Effectiveness of a multimodal hand hygiene campaign and obstacles to success in Addis Ababa, Ethiopia

• Type of Material: Article
• Authors: Karen Schmitz, Emory University; Russell Ryan Kempker, Emory University; Admasu Tenna, Addis Ababa University; Edward Stenehjem, Intermountain Medical Center; Engida Abebe, Millennium Medical College; Lia Tadesse, Millennium Medical College; Ermias Kacha Jirru, Addis Ababa University; Henry Michael Blumberg, Emory University
• Language: English
• Date: 2014
• Publisher: BioMed Central
• Publication Version: Final Published Version
• Copyright Statement: © 2014 Schmitz et al.; licensee BioMed Central Ltd.
• License: Creative Commons Attribution 2.0 Generic
• Final Published Version (URL): http://www.aricjournal.com/content/3/1/8
• Title of Journal or Parent Work: Antimicrobial Resistance and Infection Control
• ISSN: 2047-2994
• Volume: 3
• Issue: 8
• Grant/Funding Information: Financial support for this study was provided in part by the Emory University Global Health Institute (GHI), NIH NIAID (K23AI103044), and NIH Fogarty International Center (D43TW009127). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.; The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
• Keywords: Ethiopia; Infection control; World Health Organization; Hand hygiene; Health personnel
• Research Categories: Health Sciences, Hygiene; Health Sciences, Immunology; Health Sciences, Epidemiology

Abstract

Background Hand hygiene is the cornerstone of infection control and reduces rates of healthcare associated infection. There are limited data evaluating hand hygiene adherence and hand hygiene campaign effect in resource-limited settings, especially in Sub-Saharan Africa. This study assessed the impact of implementing a World Health Organization (WHO)-recommended multimodal hand hygiene campaign at a hospital in Ethiopia. Methods This study included a before-and-after assessment of health care worker (HCW) adherence with WHO hand hygiene guidelines. It was implemented in three phases: 1) baseline evaluation of hand hygiene adherence and hospital infrastructure; 2) intervention (distribution of commercial hand sanitizer and implementation of an abbreviated WHO-recommended multimodal hand hygiene campaign); and 3) post-intervention evaluation of HCW hand hygiene adherence. HCWs’ perceptions of the campaign and hand sanitizer tolerability were assessed through a survey performed in the post-intervention period. Results At baseline, hand washing materials were infrequently available, with only 20% of sinks having hand-washing materials. There was a significant increase in hand hygiene adherence among HCWs following implementation of a WHO multimodal hand hygiene program. Adherence increased from 2.1% at baseline (21 hand hygiene actions/1000 opportunities for hand hygiene) to 12.7% (127 hand hygiene actions /1000 opportunities for hand hygiene) after the implementation of the hand hygiene campaign (OR = 6.8, 95% CI 4.2-10.9). Hand hygiene rates significantly increased among all HCW types except attending physicians. Independent predictors of HCW hand hygiene compliance included performing hand hygiene in the post-intervention period (aOR = 5.7, 95% CI 3.5-9.3), in the emergency department (aOR = 4.9, 95% CI 2.8-8.6), during patient care that did not involve Attending Physician Rounds (aOR = 2.4, 95% CI 1.2-4.5), and after patient contact (aOR = 2.1, 95% CI 1.4-3.3). In the perceptions survey, 64.0% of HCWs indicated preference for commercially manufactured hand sanitizer and 71.4% indicated their hand hygiene adherence would improve with commercial hand sanitizer. Conclusions There was a significant increase in hand hygiene adherence among Ethiopian HCWs following the implementation of a WHO-recommended multimodal hand hygiene campaign. Dissatisfaction with the current WHO-formulation for hand sanitizer was identified as a barrier to hand hygiene adherence in our setting.