316. Sequential low cost interventions double hand hygiene rates among medical teams in a resource limited setting
Session: Poster Abstract Session: Hand Hygiene in Healthcare Settings
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
  • 316_IDWPOSTER.pdf (506.5 kB)
  • Background: There is limited data from resource-limited settings, especially sub-Saharan Africa, on effective strategies and the degree of their impact on hand hygiene behavior among healthcare workers (HCWs) especially physicians. We evaluated the impact of sequential multimodal low-cost strategies on hand hygiene practices among medical teams in Kigali, Rwanda.

    Methods: We conducted a 4 week observational study with sequential interventions introduced each week while conducting covert observation of hand hygiene practices during morning ward rounds among teams of medical students, residents and consultants on all 3 blocks of the male medical ward in the largest hospital in Rwanda, the University Teaching Hospital of Kigali (CHUK). We defined hand sanitizing rate (HSR) as the percentage of total hand hygiene opportunities (HHOs) during which hands were sanitized. During week 1, baseline HSR was recorded. On week 2, alcohol-based hand sanitizers were made available and strategically placed on every block. On Week 3, hand hygiene reminder posters (HHPs) were placed on entry sites of each block at eye level and on week 4, HHPs were placed at the head of each patient’s bed. HSRs were recorded weekly post-intervention and differences with baseline rates were assessed for significance using Pearson’s chi square test. 

    Results: A total of 780 HHOs were observed throughout the entire study period. Baseline HSR was 24.8%. During week 2, there was a non-significant increase in HSR compared to baseline (26.6% vs. 24.8%, P value =0.66). HSRs improved to 40.4% by week 3 and 50.6% at study completion. Overall, HSRs improved from 24.8% to 50.6% (a 104% increase) following all study interventions (P value <0.001). Post-patient contact HSRs improved more than pre-patient contact HSRs with rates improving from 25.2% to 58% and 24.5% to 43% respectively (P value <0.001).

    Conclusion: Our study showed that sequential low-cost serial interventions involving ensuring visibility of hand sanitizers and posting hand hygiene reminder notices significantly doubled HSRs among medical teams in a resource limited setting but post-intervention rates were still suboptimal. Our study also showed that strategic placement of hand sanitizers alone did not significantly impact HSRs.

    Onyema Ogbuagu, MD, Infectious Diseases, Yale University school of Medicine, Southington, CT


    O. Ogbuagu, None

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