) used an observation tool to record hand actions (e.g., procedures, hand touches on surfaces) of birth attendants 24 h per day, for a mode of 6 days (range: 5-14 days) in each of the 10 labour wards.…”

Section: Study Design and Instrumentsmentioning

confidence: 99%

“…Inadequate hand hygiene (HH) compliance amongst healthcare personnel is common [11,12] and is usually summarized as a single behaviour. However, in our previous work in Zanzibar (Tanzania), we identified the need to distinguish whether the failure to comply with the hand hygiene guidelines stemmed from omitting to rub/wash hands, or the process of subsequently avoiding recontamination of hands/gloves before a procedure [13]. This distinction cannot be made using the current WHO HH Observation Form [14]; yet, because these different behaviours may have different determinants, it is potentially important to study them separately in order to develop optimally effective interventions.…”

Section: Introductionmentioning

confidence: 99%

Behavioural Determinants of Hand Washing and Glove Recontamination before Aseptic Procedures at Birth: A Time-and-Motion Study and Survey in Zanzibar Labour Wards

Gon

Virgo

Barra

et al. 2020

IJERPH

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Recent research calls for distinguishing whether the failure to comply with World Health Organisation hand hygiene guidelines is driven by omitting to rub/wash hands, or subsequently recontamination of clean hands or gloves prior to a procedure. This study examined the determinants of these two behaviours. Across the 10 highest-volume labour wards in Zanzibar, we observed 103 birth attendants across 779 hand hygiene opportunities before aseptic procedures (time-and-motion methods). They were then interviewed using a structured cross-sectional survey. We used mixed-effect multivariable logistic regressions to investigate the independent association of candidate determinants with hand rubbing/washing and avoiding glove recontamination. After controlling for confounders, we found that availability of single-use material to dry hands (OR:2.9; CI:1.58–5.14), a higher workload (OR:29.4; CI:12.9–67.0), more knowledge about hand hygiene (OR:1.89; CI:1.02–3.49), and an environment with more reminders from colleagues (OR:1.20; CI:0.98–1.46) were associated with more hand rubbing/washing. Only the length of time elapsed since donning gloves (OR:4.5; CI:2.5–8.0) was associated with avoiding glove recontamination. We identified multiple determinants of hand washing/rubbing. Only time elapsed since washing/rubbing was reliably associated with avoiding glove recontamination. In this setting, these two behaviours require different interventions. Future studies should measure them separately.

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“…The prevalence of appropriate hand hygiene by HCW during labour and delivery has been found to be generally low (17,27,39,40). This study nds that HCW maintain inadequate hand hygiene practices into the post-natal care period.…”

Section: Discussionmentioning

confidence: 70%

Hygiene along the continuum of care in the early post-natal period: an observational study in Nigeria

Nalule

Buxton

Flynn

et al. 2020

Preprint

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Background Newborns delivered in healthcare facilities in low- and middle-income countries are at an increased risk of healthcare associated infections. Facility–based studies have focused primarily on healthcare worker behaviour during labour & delivery with limited attention to hygiene practices in post-natal care areas and largely ignore the wide variety of actors involved in maternal and neonatal care. Methods This exploratory mixed-methods study took place in six healthcare facilities in Nigeria where 31 structured observations were completed during post-natal care, discharge, and the first six hours after return to the home. Frequency of hand hygiene opportunities and hand hygiene actions were assessed for types of patient care (maternal and newborn care) and the role individuals played in caregiving (healthcare workers, cleaners, non-maternal caregivers). Qualitative interviews with mothers were completed approximately 1 week after facility discharge. Results Maternal and newborn care were performed by a range of actors including healthcare workers, mothers, cleaners and non-maternal caregivers. Of 291 hand hygiene opportunities observed at health facilities, and 459 observed in home environments, adequate hand hygiene actions were observed during only 1% of all hand hygiene opportunities. Adequate hand hygiene prior to cord contact was observed in only 6% (1/17) of cord contact related hand hygiene opportunities at healthcare facilities and 7% (2/29) in households. Discharge advice was infrequent and not standardised and could not be remembered by the mother after a week. Mothers reported discomfort around telling non-maternal caregivers to practice adequate hand hygiene for their newborn. Conclusions In this setting, hand hygiene practices during post-natal care and the first six hours in the home environment were consistently inadequate. Effective strategies are needed to promote safe hand hygiene practices within the post-natal care ward and home in low resource, high-burden settings. Such strategies need to target not just mothers and healthcare workers but also other caregivers.

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Hands washing, glove use, and avoiding recontamination before aseptic procedures at birth: A multicenter time-and-motion study conducted in Zanzibar

Cited by 21 publications

References 27 publications

Reducing hand recontamination of healthcare workers during COVID-19

Reducing hand recontamination of healthcare workers during COVID-19

Behavioural Determinants of Hand Washing and Glove Recontamination before Aseptic Procedures at Birth: A Time-and-Motion Study and Survey in Zanzibar Labour Wards

Hygiene along the continuum of care in the early post-natal period: an observational study in Nigeria

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