Health Worker and Family Caregiver Hand Hygiene in Bangladesh Healthcare Facilities: Results from a Nationally Representative Survey

Background:

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.

Methods:

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.

Results:

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.

Conclusion:

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.

Figure 1

Figure 2

References

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).