How Well Are Hand Hygiene Practices and Promotion Implemented in Sierra Leone? A Cross-Sectional Study in 13 Public Hospitals

Abstract

Healthcare-associated infections (HAIs) result in millions of avoidable deaths or prolonged lengths of stay in hospitals and cause huge economic loss to health systems and communities. Primarily, HAIs spread through the hands of healthcare workers, so improving hand hygiene can reduce their spread. We evaluated hand hygiene practices and promotion across 13 public health hospitals (six secondary and seven tertiary hospitals) in the Western Area of Sierra Leone in a cross-sectional study using the WHO hand hygiene self-Assessment framework in May 2021. The mean score for all hospitals was 273 ± 46, indicating an intermediate level of hand hygiene. Nine hospitals achieved an intermediate level and four a basic level. More secondary hospitals 5 (83%) were at the intermediate level, compared to tertiary hospitals 4 (57%). Tertiary hospitals were poorly rated in the reminders in workplace and institutional safety climate domains but excelled in training and education. Lack of budgets to support hand hygiene implementation is a priority gap underlying this poor performance. These gaps hinder hand hygiene practice and promotion, contributing to the continued spread of HAIs. Enhancing the distribution of hand hygiene resources and encouraging an embedded culture of hand hygiene practice in hospitals will reduce HAIs.

High incidence of catheter-associated urinary tract infections and related antibiotic resistance in two hospitals of different geographic regions of Sierra Leone: a prospective cohort study

“…Unlike a bibliometric review of data in Bahrain, which reported mostly ‘high’ priority pathogens, 71% of the isolates in this study are ‘critical’ priority pathogens [ 31 ]. The misuse and over use of the third-generation cephalosporins especially ceftriaxone, and the challenges of hand hygiene practices in these hospitals may explain this level of critical priority pathogens [ 15 , 16 , 32 – 34 ]. Unfortunately, in low-income countries like Sierra Leone, most of the antibiotics available are sold or dispensed over the counter without a prescription.…”

“…The high burden of ESBL Enterobacteriaceae is a persistent problem, as previous studies in Sierra Leone have reported a similar ESBL burden in patients with surgical site infections [ 35 , 36 ]. As alluded to earlier, the inappropriate antibiotic use and the challenges of hand hygiene compliance and implementation reported in some facilities in Sierra Leone may underlie the spread of ESBL Enterobacteriaceae in our healthcare settings [ 15 , 16 , 32 – 34 ]. To address the long-term threats associated with the persistent burden of ESBL Enterobacteriaceae in our hospitals, we recommend the integration of surveillance of MRO to routine clinical care and strengthen IPC and AMS interventions [ 37 ].…”

“…At the time of writing, no studies have been published on the incidence of CAUTI in Sierra Leone. This situation, and the fact that our previous work has shown deep-rooted challenges in the implementation of IPC practices in Sierra Leone prompted us to pilot a surveillance program for CAUTI in two hospitals situated in two geographic regions of Sierra Leone [ 15 – 17 ]. In this study, we aimed to determine the incidence of CAUTI and associated antibiotic resistance in order to inform preventive interventions.…”

Evaluating the tolerability and acceptability of a locally produced alcohol-based handrub and hand hygiene behaviour among health workers in Sierra Leone: a hospital-based longitudinal intervention study

“…The insights garnered from this study are particularly valuable for informing policy and strategic decisions to nance the production of local ABHR and inclusion of ABHR in countries EML and EMLc to strengthening IPC programmes within healthcare settings in LMICs like Sierra Leone. These settings often grapple with maintaining and optimizing IPC programs at both national and facility levels, with regards to the availability of essential consumables such as soap, ABHR, and Personal Protective Equipment (PPE) [17,[28][29][30].…”

Multimodal strategies to hand hygiene in Ghanaian hospitals: a cross-sectional study in the Eastern Region of Ghana

“…This is in line with a similar HHSAF assessment in the Republic of Sierra Leone, where the implementation of HH in 13 public hospitals was mainly at an intermediate level. 18 On the contrary, a baseline survey in the Dodoma Region in Tanzania found that most hospitals were rated inadequate HH implementation level. 19 The overall HHSAF score in this study is lower than what was reported by a global survey in 2019 20 and in the USA.…”