Utilizing the SEIPS model to guide hand hygiene interventions at a tertiary hospital in Ethiopia

Abstract

We aimed to apply the Systems Engineering Initiative for Patient Safety (SEIPS) model to increase effectiveness and sustainability of the World Health Organization’s (WHOs) hand hygiene (HH) guidelines within healthcare systems. Our cross-sectional, mixed-methods study took place at Jimma University Medical Center (JUMC), a tertiary care hospital in Jimma, Ethiopia, between November 2018 and August 2020 and consisted of three phases: baseline assessment, intervention, and follow-up assessment. We conducted questionnaires addressing HH knowledge and attitudes, interviews to identify HH barriers and facilitators within the SEIPS framework, and observations at the WHO’s 5 moments of HH amongst healthcare workers (HCWs) at JUMC. We then implemented HH interventions based on WHO guidelines and results from our baseline assessment. Follow-up HH observations were conducted months later during the Covid-19 pandemic. 250 HCWs completed questionnaires with an average knowledge score of 61.4% and attitude scores indicating agreement that HH promotes patient safety. Interview participants cited multiple barriers to HH including shortages and location of HH materials, inadequate training, minimal Infection Prevention Control team presence, and high workload. We found an overall baseline HH compliance rate of 9.4% and a follow-up compliance rate of 72.1%. Drastically higher follow-up compared to baseline compliance rates were likely impacted by our HH interventions and Covid-19. HCWs showed motivation for patient safety despite low HH knowledge. Utilizing the SEIPS model helped identify institution-specific barriers that informed targeted interventions beyond WHO guidelines aimed at increasing effectiveness and sustainability of HH efforts.

Adesão e barreiras à prática de higienização das mãos entre profissionais na pandemia de COVID-19: revisão integrativa

“…It was possible to analyze that all articles selected for this review addressed health professionals' practices in relation to HH during the pandemic. [15][16][17][18][19][20][21][22][23][24][25][26][27] Using Nola Pender's theoretical perspective, the studies showed some improvements of this preventive measure in health services, such as greater concern in preventing the spread of the virus and the execution of the correct technique in the five moments recommended by the WHO. However, overload.…”

“…On the other hand, it was possible to verify that there are factors that weaken the HH process in hospitals, highlighting organizational barriers, such as insufficient supervision and minimal presence of an infection control team in care sectors. 21 It is worth noting that a difficult point still present in several hospitals is related to glove use as an option to replace HH. 17 They are considered one of the effective PPE in the context of biosecurity that guarantee protection during health care.…”

“…Attitude and behavior were two variables that can directly influence HH when there is high patient demand, work overload and lack of specific training. [15][16][17]21,24 Two studies elucidated that there was greater compliance in the pre-COVID period when compared to the pandemic. 15,16 In this case, it is inferred that this fact may have been influenced by misinformation regarding the origin of the virus, its severity and forms of prevention, especially at…”