Assessment of Hand Hygiene Practices And Usage of Alcohol-Based hand Sanitizer in Three Kenyan Hospitals, 2011-12
Hand hygiene (HH) by healthcare providers (HP) prevents healthcare-associated infections. Routine use of alcohol-based handrub (ABHR) increases HH adherence but can be cost-prohibitive. The World Health Organization (WHO) published methods for local production of ABHR to sustain supply and control costs in low-resource settings.To describe: 1) baseline HH adherence; 2) perceptions of locally-produced ABHR among HP; and 3) cost savings associated with local production of ABHR in 3 Kenyan hospitals
Methods: Baseline HH adherence was defined as the number of successful HH events (HH with soap and water or ABHR) divided by the number of WHO-defined HH opportunities observed. Baseline HH adherence data was collected from December 2011 to May 2012 by trained observers in 16 wards. Differences in adherence by ward, HP type and before and after ABHR introduction were assessed using χ2 tests. Nine focus groups were conducted with doctors, nurses, and other providers to assess perceptions of ABHR; transcripts were qualitatively coded using a standardized approach to describe key themes. ABHR was prepared in the hospitals using the published WHO formulation; data were collected from April 2012 to April 2013 and compared to the average wholesale cost of 8 brands of ABHR available to hospitals.
Baseline HH adherence was 28%. ICU had the highest rates, while surgical and pediatric wards the lowest-Figure 1. HH adherence significantly varied by HP type; doctors and clinical officers had the lowest adherence. Focus group respondents most often reported liking ABHR because it is fast and efficient to use and its perceived efficacy; dislikes included its smell and the residue it left on hands. Product availability was the dominant theme for sustainability, particularly “constant supply”, “strategic placement” and “cheaper production.” Production cost of ABHR was US$3.10 per liter compared to an average commercial purchase price of US$24.50. Throughout the pilot, 2166 litres of ABHR were used in the sites, with average monthly savings of $8503.
There is low HH adherence in Kenyan hospitals. Local production may provide a cost-saving sustainable source of ABHR that could improve HH adherence by Kenyan HP who like ABHR for its time-efficiency and perceived efficacy.
L. Ndegwa, None