scholarly journals Hand Hygiene During Facility-Based Childbirth in Cambodia: A Theory-Driven, Mixed-Methods Observational Study

2021 ◽  
Author(s):  
Yolisa Nalule ◽  
Helen Buxton ◽  
Por Ir ◽  
Supheap Leang ◽  
Alison Macintyre ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Hand Hygiene ◽  
Hand Hygiene Compliance ◽  
Night Shift ◽  
Formative Research ◽  
Health Care Facilities ◽  
Environmental Drivers ◽  
Birth Attendants ◽  
Hygiene Practices ◽  
Hygiene Compliance

Abstract Background Despite current efforts to improve hand hygiene in health care facilities, compliance among birth attendants remains low. Current improvement strategies are inadequate, largely focusing on a limited set of known behavioural determinants or addressing hand hygiene as part of a generalized set of hygiene behaviours. To inform the design of a facility –based hand hygiene behaviour change intervention in Kampong Chhnang, Cambodia, a theory-driven formative research study was conducted to investigate the context specific behaviours and determinants of handwashing during labour and delivery among birth attendants. Methods This formative mixed-methods research followed a sequential explanatory design and was conducted across eight healthcare facilities. The hand hygiene practices of all birth attendants present during the labour and delivery of 45 women were directly observed and compliance with hand hygiene protocols assessed in analysis. Semi-structured, interactive interviews were subsequently conducted with 20 key healthcare workers to explore the corresponding cognitive, emotional, and environmental drivers of hand hygiene behaviours. Results Birth attendants’ compliance with hand hygiene protocol was 18% prior to performing labour, delivery and newborn aftercare procedures. Hand hygiene compliance did not differ by facility type or attendants’ qualification, but differed by shift with adequate hand hygiene less likely to be observed during the night shift (p = 0.03). The midwives’ hand hygiene practices were influenced by cognitive, psychological, environmental and contextual factors including habits, gloving norms, time, workload, inadequate knowledge and infection risk perception. Conclusion The resulting insights from formative research suggest a multi-component improvement intervention that addresses the different key behaviour determinants to be designed for the labour and delivery room. A combination of disruption of the physical environment via nudges and cues, participatory education to the midwives and the promotion of new norms using social influence and affiliation may increase the birth attendants’ hand hygiene compliance in our study settings.

scholarly journals Hand hygiene during facility-based childbirth in Cambodia: a theory-driven, mixed-methods observational study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yolisa Nalule ◽  
Helen Buxton ◽  
Por Ir ◽  
Supheap Leang ◽  
Alison Macintyre ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Hand Hygiene ◽  
Hand Hygiene Compliance ◽  
Night Shift ◽  
Formative Research ◽  
Health Care Facilities ◽  
Environmental Drivers ◽  
Birth Attendants ◽  
Hygiene Practices ◽  
Hygiene Compliance

Abstract Background Despite current efforts to improve hand hygiene in health care facilities, compliance among birth attendants remains low. Current improvement strategies are inadequate, largely focusing on a limited set of known behavioural determinants or addressing hand hygiene as part of a generalized set of hygiene behaviours. To inform the design of a facility –based hand hygiene behaviour change intervention in Kampong Chhnang, Cambodia, a theory-driven formative research study was conducted to investigate the context specific behaviours and determinants of handwashing during labour and delivery among birth attendants. Methods This formative mixed-methods research followed a sequential explanatory design and was conducted across eight healthcare facilities. The hand hygiene practices of all birth attendants present during the labour and delivery of 45 women were directly observed and compliance with hand hygiene protocols assessed in analysis. Semi-structured, interactive interviews were subsequently conducted with 20 key healthcare workers to explore the corresponding cognitive, emotional, and environmental drivers of hand hygiene behaviours. Results Birth attendants’ compliance with hand hygiene protocol was 18% prior to performing labour, delivery and newborn aftercare procedures. Hand hygiene compliance did not differ by facility type or attendants’ qualification, but differed by shift with adequate hand hygiene less likely to be observed during the night shift (p = 0.03). The midwives’ hand hygiene practices were influenced by cognitive, psychological, environmental and contextual factors including habits, gloving norms, time, workload, inadequate knowledge and infection risk perception. Conclusion The resulting insights from formative research suggest a multi-component improvement intervention that addresses the different key behaviour determinants to be designed for the labour and delivery room. A combination of disruption of the physical environment via nudges and cues, participatory education to the midwives and the promotion of new norms using social influence and affiliation may increase the birth attendants’ hand hygiene compliance in our study settings.

Hand Hygiene Compliance at Critical Points of Care

2020 ◽  
Author(s):  
Nai-Chung Nelson Chang ◽  
Heather Schacht Reisinger ◽  
Marin L Schweizer ◽  
ichael Jones ◽  
Elizabeth Chrischilles ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Healthcare Workers ◽  
Hand Hygiene Compliance ◽  
Random Effect ◽  
Task Type ◽  
Resistant Bacteria ◽  
Improve Hand Hygiene ◽  
Hygiene Practices ◽  
Hygiene Compliance ◽  
Better Than

Abstract Background Most articles on hand hygiene report either overall compliance or compliance with specific hand hygiene moments. These moments vary in the level of risk to patients if healthcare workers (HCWs) are noncompliant. We assessed how task type affected HCWs’ hand hygiene compliance. Methods We linked consecutive tasks individual HCWs performed during the Strategies to Reduce Transmission of Antimicrobial Resistant Bacteria in Intensive Care Units (STAR*ICU) study into care sequences and identified task pairs—2 consecutive tasks and the intervening hand hygiene opportunity. We defined tasks as critical and/or contaminating. We determined the odds of critical and contaminating tasks occurring, and the odds of hand hygiene compliance using logistic regression for transition with a random effect adjusting for isolation precautions, glove use, HCW type, and compliance at prior opportunities. Results Healthcare workers were less likely to do hand hygiene before critical tasks than before other tasks (adjusted odds ratio [aOR], 0.97 [95% confidence interval {CI}, .95–.98]) and more likely to do hand hygiene after contaminating tasks than after other tasks (aOR, 1.12 [95% CI, 1.10–1.13]). Nurses were more likely to perform both critical and contaminating tasks, but nurses’ hand hygiene compliance was better than physicians’ (aOR, 0.94 [95% CI, .91–.97]) and other HCWs’ compliance (aOR, 0.87 [95% CI, .87–.94]). Conclusions Healthcare workers were more likely to do hand hygiene after contaminating tasks than before critical tasks, suggesting that habits and a feeling of disgust may influence hand hygiene compliance. This information could be incorporated into interventions to improve hand hygiene practices, particularly before critical tasks and after contaminating tasks.

scholarly journals Hand hygiene compliance of healthcare professionals in an emergency department

2017 ◽  
Vol 51 (0) ◽  
Author(s):  
Caroline Zottele ◽  
Tania Solange Bosi de Souza Magnago ◽  
Angela Isabel dos Santos Dullius ◽  
Adriane Cristina Bernat Kolankiewicz ◽  
Juliana Dal Ongaro
Keyword(s):  
Emergency Department ◽  
Hand Hygiene ◽  
Hand Hygiene Compliance ◽  
Healthcare Professionals ◽  
Participant Observation ◽  
Compliance Rate ◽  
University Hospital ◽  
Hygiene Practices ◽  
Resident Physicians ◽  
Hygiene Compliance

Abstract OBJECTIVE To analyze compliance with hand hygiene by healthcare professionals in an emergency department unit. METHOD This is a longitudinal quantitative study developed in 2015 with healthcare professionals from a university hospital in the state of Rio Grande do Sul. Each professional was monitored three times by direct non-participant observation at WHO’s five recommended moments in hand hygiene, taking the concepts of opportunity, indication and action into account. Descriptive and analytical statistics were used. RESULTS Fifty-nine healthcare professionals participated in the study. The compliance rate was 54.2%. Nurses and physiotherapists showed a compliance rate of 66.6% and resident physicians, 41.3%. When compliance was compared among professional categories, nurses showed greater compliance than resident physicians (OR = 2.83, CI = 95%: 1.09-7.34). CONCLUSION Hand hygiene compliance was low. Multidisciplinary approaches could be important strategies for forming partnerships to develop learning and implementation of hand hygiene practices.

scholarly journals Hand hygiene practices and perceptions among healthcare workers in Ghana: A WASH intervention study

2019 ◽  
Vol 13 (12) ◽  
pp. 1076-1085 ◽  
Author(s):  
Appiah Labi ◽  
Noah Obeng-Nkrumah ◽  
Benjamin Demah Nuertey ◽  
Sheila Issahaku ◽  
Ndeye Fatou Ndiaye ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Healthcare Workers ◽  
Hand Hygiene Compliance ◽  
Relative Rate ◽  
Water Source ◽  
Relative Increase ◽  
Hygiene Practice ◽  
Post Intervention ◽  
Hygiene Practices ◽  
Hygiene Compliance

Introduction: We aimed to investigate whether the provision of water, sanitation, and hand hygiene (WASH) interventions were associated with changes in hand hygiene compliance and perceptions of healthcare workers towards infection control. Methodology: The study was conducted from June 2017 through February 2018 among healthcare workers in two Northern districts of Ghana. Using a pretest-posttest design, we performed hand hygiene observations and perception surveys at baseline (before the start of WASH interventions) and post-intervention (midline and endline). We assessed adherence to hand hygiene practice using the WHO direct observation tool. The perception study was conducted using the WHO perception survey for healthcare workers. Study outcomes were compared between baseline, midline and endline assessments. Results: The hand hygiene compliance significantly improved from 28.8% at baseline through 51.7% at midline (n = 726/1404; 95% CI: 49.1-54.2%) to 67.9% at endline (n = 1000/1471; 95% CI: 65.6-70.3%). The highest increase in compliance was to the WHO hand hygiene moment 5 after touching patients surrounding (relative increase, 205%; relative rate, 3.05; 95% CI: 2.23-4.04; p < 0.0001). Post-intervention, the top three policies deemed most effective at improving hand hygiene practice were: provision of water source (rated mean score, n = 6.1 ± 1.4), participation in educational activities (rated mean score 6.0 ± 1.5); and hand hygiene promotional campaign (6.0 ± 1.3). Conclusion: Hand hygiene compliance significantly improved post-intervention. Sustaining good hand hygiene practices in low resource settings should include education, the provision of essential supplies, and regular hand hygiene audits and feedback.

scholarly journals Hand Hygiene during the Early Neonatal Period: A Mixed-methods Observational Study in Healthcare Facilities and Households in Rural Cambodia

2021 ◽  
Author(s):  
Yolisa Nalule ◽  
Helen Buxton ◽  
Alison Macintyre ◽  
Por Ir ◽  
Ponnary Pors ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Hand Hygiene ◽  
Mixed Methods Research ◽  
Newborn Care ◽  
Healthcare Facilities ◽  
Hygiene Practices ◽  
Hygiene Behaviour ◽  
Wide Range ◽  
Hygiene Compliance ◽  
Context Specific

Background: Globally, infections are the third leading cause of neonatal mortality. Predominant risk factors for facility-born newborns are poor hygiene practices that span both the facility and home environments. Current improvement interventions focus on only one environment and tar-get limited caregivers, primarily birth attendants and mothers. To inform the design of a hand hygiene behaviour change intervention in rural Cambodia, a formative mixed-methods research study was conducted to investigate the context specific behaviours and determinants of hand-washing among healthcare workers, maternal and non-maternal caregivers along the early new-born care continuum. Methods: Direct observations of hygiene practices of all individuals providing care to 46 newborns across eight facilities and associated communities were completed and hand hygiene compliance assessed in analysis. Semi structured interactive interviews were subsequently conducted with 35 midwives and household members to explore the corresponding cognitive, emotional, and environmental factors influencing the observed key hand hygiene behaviours. Results: Hand hygiene opportunities during newborn care were frequent in both set-tings (n = 1319) and predominantly performed by mothers, fathers and non-parental caregivers. Compliance to hand hygiene protocol across all caregivers, including midwives, was inadequate (0%). Practices were influenced by the lack of accessible physical infrastructure, time, increased workload, low infection risk perception, nurture-related motives, norms and inadequate knowledge. Conclusion: Our findings indicate that an effective intervention in this context should be multi-modal to address the different key behaviour determinants and target a wide range of caregivers.

scholarly journals Assessing Hand Hygiene and Low-Level Disinfection of Equipment Compliance in an Acute Care Setting: Mixed Methods Approach (Preprint)

2020 ◽  
Author(s):  
Hammad Akram ◽  
Alison Andrews-Paul ◽  
Rachel Washburn
Keyword(s):  
Mixed Methods ◽  
Hand Hygiene ◽  
Hand Hygiene Compliance ◽  
Peer Pressure ◽  
Mixed Methods Approach ◽  
Hand Sanitizer ◽  
Low Level ◽  
Hygiene Compliance ◽  
Evening Shift ◽  
Morning Shift

BACKGROUND Hand hygiene and low-level disinfection of equipment behaviors among hospital staff are some of the leading cost-effective methods to reduce hospital-acquired infections (HAI) among patients. OBJECTIVE The aim of this study is to examine hand hygiene and low-level disinfection of equipment practices in a central Texas hospital and to explore pertaining gaps, perceptions, and challenges. METHODS Data were collected using a multipronged mixed methods approach that included the following: (1) observation of hand hygiene and low-level disinfection practices (12 and 8 units during morning and evening shifts, respectively); (2) observation of usability/placement of hand sanitizer dispensers; (3) semistructured interviews; and (4) a follow-up email survey. RESULTS In total, 222 (156 morning shift and 66 evening shift) staff members were observed. Of 526 hand hygiene and 33 low-level disinfection opportunities, compliance was observed 410 (78%) and 17 (51%) times, respectively. Overall, 6 units (50%) had ≥0.80 (favorable) hand hygiene compliance during the morning shift and 2 units (25%) had ≥0.80 hand hygiene compliance during the evening shift. Aggregated low-level disinfection compliance was 0.54 during the morning and 0.33 during the evening. Overall, the odds of noncompliant hand hygiene behavior were 1.4 times higher among staff who worked during night shifts compared to day shifts; however, this relationship was not statistically significant (95% CI 0.86-2.18; <i>P</i>=.18). Noncompliant behavior was most likely among unit B staff during the evening; however, this relationship was not statistically significant (OR 5.3, 95% CI 0.84-32.9; <i>P</i>=.07) All units, except one, had similar hand sanitizer dispenser usability characteristics. In the qualitative part of the study, the following challenges were identified: “shortage of time while seeing patients,” “sometimes the staff forgets,” “concern about drying hands,” “behavior is difficult or requires reminders,” and “there may be issues with resources or access to supplies to perform these behaviors.” Staff also stated that “a process that is considered effective is the Stop the Line program,” and that the “behavior is easy and automatic.” CONCLUSIONS Hand hygiene and low-level disinfection compliance is dependent on several personal and nonpersonal factors. Issues such as time constraints, peer pressure, work culture, available resources, and understanding of guidelines could influence staff behavior. The information collected through this study can be used to re-examine similar or related issues at a larger scale.

scholarly journals Birth attendants’ hand hygiene compliance in healthcare facilities in low and middle-income countries: a systematic review

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Giorgia Gon ◽  
Mícheál de Barra ◽  
Lucia Dansero ◽  
Stephen Nash ◽  
Oona M. R. Campbell
Keyword(s):  
Systematic Review ◽  
Hand Hygiene ◽  
Hand Hygiene Compliance ◽  
Middle Income ◽  
Healthcare Facilities ◽  
Middle Income Countries ◽  
Birth Attendants ◽  
Hygiene Compliance ◽  
Larger Sample

Abstract Background With an increasing number of women delivering in healthcare facilities in Low and Middle Income Countries (LMICs), healthcare workers’ hand hygiene compliance on labour wards is pivotal to preventing infections. Currently there are no estimates of how often birth attendants comply with hand hygiene, or of the factors influencing compliance in healthcare facilities in LMICs. Methods We conducted a systematic review to investigate the a) level of compliance, b) determinants of compliance and c) interventions to improve hand hygiene during labour and delivery among birth attendants in healthcare facilities of LMICs. We also aimed to assess the quality of the included studies and to report the intra-cluster correlation for studies conducted in multiple facilities. Results We obtained 797 results across four databases and reviewed 71 full texts. Of these, fifteen met our inclusion criteria. Overall, the quality of the included studies was particularly compromised by poorly described sampling methods and definitions. Hand hygiene compliance varied substantially across studies from 0 to 100%; however, the heterogeneity in definitions of hand hygiene did not allow us to combine or compare these meaningfully. The five studies with larger sample sizes and clearer definitions estimated compliance before aseptic procedures opportunities, to be low (range: 1–38%). Three studies described two multi-component interventions, both were shown to be feasible. Conclusions Hand hygiene compliance was low for studies with larger sample sizes and clear definitions. This poses a substantial challenge to infection prevention during birth in LMICs facilities. We also found that the quality of many studies was suboptimal. Future studies of hand hygiene compliance on the labour ward should be designed with better sampling frames, assess inter-observer agreement, use measures to improve the quality of data collection, and report their hand hygiene definitions clearly.

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