Healthcare worker and family caregiver hand hygiene in Bangladeshi healthcare facilities: results from the Bangladesh National Hygiene Baseline Survey

Abstract

SUMMARYBackgroundHealthcare facility hand hygiene impacts patient care, healthcare worker safety, and infection control, but low-income countries have few data to guide interventions.AimTo conduct a nationally representative survey of hand hygiene infrastructure and behaviour in Bangladeshi healthcare facilities to establish baseline data to aid policy.MethodsThe 2013 Bangladesh National Hygiene Baseline Survey examined water, sanitation, and hand hygiene across households, schools, restaurants and food vendors, traditional birth attendants, and healthcare facilities. We used probability proportional to size sampling to select 100 rural and urban population clusters, and then surveyed hand hygiene infrastructure in 875 inpatient healthcare facilities, observing behaviour in 100 facilities.FindingsMore than 96% of facilities had ‘improved’ water sources, but environmental contamination occurred frequently around water sources. Soap was available at 78–92% of handwashing locations for doctors and nurses, but just 4–30% for patients and family. Only 2% of 4676 hand hygiene opportunities resulted in recommended actions: using alcohol sanitizer or washing both hands with soap, then drying by air or clean cloth. Healthcare workers performed recommended hand hygiene in 9% of 919 opportunities: more after patient contact (26%) than before (11%). Family caregivers frequently washed hands with only water (48% of 2751 opportunities), but with little soap (3%).ConclusionHealthcare workers had more access to hand hygiene materials and performed better hand hygiene than family, but still had low adherence. Increasing hand hygiene materials and behaviour could improve infection control in Bangladeshi health-care facilities.

Examining the inclusion of patients and their family members in infection prevention and control policies and guidelines across Bangladesh, Indonesia, and South Korea

“…From this review, we found that the guidelines from Bangladesh, 32,116,127 Indonesia, 36,118,119 and South Korea 35,121,122 were not culturally grounded in regard to IPC guidelines and policy in acute care facilities. In fact, the contents in the guidelines were very similar to those in the WHO, CDC, Canada, Australia, and United Kingdom, except that they lacked the references to the use of patient empowerment and engagement in hand hygiene.…”

“…Considering the in-depth involvement of family carers in the care, the definition of carer from the western countries could not embrace the role of carers in the target countries. Despite the care activities family members and privately hired carers perform, their roles or responsibility could not be located in any guidelines from Bangladesh, 32,116,127 Indonesia, 36,118,119 and South Korea. 35,121,122 IPC strategies for family carers not considered…”

“…Of concern also is the fact that from the few studies conducted, it appears that the knowledge about HAI and IPC strategies such as hand hygiene among family members of patients is limited. 1,29,32 The literature suggests that IPC guidelines utilised in many Asian countries have been based on those established in the United States, United Kingdom, Canada, or Australia, as well as by global organizations such as WHO and the Centers for Disease Control and Prevention (CDC). [33][34][35][36][37] Considering the magnitude of cultural influence over health care delivery and the important role of family carers for Asian countries, 3,6,24,38 this study aimed to examine whether the role of patients' families has been accounted for in the IPC guidelines and policies used in Asian countries.…”

Infrastructure and Organization of Adult Intensive Care Units in Resource-Limited Settings

“…Contaminant transfer to other patients and healthcare workers is common if hand hygiene is inadequate or not performed [82]. Innumerable challenges to improving hand hygiene in resource-limited settings have been identified, but reasons vary from location to location [83]. Convincing evidence indicates that implementation of multimodal hand hygiene programs can not only improve hand hygiene compliance but also reduce ICU-acquired infection rates.…”

“…Furthermore, examination gloves do not avoid bacterial contamination of healthcare workers' hands due to microlesions [97]. Based on these results, the WHO emphasizes that wearing gloves does not replace the need for subsequent hand hygiene [83]. Reuse of medical examination or surgical gloves is commonplace in many resource-limited settings [ref], but the limited studies available suggest that reprocessing and reuse of disposable gloves may be harmful to patients and healthcare professionals.…”