Improving Hand Hygiene Practices in a Rural Hospital in Sub-Saharan Africa
Improving Hand Hygiene Practices in a Rural Hospital in Sub-Saharan Africa
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DOI：
10.1017/ice.2016.71
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发表时间：
2016-07-01
影响因子：
4.5
通讯作者：
Safdar, Nasia
中科院分区：
文献类型：
--
作者：
Holmen, Ian C.;Seneza, Celestin;Safdar, Nasia
OBJECTIVE.使用世界卫生组织（WHO）的《医疗保健手部卫生指南》，提高撒哈拉以南非洲（SSA）农村医院医生和护士的手部卫生依从性。本研究为准实验设计，分为4个阶段：（1）准备材料和获得医院管理部门的支持，（2）基线评估，（3）干预，（4）随访评估。卢旺达Gitwe一家有160张床位的非转诊医院。共有12名医生和54名护士参加了这项研究。干预措施包括引入当地生产的含酒精洗手液（ABHR）;教育医护人员（HCW）正确的HH实践;为HCW提供口袋大小的ABHR瓶;在工作场所放置HH提醒;并在周围的健康中心调查HCW对HH的依从性障碍。通过基线观察和随访评估调查，对医生和护士的手卫生基础设施、依从性和知识进行了评估。总体而言，HH依从性从基线时的34.1%提高到干预后的68.9%（P < .001），HH知识显著增强（P < .001）。本研究中包括的3个科室的29个病房只有1个水槽，100%的HH机会使用ABHR。干预前后，医生的手卫生依从性明显高于护士。除“体液暴露后”外，其他所有HH依从性指标均有所改善，干预前为51.7%，干预后为52.8%（P > 0.05）。在撒南非洲，采用世卫组织方法的手卫生运动仅在大型转诊医院开展。这项研究表明，一个HH程序使用WHO的工具，成功地提高了HH在低收入，在SSA的农村医院。
OBJECTIVE. To improve hand hygiene (HH) compliance among physicians and nurses in a rural hospital in sub-Saharan Africa (SSA) using the World Health Organization's (WHO's) Guidelines on Hand Hygiene in Health Care.DESIGN. This study was a quasi-experimental design divided into 4 phases: (1) preparation of materials and acquisition of the hospital administration's support, (2) baseline evaluation, (3) intervention, and (4) follow-up evaluation.SETTING. A 160-bed, non-referral hospital in Gitwe, RwandaPARTICIPANTS. A total of 12 physicians and 54 nurses participated in this study.METHODS. The intervention consisted of introducing locally produced alcohol-based hand rub (ABHR); educating healthcare workers (HCWs) on proper HH practice; providing pocket-sized ABHR bottles for HCWs; placing HH reminders in the workplace; and surveying HCWs at surrounding health centers regarding HH compliance barriers. Hand hygiene infrastructure, compliance, and knowledge were assessed among physicians and nurses using baseline observations and a follow-up evaluation survey.RESULTS. Overall, HH compliance improved from 34.1% at baseline to 68.9% post intervention (P < .001), and HH knowledge was significantly enhanced (P < .001). The 3 departments included in this study had only 1 sink for 29 patient rooms, and 100% of HH opportunities used ABHR. Hand hygiene compliance was significantly higher among physicians than nurses both before and after the intervention. All measures of HH compliance improved except for "after body fluid exposure," which was 51.7% before intervention and 52.8% after intervention (P > .05).CONCLUSION. Hand hygiene campaigns using WHO methods in SSA have been implemented exclusively in large, referral hospitals. This study shows that an HH program using the WHO tools successfully improved HH in a low-income, rural hospital in SSA.