Hospital hand hygiene affects patient care, health worker safety, and infection control, but research and policy are lacking in low-income countries.1,2 We present the first national study on hospital hand hygiene infrastructure and behavior in Bangladesh.
The 2013 Bangladesh National Hygiene Baseline Survey examined water, sanitation, and hand hygiene in households, schools, food vendors, traditional birth attendants, and hospitals.3 We selected 100 rural and urban clusters by probability proportional to size sampling using National Household Census data. In each cluster, we surveyed hand hygiene infrastructure in 8-9 inpatient facilities and observed hand hygiene behavior in 1 facility.
Among 875 facilities, over 90% of hand washing locations had water, but hand hygiene supplies varied (Figure 1). For health workers, soap was available at 80-90% of hand washing locations and alcohol hand sanitizer at 20-50%. For patients and family caregivers, only 25% of hand washing locations had any hand hygiene supplies. Observers noted 4676 hand hygiene opportunities, but only 2% followed recommended technique: using alcohol sanitizer or washing both hands with soap then drying by air or with a clean cloth. Behavior varied across persons observed and indications (Figure 2). Family caregivers usually washed hands with only water, 48% of 2751 opportunities, but rarely used soap or followed recommended technique, 1% of opportunities. Health workers followed recommended technique in 9% of 919 opportunities and performed hand hygiene more often after patient or body fluid contact than before patient contact.
In Bangladesh, hospital hand hygiene supplies are not uniformly available and behavior varies between health workers and family caregivers, thus interventions should be strategic and contextualized.
1. Pittet, D. et al. Infection control as a major World Health Organization priority for developing countries. Journal of Hospital Infection 68, 285–292 (2008).
2. WHO. Water, sanitation and hygiene in health care facilities: Status in low- and middle-income countries and way forward. 35 (2015).
3. Alam, M. et al. Bangladesh National Hygiene Baseline Survey Preliminary Report. (2014).
M. U. Alam, None
A. Halder, None
P. Ghosh, None
S. Luby, None