Background: Hand hygiene (HH) is considered a primary measure necessary for reducing healthcare-associated infections (HAIs). Despite its significance, the lack of compliance among healthcare workers continues to be a problem throughout the world. The Ebola outbreak in our country has accelerated efforts to strengthen the health system in Sierra Leone. The WHO multimodal strategy on HH is an integral approach to the reduction of HAIs. Objectives: We sought to improve HH compliance among healthcare workers, to maintain a culture of safety in the healthcare facility, and to implement evidence-based practices for improved patient outcomes. Methods: A WHO multimodal strategy for direct observation of HH was adapted. We observed clinical staff (doctors, nurses and community health officers) in the intensive care unit (ICU), resuscitation ward (Resus) and emergency room (ER) from August to September 2019. A 4-day training session was conducted in 3 weeks. Provision of locally produced alcohol-based hand rub (ABHR), soap, and water emphasize the importance of HH. HH reminders were posted in all clinical areas. Healthcare worker knowledge about HH was assessed before and after the intervention. Results: We observed 1,535 HH opportunities, and only 706 HH actions were performed. Locally produced ABHR was used in 470 HH actions. Handwashing with soap and water was used in the remaining HH actions. Baseline compliance was 36% and increased to 50% in the first and second months. Healthcare worker knowledge scores at the baseline averaged 25% and increased to 65% after 2 months. HH compliance was highest in the ICU (44%), followed by the emergency ward (30%). The resuscitation ward had the lowest compliance (26%). Compliance among doctors was 32%, nurses 46%, and CHOs 22%. Conclusions: Promotion of HH is feasible and attainable and can be sustained in a resource- constrained setting using a multimodal improvement strategy. The local production, availability, and use of ABHR have significantly increased HH compliance. However, absolute compliance remains low, and a strong commitment by hospital management and healthcare workers may be needed for further improvement.

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Isata Adama Bangura

Funding: None