Background: Worldwide, medical staff adherence to Hand Hygiene (HH), the most cost effective measure to decrease health care associated infections (HAIs), is around 40-60%. Infection Control Program (ICP) at An-Najah National University Hospital (NNUH), a tertiary care referral teaching hospital located in Nablus, in the North of Palestine monitors HH compliance by direct observation using WHO observation checklist. This descriptive study aims at reporting the prevalence of HH across the institution during 2017-2019.
Method: The WHO multimodal strategy to enhance HH in healthcare settings was implemented at NNUH, a tertiary care referral hospital since 2017. HH compliance is measured during routine patient care by direct observation by ICP team and anonymously by other trained observers. Results are reported on monthly basis to the administration and medical team (nurses and doctors) and corrective plans to increase the compliance are discussed. Training is reinforced by the use of ultraviolet light and fluorescent alcohol hand rub. Yearly, staff is engaged in HH day activities (Figures 1&2). Leadership support is constant by securing annual budget for the HH program and the enforcement of HH policy across the setting
Result: NNUH, using the WHO Hand Hygiene Self-Assessment Framework, is currently in the advanced level (395 out of 500) compared to 2017 (Intermediate level, 292 out of 500). Overall, HCWs' hand hygiene compliance increased from 44% (R 31%-57%) in 2017 to 53% (R 30%-72%) in 2018 and to 61% (R 55%-66%) till October 2019. During the 3 years study period, Nursing compliance increased from 36% to 59% and to 64% respectively while the compliance for doctors increased from 42% to 56% and 58% respectively. Regarding the missed opportunities, “Before patient” was the most frequent cause for missed opportunity with a rate of 60% (Figure 3).This is mainly because of the misuse of gloves (mainly among nurses) that requires actually ad hoc intervention.
Conclusion: Implementation of WHO's hand-hygiene strategy is feasible and effective in low-income countries and leads to significant improvements in terms of compliance. Periodic training, personnel engagement and leadership are key factor for HH improvement in our setting
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