Practice and compliance with WHO five moments of hand hygiene in surgical wards at CHUK, a Rwanda tertiary hospital

Abstract

Background The hand hygiene was considered as a simple, cost effective recommended procedure for health

care providers to prevent and control Hospital acquired hand infection. The hand hygiene compliance is one measure to assess the effectiveness of infection control and prevention. This study aimed to assess the hand hygiene compliance, reasons of poor compliance and proposed strategies to improve compliance, in surgical ward at CHUK.

Methods

A cross sectional, descriptive observational study was conducted in surgical wards at KUTH with observations of practice of hand hygiene by health care providers while caring for patients during the 2 months study period with interview and questionnaire completion to assess reasons of poor compliance and strategies to improve it.

Results

A total of 297 observations were done in which 489 hand hygiene moments were assessed. The overall hand hygiene compliance found is 42.94% with more compliance in the moments after body fluids exposure (66.23%) and after touching patient (61.53%). The majority of health care providers agreed that the overcrowding, understaffing, high workload, insufficient hand hygiene resources especially alcohol based hand sanitizers, inconsistently located water sinks, self- protection believes and insufficient training on infection control and prevention are the main causes of poor HH compliance. The findings revealed that the majority of health care providers agreed with six over seven proposed strategies to improve compliance which are making available alcohol based hand sanitizer, avoiding overcrowding workload and understaffing, putting remainders in workplace, having the ownership of hand hygiene behavior, training of health care providers about hand hygiene and WHO 5 moments of hand hygiene, and getting routine audit observation and feedback.

Conclusion and recommendations

In the present study the overall compliance was found 42.94%. After assessing the reasons of poor compliance, to avoid the overcrowding, workload and understaffing, regular audits and feedback, making available hand hygiene resources and education of health care providers on infection control and prevention were among the suggested strategies to improve hand hygiene compliance The findings from herein study will form a baseline for establishing policies by health care institutions and government. They will further provide informational bases for future researchers.