Hand Hygiene Compliance and Associated Factors among Healthcare Workers in Ethiopia: A Systematic Review and Meta-Analysis

Background. Promoting hand hygiene compliance should be a priority for health authorities and all healthcare facilities at all levels. Therefore, this systematic review and meta-analysis aimed to provide a pooled estimate of hand hygiene compliance and associated factors among healthcare professionals in Ethiopia. Methods. PubMed, Science Direct, EMBASE, the Google search engine, and Google Scholar were used to retrieve studies that were eligible for the study. The searches included all studies published in English prior to July 2021. Using a structured data extraction format, two authors independently extracted the required data. STATA Version 16 software has been used for statistical analysis. To measure the heterogeneity of the studies, the Cochrane Q-test statistics and I2 test were used. Because of the significant heterogeneity, a random-effects model was used. Results. The pooled hand hygiene compliance among healthcare workers in Ethiopia was 38% (95% CI: 0.16–0.59). According to the study’s subgroup analysis, Addis Ababa City administration health workers had the highest hand hygiene compliance, at 73% (95% CI: 0.50–0.96), while SNNP regional state had the lowest, at 9% (95% CI: 0.05–0.13). Presence of hand hygiene promotion (OR: 2.14, 95% CI: 1.04–3.24), towel/tissue paper availability (OR: 3.97, 95% CI: 2.09–5.86), having a positive attitude toward hand hygiene (OR: 1.79, 95% CI: 1.28–2.30), having good knowledge about hand hygiene (OR: 3.45, 95% CI: 1.26–5.64), and being trained for hand hygiene (OR:4.97, 95% CI:1.81–8.14) were significantly associated with hand hygiene compliance. Conclusion. In this analysis, hand hygiene compliance among healthcare workers in Ethiopia was less than half. Providing hand hygiene promotion, towel/tissue paper presence, having a positive attitude toward hand hygiene, having good knowledge about hand hygiene, and being trained for hand hygiene were important variables for the increment of hand hygiene compliance.

The effect of hand hygiene promotion programs during epidemics and pandemics of respiratory droplet-transmissible infections on health outcomes: a rapid systematic review

Background Public health strategies in the context of respiratory droplet-transmissible diseases (such as influenza or COVID-19) include intensified hand hygiene promotion, but a review on the effectiveness of different ways of promoting hand hygiene in the community, specifically for this type of infections, has not been performed. This rapid systematic review aims to summarize the effectiveness of community-based hand hygiene promotion programs on infection transmission, health outcomes and behavioral outcomes during epidemic periods in the context of respiratory droplet-transmissible diseases. We also included laboratory-confirmed health outcomes for epidemic-prone disease during interepidemic periods. Methods We searched for controlled experimental studies. A rapid systematic review was performed in three databases and a COVID-19 resource. Following study selection (in which studies performed in the (pre-)hospital/health care setting were excluded), study characteristics and effect measures were synthesized, using meta-analyses of cluster-RCTs where possible. Risk of bias of each study was assessed and the certainty of evidence was appraised according to the GRADE methodology. Results Out of 2050 unique references, 12 cluster-RCTs, all in the context of influenza, were selected. There were no controlled experimental studies evaluating the effectiveness of hand hygiene promotion programs in the context of COVID-19 that met the in−/exclusion criteria. There was evidence that preventive hand hygiene promotion interventions in interepidemic periods significantly decreased influenza positive cases in the school setting. However, no improvement could be demonstrated for programs implemented in households to prevent secondary influenza transmission from previously identified cases (epidemic and interepidemic periods). Conclusions The data suggest that proactive hand hygiene promotion interventions, i.e. regardless of the identification of infected cases, can improve health outcomes upon implementation of such a program, in contrast to reactive interventions in which the program is implemented after (household) index cases are identified.

SCHOOL HYGIENE PROMOTION APPROACHES AND THEIR INFLUENCE ON PUPIL’S HYGIENE PRACTICES IN PUBLIC PRIMARY SCHOOLS IN DAGORETTI, NAIROBI CITY COUNTY, KENYA

Purpose: The purpose of this study was to examine hygiene promotion approaches that were being employed by public primary schools in Dagoretti North and South Sub Counties in Nairobi City County and whether the approaches influenced hygiene behaviors that were practiced by pupils. Methodology: The study applied a descriptive cross-sectional design. Questionnaires were administered to 384 pupils with the aim of collecting data on hygiene knowledge and practices. A questionnaire was also used to collect data on hygiene promotion approaches from 32 school health teachers. Pupils’ demographic data was collected from school head teachers. Five key informant interviews were conducted with Nairobi City County public health and education officers and a staff from a non-governmental organization that was implementing school hygiene activities in Dagoretti South and North Sub Counties. Observation checklists were used to triangulate information on hygiene practices by pupils. Analysis was done using SPSS software. Findings: Results indicate that 95.6% of the pupils practiced hand washing at critical times, 98.7% used the toilet while 85.4% safely disposed solid waste. The study reveals that water, sanitation and hygiene in schools approach is implemented by 31.3% of the school health teachers. There was a significant relationship between school health clubs approach and hand washing at critical times (p=0.04) and proper solid waste disposal (p=0.02). One way analysis of variance established that there is a significant difference among hygiene promotion approaches and pupils hygiene knowledge, F(5, 162) = 6.41, p <.05 ƞ²p = 0.076. Unique contribution to theory, practice and policy: The study establishes that different hygiene promotion approaches have the potential to influence hygiene practices and in particular, hand washing at critical times and proper solid waste disposal amongst pupils. The study recommends the use of school health clubs approach for hygiene promotion at public primary schools

Knowledge and practice of environmental sanitation and personal hygiene by traders. A case study of Tamale Central Market

Tamale is one of the rapidly growing cities in Ghana which is faced with numerous sanitation and hygiene problems. Markets generate large volumes of wastes due to their functions. Poor waste management in markets poses a threat to public health. This study sought to assess traders’ knowledge and practice of environmental sanitation and personal hygiene. It also sought to identify the environmental sanitation challenges in the market. Questionnaire surveys, interviews, and personal observations were employed for data collection. The traders demonstrated fair knowledge on environmental sanitation but most did not practice recommended sanitation practices. Moreover, both males (50.1%) and females (49.9%) demonstrated good knowledge of personal hygiene and practiced it. The study identified poor drainage systems, lack of potable water, inadequate waste bins, littering, pilling of wastes, poor wastewater handling as major environmental challenges in the market. The findings of this study underline the need for bolstering up environmental education and hygiene promotion activities in public places like markets. It is also recommended that the toilet facility within the market get replace or renovated. The need for sanitation equipment and tools like waste bins should be met by the Metropolitan Assembly, as well as supports from NGOs and other bodies.

Household Disinfection Interventions to Prevent Cholera Transmission: Facilitators, Barriers, Training, and Evidence Needs

There are two common household disinfection interventions to prevent interhousehold transmission of cholera: household spraying, whereby a team disinfects cholera patients’ households, and household disinfection kits (HDKs), whereby cleaning materials are provided to cholera patients’ family members. Currently, both interventions lack evidence, and international agencies recommend HDK distribution; however, household spraying remains widely implemented. To understand this disconnect, we conducted 14 key informant interviews with international and national responders and a study in Haiti assessing HDK efficacy using two training modules including 20 household surveys and 327 surfaces samples before and after cleaning. During interviews, 80% of the international-level informants discussed evidence gaps for both interventions, and 60% preferred HDKs. Conversely, no national-level informants knew what an HDK was; therefore, they all preferred spraying. Informants discussed behavior changes, bleach perceptions, and implementation as facilitators and/or barriers to implementing both interventions. In households, training with demonstrations regarding the use of HDK led to increased reductions of Escherichia coli (P < 0.001) and Vibrio spp. (P < 0.001) on surfaces after participants cleaned the household compared with a hygiene promotion session only. These results emphasize the gap between the current international-level policy and the realities of cholera response programs, highlight the need for evidence to align household disinfection recommendations, and underscore the importance of the dissemination and training of responders and affected populations regarding methods to prevent intrahousehold cholera transmission.

WASH Upgrades for Health in Amhara (WUHA): study protocol for a cluster-randomised trial in Ethiopia

IntroductionFacial hygiene promotion and environmental improvements are central components of the global trachoma elimination strategy despite a lack of experimental evidence supporting the effectiveness of water, sanitation and hygiene (WASH) measures for reducing trachoma transmission. The objective of the WUHA (WASH Upgrades for Health in Amhara) trial is to evaluate if a comprehensive water improvement and hygiene education programme reduces the prevalence of ocular chlamydia infection in rural Africa.Methods and analysisForty study clusters, each of which had received at least annual mass azithromycin distributions for the 7 years prior to the start of the study, are randomised in a 1:1 ratio to the WASH intervention arm or a delayed WASH arm. The WASH package includes a community water point, community-based hygiene promotion workers, household wash stations, household WASH education books, household soap distribution and a primary school hygiene curriculum. Educational activities emphasise face-washing and latrine use. Mass antibiotic distributions are not provided during the first 3 years but are provided annually over the final 4 years of the trial. Annual monitoring visits are conducted in each community. The primary outcome is PCR evidence of ocular chlamydia infection among children aged 0–5 years, measured in a separate random sample of children annually over 7 years. A secondary outcome is improvement of the clinical signs of trachoma between the baseline and final study visits as assessed by conjunctival photography. Laboratory workers and photo-graders are masked to treatment allocation.Ethics and disseminationStudy protocols have been approved by human subjects review boards at the University of California, San Francisco, Emory University, the Ethiopian Food and Drug Authority, and the Ethiopian Ministry of Innovation and Technology. A data safety and monitoring committee oversees the trial. Results will be disseminated through peer-reviewed publications and presentations.Trial registration number(http://www.clinicaltrials.gov): NCT02754583; Pre-results.

A study on Facility (Hospital) upkeep, hygiene promotion and Support services at Primary Health Centers of western Gujarat: Assessment of performance parameters by using Kayakalp tool

Introduction: Primary Health Centre (PHC) is the cornerstone ofpreventive and promotive health care. Thus services provided at PHCs should be quality care and adequate care.To promote the same, GOI has started award giving based on performance of health facility under different themes. The present study was intended to have insight of the implementation status of swachhta guidelines (Kayakalp).Objective: To assess the Facility upkeep, Support services and Hygiene promotion at Primary Health centers of western Gujarat. Method: The cross sectional study carried out in 33 PHCs (universal sample) of Jamnagar district from 2017 to 2018. The assessment were done for following three categories: 1. Thematic Area 2. Criteria 3. Checkpoint. Under this study three thematic areas(from total 6), Hospital/Facility Upkeep, Support Services and Hygiene Promotion were covered. The data were obtained in present study in the terms of score for each variable. The score divided into up to 50%, 50%-70% and more than 70% then it was compared with different criterion under each theme and data were entered in Microsoft Excel version 2007. Data collection was done through Staff interview, Observations, patient Interview, Record review. Ethical clearance was taken from Institutional ethical committee before commencement of the study. Results: For criterion ; Maintenance of Open Areas, Facility Appearance, Infrastructure Maintenance, Illumination, water sanitation, pharmacy store, outreach services majority of health facilities obtained score >70%, whereas for Water conservation, pest & animal control, Laundry Services and Linen Management, Security services it was around 50%. Community Monitoring & Patient Participation & Information Education and Communication was observed average as per the criteria used.Conclusion:Half of the health facilities performed satisfactorily in work placemanagement. Involvement of Local community and organization in monitoring and promoting cleanliness.poor performance was seen regarding water conservation like maintenance of Water supply system, the preventive measures which were taken to reduce wastage.

Evaluating Two Novel Handwashing Hardware and Software Solutions in Kyaka II Refugee Settlement, Uganda

The Promotion and Practice Handwashing Kit (PPHWK), a robust, user-friendly handwashing station, and Mum’s Magic Hands (MMH), a creative hygiene promotion strategy, were evaluated in a clustered randomized controlled trial in Kyaka II refugee settlement in Uganda. The trial evaluated whether their provision increased handwashing with soap practice among residents, with a focus on three community intervention arms and two school-based intervention arms. The findings outlined in this report suggest that exposure to both the PPHWK and MMH increased hygiene knowledge and handwashing behaviour with soap, and improved health outcomes. Intervention households also preferred the PPHWK over existing handwashing stations, typically a basic bucket with a tap.

Handwashing Compendium for Low Resource Settings: A Living Document, Edition 3

Frequent and proper handwashing with soap is vital to prevent the spread of COVID-19. In response, the Sanitation Learning Hub at the Institute of Development Studies has developed this Handwashing Compendium for Low Resource Settings. Bringing existing information from different organisations into one place, the compendium provides guidance, local examples of and further resources on accessible low-cost handwashing facilities, environmental cues and physically distanced hygiene promotion. The compendium is a living document which will be updated regularly as learning emerges. It has been developed and disseminated quickly so immediate, relevant and timely actions can be taken. Please share feedback and contributions via email ([email protected]) or Twitter (@SanLearningHub). For those with limited internet access, individual sections of the compendium can also be sent upon request.